The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated

2009 ◽  
Vol 15 (3) ◽  
pp. 385-392 ◽  
Author(s):  
RA Marrie ◽  
R Horwitz ◽  
G Cutter ◽  
T Tyry ◽  
D Campagnolo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Socioeconomic Status ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Lower Socioeconomic Status ◽  
Research Committee ◽  
The North ◽  
Lower Socioeconomic ◽  
Mental Comorbidities ◽  
Mental Comorbidity

Background Mental comorbidity is common in multiple sclerosis (MS), but some studies suggest that mental comorbidity may be underrecognized and undertreated. Objective Using the North American Research Committee on MS Registry, we assessed the frequency of mental comorbidities in MS and sociodemographic characteristics associated with diagnosis and treatment of depression. Methods We queried participants regarding depression, anxiety, bipolar disorder, and schizophrenia. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD); a score ≥21 indicated probable major depression. Results Mental comorbidity affected 4264 (48%) responders; depression most frequently (4012, 46%). Among participants not reporting mental comorbidity, 751 (16.2%) had CESD scores ≥21 suggesting undiagnosed depression. Lower socioeconomic status was associated with increased odds of depression (Income $15,000–30,000 vs >$100,000 OR 1.34; 1.11–1.62), undiagnosed depression (Income $15,000–30,000 vs >$100,000 OR 1.52; 1.08–2.13), and untreated depression (<high school vs postgraduate degree OR 3.13; 1.65–5.99). Conclusions Mental comorbidity remains underdiagnosed and undertreated in MS. Patients of lower socioeconomic status bear a disproportionate share of the burden of depression.

Effect of Physical Comorbidities on Risk of Depression in Multiple Sclerosis

2009 ◽  
Vol 11 (4) ◽  
pp. 161-165 ◽  
Author(s):  
Ruth Ann Marrie ◽  
Gary Cutter ◽  
Tuula Tyry ◽  
Denise Campagnolo ◽  
Timothy Vollmer
Keyword(s):  
Multiple Sclerosis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Research Committee ◽  
The North ◽  
Increased Risk

Depression in multiple sclerosis (MS) may be due to several factors, including the presence of physical comorbidities. Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we examined whether individuals with MS and physical comorbidities have an increased risk of depression compared with those without physical comorbidities and whether they are more likely to remain untreated for depression. In 2006, NARCOMS participants reported their physical and mental comorbidities and completed the Center for Epidemiologic Studies Depression Scale (CESD). We defined a CESD score of 21 or higher as indicating probable major depression. Individuals with elevated CESD scores but no diagnosis of depression were considered undiagnosed. Forty-six percent of participants reported a lifetime history of depression. In a multivariable Cox proportional hazards model, reporting any physical comorbidity was associated with an increased risk of being diagnosed with depression (hazard ratio [HR], 2.20; 95% confidence interval [CI], 2.04–2.38) after MS onset and with an increased risk of diagnosed or undiagnosed depression (HR, 2.37; 95% CI, 2.21–2.54). After adjustment for education, participants with any physical comorbidity were more likely to report treatment for depression (odds ratio [OR], 1.67; 95% CI, 1.24–2.23). Patients with MS and physical comorbidities are at increased risk of depression, but they are more likely to be diagnosed and treated than MS patients without other chronic conditions.

scholarly journals Validation of NARCOMS Depression Scale

2008 ◽  
Vol 10 (3) ◽  
pp. 81-84 ◽  
Author(s):  
Ruth Ann Marrie ◽  
Gary Cutter ◽  
Tuula Tyry ◽  
Denise Campagnolo ◽  
Timothy Vollmer
Keyword(s):  
Multiple Sclerosis ◽  
Body Mass Index ◽  
Convergent Validity ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Divergent Validity ◽  
Research Committee ◽  
The North ◽  
American Research ◽  
Registry Report

Participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry report depression with one question. We aimed to validate the NARCOMS depression scale against the Center for Epidemiologic Studies Depression Scale (CESD) and self-reported diagnoses of depression. The NARCOMS scale correlated with the CESD (r = 0.73; 95% confidence interval 0.72–0.74), and a score ≥2 had a sensitivity of 87% and specificity of 92% for depression. Correlations between the NARCOMS scale and age and body mass index were low, indicating divergent validity, whereas correlations with pain and fatigue were moderate, indicating convergent validity. The NARCOMS depression scale has adequate criterion and construct validity in MS.

Comorbidity, socioeconomic status and multiple sclerosis

2008 ◽  
Vol 14 (8) ◽  
pp. 1091-1098 ◽  
Author(s):  
RA Marrie ◽  
R Horwitz ◽  
G Cutter ◽  
T Tyry ◽  
D Campagnolo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Socioeconomic Status ◽  
Odds Ratio ◽  
Inclusion Criteria ◽  
Research Committee ◽  
Adverse Health Outcomes ◽  
The North ◽  
American Research ◽  
The Impact ◽  
Substantial Morbidity

