The assessment of depression in people with multiple sclerosis: a systematic review of psychometric validation studies

Abstract

BackgroundThe prevalence of depression in people with multiple sclerosis (PwMS) is high; however, symptoms common to both conditions makes measurement difficult. There is no high quality overview of validation studies to guide the choice of depression inventory for this population.MethodsA systematic review of studies validating the use of generic depression inventories in people with MS was conducted using MEDLINE and PsycINFO. Studies validating the use of depression inventories in PwMS and published in English were included; validation studies of tests for cognitive function and general mental health were excluded. Eligible studies were then quality assessed using the COSMIN checklist and findings synthesised narratively by instrument and validity domain.ResultsTwenty-one studies (N = 5,991 PwMS) evaluating 12 instruments were included in the review. Risk of bias varied greatly between instrument and validity domain.ConclusionsThe review of validation studies was constrained by poor quality reporting and outcome reporting bias. Well-conducted evaluations of some instruments are unavailable for some validity domains. This systematic review provides an evidence base for trade-offs in the selection of an instrument for assessing self-reported symptoms of depression in research or clinical practice involving people with MS. We make detailed and specific recommendations for where further research is needed.Trial RegistrationPROSPERO CRD42014010597

Serotonin decreases the production of Th1/Th17 cytokines and elevates the frequency of regulatory CD4+ T‐cell subsets in multiple sclerosis patients

“…Besides MS being characterized by increased physical disability over 30–40 years , some symptoms, such as fatigue and cognitive impairment, are also commonly associated with depression . Although the rate of major depressive disorder (MDD) is high in MS patients, some psychiatric symptoms associated with MDD may also be linked to advanced neurodegeneration . Nevertheless, in patients with the relapsing remitting form, depression might be linked to elevated levels of proinflammatory cytokines, such as IL‐1β, IL‐6, and TNF‐α, which deregulates the production of some neurotransmitters, such as serotonin .…”

Psychometric properties of the PHQ-9 depression scale in people with multiple sclerosis: a systematic review

“…A number of PROMS have been applied to quantify the burden of affective symptoms in pwMS across research and clinical settings, including the Beck Depression Inventory (BDI-II), Hospital Anxiety and Depression Scale (HADS), and the nine-item Patient Health Questionnaire (PHQ-9)(8). The PHQ-9 scale is notable in this context because it is freely available and has been validated across a wide range of clinical populations(9).…”

Altered Microbiota Composition Mediates Depressive Behavior During Chronic Stress

“…While the DSM-5 excludes patients with inflammatory disorders from being diagnosed with depressive disorders, the manual also acknowledges that many patients suffering of chronic inflammation experience depression symptoms 1 . For instance, up to half of the patients suffering from multiple sclerosis experience depression 77,78 . The exclusion of such patients from being diagnosed with depressive disorder is due to the fact that sustained inflammation induces an array of CNS symptoms in addition to depression, i.e.…”

“…Giving the vast literature showing that activation of the immune system (both adaptive and innate) is detrimental [77][78][79][80][81] , this is an intriguing finding. Nevertheless, full immune competence has also been shown to be necessary for other behaviors, such as learning and memory [198][199][200][201][202] .…”

“…Moreover, many diseases, such as autoimmune multiple sclerosis, are hallmarked by depressive behavior 77,78 . In the case of multiple sclerosis, for instance, we are still uncertain of what brain changes lead to depressive behavior, specifically.…”