Multifactorial model of predictors of the development of depressive disorders in multiple sclerosis: a prospective longitudinal study

Abstract

Up to 50% of patients with multiple sclerosis (MS) are affected by depression.Objective: to develop a multifactorial model of predictors of depression in MS, considering sociodemographic, clinicopsychopathological and clinicofunctional characteristics.Material and methods. 157 patients with MS and depression were analyzed. The control group consisted of 100 MS patients without depression. The observation period was 10 years. The following scales were used: Beck, MFI-20, Spielberger-Hanin, visual analogue scale (VAS) for pain, PASAT test, EDSS. We performed an MRI scan, and identified significant stressful events, the type of MS, clinically isolated and radiologically isolated syndromes, concomitant diseases and the use of MS disease-modifying treatments (DMTs). The diagnosis of depression was made according to the ICD-10 criteria. Multivariate models were developed using analysis of variance and multiple linear regression equation.Results. A multifactorial model of predictors for the development of depression with a high multiple correlation value (r=0.85) was proposed. Factors with pronounced influence on the development of depression were: high rate of progression of MS (Beta=0.879), highly active course of MS (Beta=0.876), asthenia 89.6±1.1 points on the MFI-20 scale with an increase of 1.48% per year (Beta=0.784). Significant factors were: localization of lesions in the frontal, temporal regions of the right hemisphere (Beta=0.742), reactive anxiety 56±2.64 points on the SpielbergerKhanin scale with an increase of 1.89 % per year (Beta=0.682), increase in the area of lesions in the brain by 1.83 % per year (Beta=0.618), multiple lesions in the brain (Beta=0.591). Statistically significant predictors with less influence on the development of depression were: female gender, secondary education, living alone, significant stressful events in the past, autoimmune diseases, depression before the development of MS, depression in close relatives, pain syndrome (6–8 points on VAS). Cognitive impairment, increase in PASAT score of 2.87% per year, body mass index with an increase of 1.61% per year, clinically isolated and radiologically isolated syndromes before the development of MS, age of onset of MS, age of onset of depression, disability indicator according to EDSS, type of MS, comorbidity and medication use are not predictors of depression in MS.Conclusion. A high rate of MS progression, a very active course of MS, an increase in asthenia on the MFI-20 scale, localization of lesions in the frontal and temporal regions of the right hemisphere and an increase in reactive anxiety were identified as important predictors of depression in MS.

Keywords

• multiple sclerosis
• depressive disorders
• predictors