Not for everyone: Factors influencing who receives psychotherapy in people with multiple sclerosis

Although depression and anxiety are common in people with multiple sclerosis (pwMS), access to psychotherapy remains limited.

This study aimed to identify clinical factors that predict use of psychotherapy among pwMS.

From a retrospective chart review of a tertiary neuropsychiatry clinic in Toronto, Canada, data were obtained for 267 pwMS who received neuropsychiatric treatment (either with antidepressants or psychotherapy). Candidate predictor variables included demographics (e.g. age, sex), disease-related factors (e.g. disease duration, MS subtype, Expanded Disability Status Scale (EDSS) score), symptom data (e.g. Hospital Anxiety and Depression Scale sub-scales for anxiety and depression, five-item Modified Fatigue Impact Scale), and other treatment use (e.g. disease-modifying therapies, psychotropic medications). A backward stepwise logistic regression analysis identified predictors of psychotherapy use (p<.05).

Mean age was 46.97 years, 70.41 % were female, median EDSS was 2.50, 63.30 % had relapsing illness, and 22.47 % received psychotherapy. Increased EDSS scores (OR=0.74, 95 % CI 0.58-0.95, p=.02) and prolonged disease duration (OR=0.94, 95 % CI 0.89-0.99, p=.03) predicted decreased use of psychotherapy.

Neurological disability and disease duration may influence psychotherapy use among pwMS. Studies are now needed to evaluate contributors to these associations to expand access to non-pharmacological treatments for pwMS.