Incidence of Anxiety in Patients with Multiple Sclerosis (MS)

Background: The exact incidence of anxiety varies in the literature but is estimated to affect 44.5% of persons with Multiple Sclerosis (MS). Though research has shown that patients newly diagnosed experience higher anxiety levels, the relationship between anxiety and disease duration is unclear. Since anxiety can be comorbid with depression in MS populations, it is relevant to establish its association. Though anxiety typically increases in older age, research for this relationship in MS populations is inconclusive.

Objectives: To investigate the incidence of anxiety in an outpatient MS Center with the predictors; disease duration, depression, and age while controlling for disability status. 

Methods: The Hospital Anxiety and Depression Scale (HADS), which has demonstrated good reliability and validity when preformed in outpatient settings, was distributed once to MS patients over 3 months to assess anxiety and depression. Patient Determined Disease Steps (PDDS) scores determined disability status. Disease duration and age were confirmed by neurologists. 

Results: Out of 160 patients with MS who completed the HADS, 19% reported abnormal anxiety, 14% reported borderline cases, and 67% did not report anxiety. Disease duration was mildly inversely related to anxiety, depression and anxiety scores were positively correlated, and age was inversely related to anxiety. The control predictor variables were significantly related to this outcome, (R2=.35, F(4,144)=19.26, p<0.001). The standardized partial regression coefficients indicated 2 statistically significant predictors, depression (β=.55, p=<.001) and age (β=-.25, p=<.001). These results indicate that both higher depression scores and younger age significantly and independently impacted anxiety in this population, while controlling for the effects of other predictors in this regression model.

Conclusions: 33% of patients reported symptoms of anxiety, emphasizing the need to focus on treating anxiety, especially early in one's disease course. Clinicians may want to recognize that elevated depression scores can predict higher anxiety levels. Lastly, in our cohort, the younger population predicted higher anxiety levels, demonstrating that progressive illnesses may affect younger populations greater. Since approximately one third of patients with MS expressed anxiety symptoms, it is important to incorporate this into treatment plans.