This study compared the efficacy of 3 16-week treatments for depression in 63 patients with multiple sclerosis (MS) and major depressive disorder (MDD): individual cognitive-behavioral therapy (CBT), supportive-expressive group therapy (SEG). and the antidepressant sertraline. Significant reductions were seen from pre- to posttreatment in all measures of depression. Intent-to-treat and completers analyses using the Beck Depression Inventory (BDI; A. T. Beck, C. H. Ward. M. Medelson. J. Mock, & J. Erbaugh, 1961) and MDD diagnosis found that CBT and sertraline were more effective than SEG at reducing depression. These results were largely supported by the BDI-18, which eliminates BDI items confounded with MS. However, the Hamilton Rating Scale for Depression (M. Hamilton, 1960) did not show consistent differences between treatments. Reasons for this inconsistency are discussed. These findings suggest that CBT or sertraline is more likely to be effective in treating MDD in MS compared with supportive group treatments.

This study examined subjective patient experiences of the psychosocial consequences of multiple sclerosis (MS). Fifty patients were interviewed regarding the effects MS had on their lives and interpersonal relationships. These statements were collated and administered with a 5-point Likert scale to 94 MS patients. The responses were subjected to factor analysis. Three areas of subjective patient experience of the psychosocial consequences of MS emerged: demoralization, benefit-finding, and deteriorated relationships. Of particular interest was benefit-finding, which included a deepening of relationships, enhanced appreciation of life, and an increase in spiritual interests. Although benefit-finding was related to adaptive coping strategies such as positive reappraisal and seeking social support, it was unrelated to depression and was related to higher levels of anxiety and anger. These findings indicate that benefit-finding is a substantial and poorly understood part of the illness experience for MS patients.

These data provide support for the notion that conflict and disruption in routine are related to subsequent disease activity in MS. However, this relationship is not sufficiently robust to predict clinical exacerbations reliably in individual patients.

Childhood sexual abuse (CSA) as a predictor of depression and self-destructive behaviors in adulthood was examined relative to other traumatic stressors in childhood and adulthood with special attention to sex differences. In a college sample of 173 men and 265 women, 16% of male (n = 28) and 24% of female respondents (n = 63) reported having been sexually abused as children. CSA, ranging from unwanted kissing and fondling to unwanted sexual intercourse, predicted depression, chronic self-destructiveness, self-harm ideation, acts of self-harm, suicide ideation, and suicide attempts, for both men and women. The more frequent and severe the sexual abuse and the longer its duration, the more depression and self-destructiveness reported in adulthood. Other stressors predicted these effects less consistently but their occurrence in combination with CSA contributed to the negativity of long-term outcomes. Study results affirm previous findings of a relationship between CSA and depression and self-destructiveness in adult females and extend them to males.