Screening for Depression in Adults Patients with MS

Background:

Depression in MS is under-diagnosed and undertreated. Studies reported that approximately only one half of MS patients diagnosed with depressive symptoms receive treatment for depression.  Others reported that 30% of patients who did not report depressive symptoms had scores above the threshold for major depression. These findings suggest that depression in MS frequently remains undiagnosed. Screening for depression in patients MS is critical therefore screening should be done routinely during every follow up visit.  

Objectives:

1. Compare the number of agreements between the Beck Depression inventory-II (BDI-II) and the Beck Depression Inventory Fast Screen (BDI-FS) in screening for depression in MS 
2. Describe the prevalence of depression as measured by the both BDI
3. Determine if the number of relapses in MS is correlated with severity of depression as measured by the both BDI
4. Determine if disability in MS as measured by the EDSS is correlated with depression as measured by both BDI

Methods:

A descriptive correlational design was used to explore the relationship between the severity of depression as measured by the BDI-II, and by the BDI-FS in adult MS patients. Patients with MS who attended an outpatient neurology clinic were assessed once during a medical visit. 35 patients tested once with 2 tools: BDI-II & BDI-FS; assessed for number of relapses and degree of disability based on the EDSS.

Results:

The prevalence of depressive symptoms as assessed by the BDI-FS using cutoff score ≥ 4 was 20.59% while the prevalence of depressive symptoms as assessed by the BDI –II using cutoff score ≥ 14 was 14.7%. Nine percent of subjects had moderate to severe depression (cutoff score ≥ 9) as assessed by the BDI-FS while only 6% had moderate to severe depression (cutoff score ≥ 20) based on the BDI-II. The BDI-FS identified a significantly higher number of individuals who were depressed. There was no correlation between disability as measured by the EDSS or number of relapses and depression as measured by both BDIs. Patients that were married and living with family were least likely to be depressed. Whites reported significantly lower suicidality than other ethnic groups. Married subjects also reported significantly lower suicidal ideation. In addition, subjects who lived alone reported significantly higher scores on the item assessing suicidal ideation than those who lived with other family members.

Conclusions:

The short form BDI is more significant in screening for depression in adult patients with MS in this pilot study. Health care professionals can easily learn how to use the tool and screen for depression on an ongoing basis. Depression is a prevalent syndrome in MS and has high effect on quality of life. Therefore, it is important that clinicians assess the extent of depression among MS patients and offer support and referral for further assessment and/or treatment.