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Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis
Anibal S Chertcoff1, Fardowsa L A Yusuf1, Feng Zhu1
1From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Background And Objectives:
Psychiatric morbidity is common after a multiple sclerosis (MS) diagnosis. However, little is known about psychiatric comorbidity during the prodromal phase (before MS onset). To compare the prevalence and relative burden of psychiatric morbidity in individuals with MS with matched controls before MS onset.
Methods:
Using linked administrative and clinical data from British Columbia, Canada, we identified cases with MS through a validated algorithm or from neurologist-diagnosed MS clinic attendees. Cases were matched by age, sex, and geographical location with up to 5 general population controls. We identified psychiatric morbidity through a validated definition and determined its prevalence in cases/controls in the 5 years before the first demyelinating claim of cases with MS ("administrative cohort") or symptom onset ("clinical cohort") and estimated case/control prevalence ratios with 95% CIs. We also compared the yearly number of physician visits for psychiatric morbidity, visits to psychiatrists, psychiatric-related admissions, and psychotropic dispensations pre-MS onset in cases/controls regardless of whether psychiatric morbidity algorithm was fulfilled using negative binomial regression fitted through generalized estimating equations; results were reported as adjusted rate ratios with 95% CIs. We assessed yearly trends through interaction terms between cases/controls and each year pre-MS onset.
Results:
The administrative cohort comprised 6,863/31,865 cases/controls; the clinical cohort comprised 966/4,534 cases/controls. Over the entire 5-year period pre-MS onset, 28.0% (1,920/6,863) of cases and 14.9% (4,738/31,865) of controls (administrative cohort) had psychiatric morbidity, as did 22.0% (213/966) of clinical cases and 14.1% (638/4,534) controls. Psychiatric morbidity prevalence ratios ranged from 1.58; 95% CI 1.38-1.81 (clinical cohort) to 1.91; 95% CI 1.83-2.00 (administrative cohort). In the administrative cohort, health care use was higher for cases in each year pre-MS onset (all 95% CIs >1); physician visits were 78% higher in year 5 pre-MS onset and 124% 1 year before; visits to psychiatrists were 132% higher in year 5 and 146% in year 1; hospitalizations were 129% higher in year 5 and 197% in year 1; and prescription dispensations were 72% higher in year 5 and 100% in year 1. Results were not significant in the clinical cohort.
Discussion:
Psychiatric morbidity represents a significant burden before MS onset and may be a feature of the MS prodrome.
Insights
Psychiatric morbidity, including depression and anxiety, is significantly more common in the years leading up to a multiple sclerosis (MS) diagnosis. This increased burden suggests psychiatric conditions may be an early indicator of MS onset.
Area of Science:
- Neurology
- Psychiatry
- Epidemiology
Background:
- Psychiatric morbidity is a known complication following a multiple sclerosis (MS) diagnosis.
- However, the prevalence and impact of psychiatric conditions during the prodromal phase (before MS onset) remain largely uncharacterized.
Purpose of the Study:
- To compare the prevalence and relative burden of psychiatric morbidity in individuals who later develop MS versus matched controls before MS onset.
- To investigate healthcare utilization patterns for psychiatric conditions in the pre-MS period.
Main Methods:
- Utilized linked administrative and clinical data from British Columbia, Canada.
- Identified MS cases and matched them with general population controls.
- Assessed psychiatric morbidity and healthcare utilization in the 5 years preceding MS onset using validated definitions and statistical models.
Main Results:
- Individuals who developed MS showed a significantly higher prevalence of psychiatric morbidity in the 5 years before diagnosis compared to controls (14.9% vs. 28.0% in the administrative cohort).
- Pre-MS onset, MS cases exhibited increased physician visits, psychiatrist consultations, hospitalizations, and psychotropic medication prescriptions compared to controls.
- These differences were particularly pronounced in the year immediately preceding MS onset.
Conclusions:
- Psychiatric morbidity represents a substantial burden in the prodromal phase of multiple sclerosis.
- Elevated psychiatric morbidity and associated healthcare utilization may serve as potential early indicators or features of the MS prodrome.
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