More than 20% of patients with multiple sclerosis experience moderate to high trait anxiety—a psychological symptom whose role in the disease course has not been well-defined.
MONTREAL—State and trait anxiety are prevalent in patients with multiple sclerosis (MS), and that increased anxiety correlates strongly with lower mental quality of life and higher depression and fatigue, according to research that was presented at the 25th Annual Meeting of the Consortium of Multiple Sclerosis Centers.
“MS patients have an increased rate of psychological symptoms beyond those found in controls and even in other chronic diseases,” reported Line E. Hviid, a research assistant and study coordinator at the Brigham and Women’s Hospital at Harvard Medical School in Boston. “While depression in the MS population has been studied in great detail, there has been little study of anxiety in MS, despite evidence of a nearly equally high prevalence.”
Ms. Hviid and colleagues enrolled 303 patients (mean age, 47.2) with clinically isolated syndrome or MS and administered questionnaires regarding state and trait anxiety, quality of life and health status, fatigue, social support, and depression to examine the role of anxiety in MS disease course. The patients also completed cognitive screening tests and were annually evaluated using the Expanded Disability Status Scale (EDSS).
A Significant Number of Patients With MS Experience Anxiety
“Using the published normal ranges, 14.5% of our subjects reported moderate to high state anxiety and 21.9% reported moderate to high trait anxiety,” the investigators stated. “Only 3.0% of our subjects reported high state anxiety, and 9.3% reported high trait anxiety.”
The researchers found statistically significant correlations when comparing measures of state and trait anxiety and all patient-reported outcomes; the highest correlations were recorded between anxiety and depression, the mental health scale, and the mental components summary score.
The team of investigators also observed mild but statistically significant associations between anxiety and both EDSS scores and the number of recent attacks. “No significant differences were found due to cognitive functioning, disease duration, disease course, or treatment status,” they reported.
The weak but significant correlation observed between anxiety and physical functioning—as measured by EDSS scores—and the stronger relationship between anxiety and role-physical subscale of the health status questionnaire—which measures the impact of physical functioning on daily life—suggest that the impact of physical disability on anxiety may be more profound than the physical disability itself, according to the researchers.
Comorbidities of MS-Associated Anxiety
“A striking comorbidity was found between depression and anxiety,” the authors stated. Increased anxiety was also correlated with a lower mental quality of life, as well as with increased fatigue, depression, and lower levels of social support.
“Anxiety is an important feature of MS,” the researchers concluded. “These findings highlight the need for identification and treatment of patients with anxiety, particularly in patients who experience depression.”
—Ariel Jones