Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis

Abstract

Background: Depression is common and has a significant impact on quality of life for many people with multiple sclerosis (MS). A preventive management approach via modification of lifestyle risk factors holds potential benefits. We examined the relationship between modifiable lifestyle factors and depression risk and the change in depression over 2.5 years.Methods: Sample recruited using online platforms. 2,224 (88.9%) at baseline and 1,309 (93.4%) at 2.5 years follow up completed the necessary survey data. Depression risk was measured by the Patient Health Questionnaire-2 (PHQ-2) at baseline and Patient Health Questionniare-9 (PHQ-9) at 2.5-years follow-up. Multivariable regression models assessed the relationships between lifestyle factors and depression risk, adjusted for sex, age, fatigue, disability, antidepressant medication use, and baseline depression score, as appropriate.Results: The prevalence of depression risk at 2.5-years follow-up in this cohort was 14.5% using the PHQ-2 and 21.7% using the PHQ-9. Moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later. Moderate alcohol intake was associated with greater likelihood of becoming depression-free and a lower likelihood of becoming depressed at 2.5-years follow-up. Meditating at least once a week was associated with a decreased frequency of losing depression risk, against our expectation. After adjusting for potential confounders, smoking, diet, physical activity, and vitamin D and omega-3 supplementation were not associated with a change in risk for depression.Conclusion: In a large prospective cohort study of people with MS and depression, in line with the emerging treatment paradigm of early intervention, these results suggest a role for some lifestyle factors in depression risk. Further studies should endeavor to explore the impact of positive lifestyle change and improving depression in people living with MS.

Associations between Lifestyle Behaviors and Quality of Life Differ Based on Multiple Sclerosis Phenotype

“…Both antiinflammatory and other diets were associated with improved mobility, consistent with proposed neuroinflammatory and microbiota-gut-brain-axis disease mechanisms. Though studies have reported associations between diet quality and MS-specific diets with lower depression and fatigue respectively [24,25], we did not observe associations in these symptom subdomains. Discrepancies may be attributable to outcome measure tools in addition to potential additive benefits of adhering to multiple lifestyle behaviors.…”

Estimating person parameters via item response model and simple sum score in small samples with few polytomous items: A simulation study

“…Additionally, we would draw the conclusion that one parameter (sample size or item number) can be small, given the other is sufficiently large. What is the implication, what should change now. The recent trend in medicine to use very short scales (as low as two items) (see, eg, the works of Taylor et al and Staples et al) seems critical in light of the present simulation results. Neither IRT nor CTT can be expected to yield valid results in such short scales. …”

The relationship between lifestyle risk factors and depression in Korean older adults: a moderating effect of gender

“…For example, in a 7-year follow-up of the Komo-Ise cohort study, Tanaka et al [ 16 ] showed that heavy alcohol consumption and physical inactivity were associated with a higher prevalence of depression in Japanese men, and obesity, inadequate sleep, and smoking were associated with a higher prevalence of depression in Japanese women. In an international cohort study of patients with muscle sclerosis, Taylor et al [ 17 ] showed that healthy lifestyles, including moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline, were associated with lower incidences of depression.…”