Objective Multiple sclerosis (MS) is associated with substantial morbidity. The impact of comorbidity on MS is unknown, but comorbidity may explain some of the unpredictable progression. Comorbidity is common in the general population, and is associated with adverse health outcomes. To begin understanding the impact of comorbidity on MS, we need to know the breadth, type, and frequencies of comorbidities among MS patients. Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we aimed to describe comorbidities and their demographic predictors in MS. Methods In October 2006, we queried NARCOMS participants regarding physical comorbidities. Of 16,141 participants meeting the inclusion criteria, 8983 (55.7%) responded. Results Comorbidity was relatively common; if we considered conditions which are very likely to be accurately self-reported, then 3280 (36.7%) reported at least one physical comorbidity. The most frequently reported comorbidities were hypercholesterolemia (37%), hypertension (30%), and arthritis (16%). Associated with the risk of comorbidity were being male [females vs. males, odds ratio (OR) 0.77; 0.69–0.87]; age (age >60 years vs. age ≤44 years, OR 5.91; 4.95–7.06); race (African Americans vs. Whites, OR 1.46; 1.06–2.03); and socioeconomic status (Income <$15,000 vs. Income >$100,000, OR 1.37; 1.10–1.70). Conclusions Comorbidity is common in MS and similarly associated with socioeconomic status.

scholarly journals Social Disparities in Adopting Non-pharmaceutical Interventions During COVID-19

2021 ◽  
pp. 0169796X2199685
Author(s):  
Svenn-Erik Mamelund ◽  
Jessica Dimka ◽  
Nan Zou Bakkeli
Keyword(s):  
Socioeconomic Status ◽  
Survey Data ◽  
Public Transportation ◽  
Positive Association ◽  
Social Disparities ◽  
Lower Socioeconomic Status ◽  
Home Office ◽  
Disease Outcomes ◽  
Lower Socioeconomic ◽  
Pharmaceutical Interventions

In the absence of vaccines to fight the COVID-19 pandemic, in 2020 governments had to respond by rely on non-pharmaceutical interventions (NPIs). Socioeconomic inequalities likely influenced the uptake of NPIs. Using Norwegian survey data, we study whether income was associated with increased handwashing, keeping 1 m distance, using facemasks increased use of home office, and less use of public transportation. Except for using facemasks and less public transportation in a non-work context, all analyzed NPIs showed an independent positive association with income. Social disparities in NPI uptake may be important drivers of higher risks of disease outcomes for people of lower socioeconomic status.

scholarly journals Disease-modifying therapy prescription patterns in people with multiple sclerosis by age

2021 ◽  
Vol 14 ◽  
pp. 175628642110064
Author(s):  
Yinan Zhang ◽  
Amber Salter ◽  
Shan Jin ◽  
William J. Culpepper ◽  
Gary R. Cutter ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Activity ◽  
Age Groups ◽  
The Elderly ◽  
Department Of Veterans Affairs ◽  
Real World Data ◽  
Research Committee ◽  
The North ◽  
Disease Modifying ◽  
Magnetic Resonance Imaging Mri

Background: Disease-modifying therapies (DMTs) for multiple sclerosis (MS) are approved for their ability to reduce disease activity, namely clinical relapses and signal changes on magnetic resonance imaging (MRI). Disease activity appears age dependent. Thus, the greatest benefit would be expected in younger people with MS (PwMS) whereas benefits in the elderly are uncertain. Methods: Real-world data were obtained from PwMS from the North American Research Committee on Multiple Sclerosis (NARCOMS) registry and the US Department of Veterans Affairs Multiple Sclerosis Surveillance Registry (MSSR). Results: 6948 PwMS were surveyed from NARCOMS, and the MSSR had 1719 participants. In younger adult PwMS 40-years old or less, 183 (61.4%) in NARCOMS and 179 (70.5%) in the MSSR were prescribed DMTs. Among PwMS over age 60, 1575 (40.1%) in NARCOMS and 239 (36.3%) in the MSSR were prescribed DMTs. More PwMS in the age group of 31–40 ( p = 0.035) and 41–50 ( p = 0.001) in the MSSR were using DMTs compared with PwMS of the same age groups in NARCOMS. Conclusion: These findings suggest that DMTs are under-utilized in the younger population and continue to be commonly prescribed in the elderly. Broader access may explain the higher prescription rate of DMTs in US veterans.

Is Fringe Baking A Component of Socially Determined Health?

2017 ◽  
Vol 32 (3) ◽  
Author(s):  
Courtney L Hundley ◽  
Richard W. Wilson ◽  
John Chenault ◽  
Jamie L. Smimble
Keyword(s):  
Socioeconomic Status ◽  
Health Status ◽  
Exploratory Study ◽  
Health It ◽  
Lower Socioeconomic Status ◽  
Health Measures ◽  
Lower Socioeconomic ◽  
Level Data ◽  
Indirect Association ◽  
Zip Code

This was an exploratory study to assess the association between density of fringe lenders (e.g.payday) and health status. For Louisville, Kentucky, ZIP code level data on hospitalizations and mortalityrates as health measures were compared to fringe bank locations. We found lower socioeconomic status(SES) positively correlated with greater frequency of fringe banks; rates of illness appear to be higher in ZIPcodes with more fringe banks, but this finding was not statistically significant. In conclusion, neighbor-hoods between higher frequencies of fringe banks appear to have poorer health; it is premature to rule in orrule out a direct or indirect association between neighborhood presence of fringe banks, but there is enoughevidence to justify additional research to put any conclusions on a firmer footing.

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