Differences in Functioning: Who Gets Referred to Health Psychology?

Background:

Neurologists are increasingly being called to address mental health issues with multiple sclerosis (MS) patients.¹ However, evidence suggests a discrepancy between the high rate of mood symptoms in the MS population and lack of adequate mental health services.² The complexity in distinguishing mood and MS symptoms is difficult and often contributes to the disparity.³ Disease severity and time since diagnosis have been found to be strongly correlated with mood symptoms in MS patients.⁴ However, if demographic characteristics and disease-specific variables are controlled for, it is unclear whether or not patients with MS who are referred for Health Psychology (HP) differ from those who are not in terms of emotional and physical functioning. That is, do patients receiving a referral to HP have increased emotional distress, decreased quality of life, and worsened physical functioning at time of referral when compared to patients who do not despite having equivalent demographic and disease-related characteristics?

Objectives:                                                                           

To examine the baseline differences in psychological (PHQ9, GAD7, and EQ5D) and physical (25ft timed walk, 9-hole peg test) functioning between patients with MS that receive HP services and those that do not after controlling for demographic information, disease course, and length of time since disease onset.

Methods:

This is a retrospective, observational, IRB-approved study.

Study population: adult patients (ages 18 and up) receiving MS treatment from the Mellen Center for MS Treatment and Research during a four-year period (N=8235). Planned analyses include generating propensity scores for patients receiving HP to control for demographic information, disease course, and length of time since disease onset. Following propensity score matching between patients who did or did not receive HP, general estimating equations will be used to evaluate the differences on psychological and physical outcomes.

Results:

Ongoing; will be completed by time of presentation.

Conclusions:

Ongoing; will be completed by time of presentation.

References:

[1] Mohr, D. C., Hart, S. L., Fonareva, I., & Tasch, E. S. Treatment of depression for patients with multiple sclerosis in neurology clinics. Mult. Scler. 12, 204-208 (2006).

[2] Skokou, M., Soubasi, E., Gourzis, P. Depression in multiple sclerosis: a review of assessment and treatment approaches in adult and pediatric populations. ISRN Neurol. 427102 (2012).

[3] Feinstein, A., Magalhaes, S., Richard, J., Audet, B., and Moore, C. The link between multiple sclerosis and depression. Nat. Rev. Neurol. 10,  507-517 (2014).

[4] Chwastiak, L., Ehde, D. M., Gibbons, L. E., Sullivan, M., Bowen, J. D., Kraft, G. H. Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry. 159, 1862-1868 (2002).