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Updated: Jun 26, 2026

Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated
R A Marrie1, R Horwitz, G Cutter
1Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. rmarrie@hsc.mb.ca
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>or=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>or=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 (
Conclusions:
Mental comorbidity remains underdiagnosed and undertreated in MS. Patients of lower socioeconomic status bear a disproportionate share of the burden of depression.
Insights
Mental health conditions are common in multiple sclerosis (MS) but often missed. Lower socioeconomic status is linked to higher rates of depression in MS patients.
Area of Science:
- Neurology
- Psychiatry
- Public Health
Background:
- Mental comorbidity is prevalent in multiple sclerosis (MS).
- Existing research suggests mental health issues in MS are frequently underrecognized and undertreated.
- This highlights a critical gap in patient care.
Purpose of the Study:
- To determine the frequency of mental comorbidities in individuals with MS.
- To identify sociodemographic factors associated with the diagnosis and treatment of depression in MS patients.
- To assess the prevalence of undiagnosed and untreated depression within the MS population.
Main Methods:
- Utilized data from the North American Research Committee on MS Registry.
- Surveyed participants on depression, anxiety, bipolar disorder, and schizophrenia.
- Assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD), with scores ≥21 indicating probable major depression.
Main Results:
- Nearly half of responders (48%) reported mental comorbidity, with depression being the most common (46%).
- A significant portion (16.2%) of those not reporting mental comorbidity had scores indicative of undiagnosed depression.
- Lower socioeconomic status correlated with increased odds of depression, undiagnosed depression, and untreated depression.
Conclusions:
- Mental comorbidity in MS continues to be underdiagnosed and undertreated.
- Individuals with lower socioeconomic status experience a disproportionately higher burden of depression in the context of MS.
- Addressing mental health disparities is crucial for improving MS patient outcomes.
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