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Review
. 2022 Jul 6:24:100484.
doi: 10.1016/j.bbih.2022.100484. eCollection 2022 Oct.

Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis

Diulle Spat Peres  1 , Patrícia Rodrigues  1 , Fernanda Tibolla Viero  1 , Julia Maria Frare  1 , Sabrina Qader Kudsi  1 , Graziela Moro Meira  1 , Gabriela Trevisan  1
Affiliations
Review

Prevalence of depression and anxiety in the different clinical forms of multiple sclerosis and associations with disability: A systematic review and meta-analysis

Diulle Spat Peres et al. Brain Behav Immun Health. .

Abstract

Multiple sclerosis (MS) is a chronic neurodegenerative and autoimmune disease. Motor, sensory and cognitive deficits in MS are commonly accompanied by psychiatric disorders. Depression and anxiety affect the quality of life of MS patients, and the treatment is still not well-established. Prevalence rates in MS patients for depression and anxiety vary widely between studies. However, the prevalence of these psychiatric disorders in the subgroups of MS patients and their association with a disability has not been studied yet. Therefore, this systematic review and meta-analysis proposes to estimate the prevalence of depression and anxiety in MS and to perform subgroup analyses (study type, Extended Disability Status Scale/EDSS, duration of MS, region, type of MS) on observational studies. The protocol was registered in PROSPERO (4202125033). A computerized search on PubMed, EMBASE and Scopus for studies on depression and anxiety in MS was performed from 2015 to 2021, and 12 articles were included. Most of the studies in the meta-analysis had a low risk of bias. The prevalence of depression was 27.01% (MS), 15.78% (relapsing-remitting multiple sclerosis/RRMS), and 19.13% (progressive multiple sclerosis/PMS). For anxiety the prevalence was 35.19% (MS), 21.40% (RRMS), and 24.07% (PMS). The prevalence of depression/anxiety for patients with EDSS <3 was 26.69/45.56% and for EDSS >3 was 22.96/26.70%. Using HADS-A (8) the prevalence was 38.5% and for depression was 22.4%. Then, our study brought together current data regarding psychiatric disorders in MS patients, which are comorbidities that affect the quality of life of these patients.

Keywords: EDSS; HADS-A; HADS-D; PMS; Quality of life; RRMS.

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Conflict of interest statement

The authors declare that no competing interests exist.

Figures

Fig. 1
Fig. 1
Flow diagram of studies identification.
Fig. 2
Fig. 2
Funnel plot of depression and anxiety in multiple sclerosis patients. A) Prevalence of depression in MS patients; B) Prevalence of anxiety in MS patients.
Fig. 3
Fig. 3
Meta-analysis of study types for depression and anxiety in MS expressed as forest plots. A) Prevalence of depression comparing cross-sectional versus prospective studies; B) Prevalence of anxiety comparing cross-sectional versus prospective studies. The forest graphs presented the number of depressive and anxious patients in MS and the total number of patients with MS.
Fig. 4
Fig. 4
Meta-analysis of depression and anxiety in MS subtypes expressed as forest plots. A) prevalence of depression in RRMS versus PMS; B) prevalence of anxiety in RRMS versus PMS. The forest graphs presented the number of depressive and anxious patients in the different clinical forms of MS (RRMS/PMS) and the total number of MS patients.
Fig. 5
Fig. 5
Meta-analysis of depression and anxiety in MS different regions expressed as forest plots. A) prevalence of depression in MS patients in North America, Oceania and Europe; B) prevalence of anxiety in MS patients in North America, Oceania and Europe. The forest graphs presented the number of depressive and anxious patients in the different regions and the total number of MS patients.
Fig. 6
Fig. 6
Meta-analysis of HADS in depression and anxiety in MS patients expressed as forest plots. A) prevalence of HADS-D in MS patients; B) prevalence of HADS-A in MS patients. The forest plots presented the number of HADS-D and HADS-A patients compared to the total number of MS patients.
Fig. 7
Fig. 7
Meta-analysis of EDSS in depression and anxiety in MS patients expressed as forest plots. A) prevalence of EDSS the depression in MS patients; B) prevalence of EDSS the anxiety in MS patients. The forest plots presented the number of EDSS depression and anxiety patients compared to the total number of MS patients.
Fig. 8
Fig. 8
Meta-analysis of the duration of MS in depression expressed as forest plots. A) prevalence of depression in time >10 years; B) prevalence of depression in time <10 years. The forest plots presented the number of depressed patients in MS and the total number of patients with MS.
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