Depression in Pediatric Multiple Sclerosis and Clinically Isolated Syndrome

Background: Little is known about the longitudinal course of depression in adult multiple sclerosis. A small number of studies have investigated depression in pediatric multiple sclerosis (POMS) using a variety of assessment methods, but the long-term course of depression has not been studied in this population. The present study utilizes a larger patient population.

Objectives: To compare the prevalence and persistence of depression over time in POMS and clinically isolated syndrome (CIS) using child and parent forms of a depression measure.

Methods: The Children’s Depression Inventory (CDI), a self-report measure to assess depression, was administered to children and their parents during multiple routine clinic visits to the Partners Pediatric Multiple Sclerosis Center at the Massachusetts General Hospital for Children over a 3-year period. 81 patients and their parents met inclusion criteria and were enrolled (27 POMS and 54 CIS patients, 30.9% male, 77.8% white, mean age 15.9 +/- 3.2 years at first CDI administration). A trained research coordinator administered the questionnaire. A score of 65 or greater, the standard cutoff for clinical significance, was utilized for both reports. A psychologist was available for anyone scoring in the clinically significant range.

Results: A low percentage of patients were classified as depressed using either the child CDI (6.17%) or parent CDI (9.88%). There were no significant differences observed between CIS and POMS patients in parent or child T scores (p>0.25, two sample t-test) or in terms of proportion depressed (p>0.25, Fisher’s exact test). In both groups, parents scored their child’s depression significantly higher than the children scored their depression (p= 0.01, paired t-test) with only a minor difference in significance between POMS and CIS (p=0.01 and p=0.07, respectively). Longitudinal analysis will describe depression in those patients who converted from CIS to POMS and compare depression over time in the two groups.

Conclusions: Overall, children with CIS and multiple sclerosis did not show significant depression at first administration of the CDI. Depression was also not significantly different between CIS and POMS patients. Parent scores demonstrated significantly higher depression than child’s self-reported scores, suggesting the importance of including parents in the assessment of patient reported outcomes. These results support investigation of the longitudinal course of depression in this population.