Psychiatric morbidity during the multiple sclerosis prodrome is associated with future disability

Area of Science:

• Neurology
• Psychiatry
• Epidemiology

Background:

• A prodromal phase of multiple sclerosis (MS) may be indicated by healthcare utilization, including psychiatric symptoms.
• The link between pre-MS psychiatric morbidity and long-term outcomes is not well understood.

Purpose of the Study:

• To examine the association between psychiatric morbidity in the five years preceding MS onset and subsequent Expanded Disability Status Scale (EDSS) scores.

Main Methods:

• The study analyzed data from 2212 MS patients in British Columbia, Canada (1991-2018).
• Psychiatric morbidity was identified through physician and hospital visits in the five years before MS onset.
• Multivariable generalized linear models assessed the relationship between pre-MS psychiatric morbidity and EDSS scores, exploring effect modification by sex, age, and MS course.

Main Results:

• Over 21% of MS patients experienced psychiatric morbidity in the five years prior to diagnosis.
• Pre-diagnosis psychiatric morbidity was associated with higher post-diagnosis EDSS scores (adjβ=0.17).
• This association was more pronounced in males, individuals under 30, relapsing-onset MS, and those with a high burden of psychiatric-related healthcare visits or hospitalizations.

Conclusions:

• Psychiatric morbidity preceding MS diagnosis is linked to increased future disability.
• The impact is particularly significant for males, younger individuals, relapsing-onset MS, and those with a substantial psychiatric morbidity burden before diagnosis.