Within the multiple sclerosis (MS) population, high prevalence of psychiatric concerns, such as depression and anxiety, has been well documented. The purpose of this study was to examine factors contributing to higher depression and anxiety levels in a sample of 82 patients utilizing MS clinic services. Independent variables included MS physical severity, self-reported cognitive impairment, and perceived illness management, respectively. Results from hierarchical regression analyses indicated that depression was related to the physical severity, self-reported cognitive impairment, and perceived illness management variables. Anxiety was also related to the physical severity and self-reported cognitive impairment variables but not to the perceived illness management ones, suggesting that depression and anxiety symptoms may involve somewhat different processes within MS. The findings of this study support further clinical consideration and additional investigation of these variables in the treatment of anxiety and depression in an MS clinic population.
Similar content being viewed by others
REFERENCES
Arnet, P., Higginson, C., and Voss, W. (1999a). Depressed mood in multiple sclerosis: Relationship to capacity demanding memory and attentional functioning. Neuropsychology 13: 434–446.
Arnet, P., Higginson, C., and Voss, W. (1999b). Depression in multiple sclerosis: Relationship to working memory capacity. Neuropsychology 13: 546–556.
Arnet, P., Higginson, C., Voss, W., Randolph, J., and Grandey, A. (2002). Relationship between coping, cognitive dysfunction, and depression in multiple sclerosis. Clin. Neuropsych. 16: 341–355.
Bandura, A. (1989). Human agency in social cognitive theory. Am. Psychol. 44: 1175–1184.
Benedict, R. H. B., Cox, D., Thompson, L. L., Foley, F., Weinstock-Guttman, B., and Munschauer, F. (2004). Reliable screening for neuropsycholgical impairment in multiple sclerosis. Mult. Scler. 10: 675–678.
Benedict, R. H. B., Munschauer, F. E., Linn, R., Miller, C., Foley, F. W., and Jacobs, L. D. (2003). Screening for multiple sclerosis cognitive impairment using a self-administered 15-item questionnaire. Mult. Scler. 9: 95–101.
Berg, D., Supprian, T., Thomae, J., Warmuth-Metz, M. (2000). Lesion pattern in patienst with multiple sclerosis and depression. Mult. Scler. 6: 156–162.
Bobholz, J. A., and Rao, S. M. (2003). Cognitive dysfunction in multiple sclerosis: a review of recent developments. Curr. Opin. Neurol. 16: 283–288.
Brassington, J., and Marsh, N. (1998). Neuropsychological aspects of multiple sclerosis. Neuropsychol. Rev. 8: 43–77.
Bruce, J., and Arnet, P. (2005). MS patients with depressive symptoms exhibit affective memory biases when verbal encoding strategies are suppressed. J. Int. Neuropsych. Soc. 11: 514–521.
Chwastiak, L., Ehde, D. M., and Gibbons, L. E. (2002). Depressive symptoms and severity of illness in multiple sclerosis: Epidemiologic study of a large community sample. Am. J. Psychiatry 159: 1862–1868.
Dalton, E. J., and Heinrichs, R. W. (2005). Depression in multiple sclerosis: A quantitative review of the evidence. Neuropsychology 19: 152–158.
Devins, G. M., Styra, R., O’Connor, P., Gray, T., Seland, T. P., Klein, G. M., and Shapiro, C. M. (1996). Psychosocial impact of illness intrusivenss moderated by age in multiple sclerois. Psychology Health Med. 1: 179–191.
Devins, G. M., Edworthy, S. M., Paul, L. C., Mandin, H., Seland, T. P., and Klein, G. (1993). Restless sleep, illness intrusiveness, and depressive symptoms in three chronic illness conditions: RA, end-stage renal disease, and MS. J. Psychosom. Res. 37: 163–170.
Devins, G. M., and Seland, T. P. (1987). Emotional impact of multiple sclerosis: Recent findings and suggestions for future research. Psychol. Bull. 101: 363–375.
D’Zurilla, T. (1990). Problem solving training for effective stress management and prevention. J. Cogn. Psychoth.: Int. Q. 4: 327–355.
Feinstein, A. (2002). An examination of suicidal intent in patients with multiple sclerosis. Neurology 59: 674–678.
Fruehwalds, S., Loettler-Stastka, H., Eher, R., Saletu, B., and Baurnhackl, U. (2001). Depression and quality of life in multiple sclerosis. Acta Neurologica Scandinavia 104: 257–261.
Hobart, J., and Lamping, D. T. (2001). The Multiple Sclerosis Impact Scale (MSIS-29). A new patient based outcome measure. Brain 124: 962–973.
Janssens, A. C. J. W., van Doorn, P. A., de Boer, J. B., van der Meche,’ F. G. A., Passchier, J., and Hintzen, R. Q. (2003). Impact of recently diagnosed multiple sclerosis on quality of life, anxiety, depression, and distress of patients and partners. Acta Neurological Scandinavica 108: 389–395.
Kurtzke, J. F. (1983). Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33: 1444–1452.
Lorig, K. R., Sobel, D. S., Ritter, P. L., Laurent, D., and Hobbs, M. (2001). Effect of a self-management program for patients with chronic disease. Eff. Clin. Pract. 4: 256–262.
Minden, S. L., Orav, J., and Reich, P. (1987). Depression in multiple sclerosis. Gen. Hosp. Psychiatry 9: 426–434.
Minden, S. L., and Schiffer, R. B. (1991). Affective disorders in MS: Review and recommendations for clinical research. Arch. Neurol. 47: 98–104.
Mohr, D., and Cox, D. (2001). Multiple sclerosis: Empirical literature for the clinical health psychologist. J. Clin. Psychol. 57: 479–499.
Mohr, D. C., Hart, S. L., Fonareva, I., and Tasch, E. S. (2006). Treatment of depression for patients with multiple sclerosis in neurology clinics. Mult. Scler. 12: 204–208.
Mohr, D., Likosky, W., Bertagnolli, A., Goodkin, D. E., van der Wende, J., and Dweyer, P. (2000). Telephone administered cognitive behavioral therapy for the treatment of depressive symptoms in multiple sclerosis. J. Consult. Clin. Psychol. 68: 356–361.
Mullins, L., Cote, M. P., Fuemmeier, B. F., Jean, V. M., Beatty, W. W., and Paul, R. H. (2001). Illness intrusiveness, uncertainty, and distress in individuals with multiple sclerosis. Rehabil. Psychol. 46: 139–153.
National Institutes of Health. (2004). Multiple Sclerosis: Hope through Research. Retrieved January 2004 from http://accessible.ninds.nih.gov/health and medical/pubs/multiple_sclerosis.htm.
Nicholl, C. R., Lincoln, N. B., and Francis, V. M. (2001). Asssesment of emotional problems in people with multiple sclerosis. Clin. Rehabil. 15: 657–668.
Patten, S. B., Beck, C. A., and Williams, J. V. A. (2003). Major depression in multiple sclerosis: A population-based perspective. Neurology 61: 1524–1527.
Pittock, S. J., Mayr, W. T., McClelland, R. L., Jorgensen, N. W., Weigand, S. D., Noseworthy, J. H., and Rodriguez, M. (2004). Quality of life is favorable for most patients with multiple sclerosis. Arch. Neurol. 61: 679–686.
Plohmann, A., Kappos, L., Ammann, A., Thordai, A., Wittwer, A., Huber, S., et al. (1998). Computer assisted retraining of attentional impairments. J. Neurol. Neurosurg. Psychiatry 64: 455–462.
Rao, S. M. (1997). Neuropsychological aspects of multiple sclerosis. In Raine, C. S., McFarland, H. F., and Tourtellotte, W. W. (Eds.), MS: Clinical and pathogenetic basis. Chapman and Hall, London, pp. 357–362.
Rao, S. M., Leo, G. J., Bernardin, L., and Unverzagt, F. (1991). Cognitive dysfunction in multiple sclerosis. Frequency, pattern, and prediction. Neurology 41: 685–691.
Ron, M. A., and Logsdail, S. J. (1989). Psychiatric comorbidity in MS: A clinical and MRI study. Psychol. Med. 19: 887–895.
Rudick, R., Antel, J., Confavreux, C., Cutter, G., Ellison, G., Fischer, J., et al. (1996). Clinical outcomes assessment in multiple sclerosis. Annu. Neurol. 40: 469–479.
Savard, J., Laberge, B., Gauthier, J. G., Ivers, H., and Bergeron, M. G. (1996). Evaluating anxiety and depression in HIV-infected patients. J. Pers. Assess. 7: 349–367.
Schulberg, H. C., Raue, P. J., and Rollman, B. L. (2002). The effectiveness of psychotherapy in treating depressive disorders in primary care practice:clinical and cost perspectives. Gen. Hosp. Psychiatry 24: 203–212.
Schulz, D., Kopp, B., Kunkel, A., and Faiss, J. H. (2006). Cognition in early stage of multiple sclerosis. J. Neurol. 253: 1002–1010.
Silverstone, P. H. (1996). Prevalence of psychiatric disorders in medical inpatients. J. Neurol. Neurosurg. Psychiatry 184: 43–51.
Smith, S. J., and Young, C. A. (2000). The role of affect on the perception of disability in multiple sclerosis. Clin. Rehabil. 14: 50–54.
Sadovnick, A. D., Remick, R. A., and Allen, J. (1996). Depression and Multiple Sclerosis. Neurology 46: 628–632.
Taillefer, S. S., Kirmayer, L. J., Robbins, J. M., and Lasry, J. (2003). Correlates of illness worry in CFS. J. Psychosom. Res. 54: 331–337.
Taube, S. M., and Segal, Z.(2006). Telephone delivered cognitive behavioral therapy improves depression in people with multiple sclerosis faster than telephone delivered supportive emotion focused therapy. Evidence Based Mental Health 9: 49.
Thomas, P. W., Thomas, S., Hillier, C., Galvin, K., and Baker, R. (2006). Psychological intervention for multiple sclerosis. Cocaine Database Syst. Rev. 4.
Thornton, E. W., Tedman, S., Rigby, S. H., Bashforth, H., and Young, C. (2006). Worries and concerns of patients with MS: Development of an assessment scale. Mult. Scler. 12: 196–203.
Ware, J. E. (1993). SF-36 health survey: Manual and interpretation guide. The Health Institute, New England Medical Center, Boston.
Walther, E. U., and Hohlfeld, R. (1999). Multiple sclerosis. Side effects of interferon beta therapy and their management. Neurology 53: 1622–1627.
Zephir, H., De Seze, J., Stojkovic, T., Delisse, B., Ferriby, D., Caberet, M., and Vermersch, P. (2003). Multiple sclerosis and depression: influence of interferon B therapy. Mult. Scler. 9: 284–288.
Zigmond, A. S., and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67: 361–370.
Zorzon, M., de Masi, R., and Nasuelli, D. (2001). Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 participants. J. Neurol. 248: 416–421.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lester, K., Stepleman, L. & Hughes, M. The Association of Illness Severity, Self-Reported Cognitive Impairment, and Perceived Illness Management with Depression and Anxiety in a Multiple Sclerosis Clinic Population. J Behav Med 30, 177–186 (2007). https://doi.org/10.1007/s10865-007-9095-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-007-9095-6