Mental health in myasthenia gravis patients and its impact on caregiver burden

Abstract

Psychiatric comorbidities are relevant in patients with Myasthenia gravis (MG). Also, MG patients experience a reduced health-related quality of life (HRQoL). We aimed to quantify the impact of depression as well as self-perceived MG severity on HRQoL and caregivers' burden. In this cross-sectional study, we used a survey encompassing demographic, disease-related information, and standardized questionnaires to assess symptoms of depression, anxiety, HRQoL (MG Quality of Life scale; MG-QoL15), and caregiver burden (Burden Scale for Family Caregivers; BSFC). Data from 1399 participating patients (96%) and 1042 caregivers (65%) were eligible for further analysis. Symptoms of depression and anxiety disorder were indicated by 31% and 36% of patients. Self-reported MG severity (MG severity) and MG-QoL15 scores were strongly associated (estimated marginal means for severe versus mild MG severity = 18 95% CI [16; 21]; p ≤ 0.001). Adjusting for symptoms of depression decreased the estimated strength of this association (estimated marginal means for severe versus mild MG severity = 15 [13; 17]; p ≤ 0.001). Caregiver burden was associated to MG disease severity (estimated marginal means for severe vs. mild MG severity = 0.16 [0.13; 0,19); p ≤ 0.001) and also negatively influenced by symptoms of depression (estimated marginal means = 0.12 [0.09; 0.15]). Symptoms of depression and anxiety disorder in MG are frequent. Beyond MG severity, symptoms of depression have negative effects on HRQoL as well as on caregivers’ burden. Diagnosis and treatment of psychiatric comorbidities should be considered an important element in MG care. Screening tools for mental health conditions should be implemented at least in specialized MG centers.

Insights Into the Association Between Myasthenia Gravis and Depression: A Clinical Case Study

“…However, a study of over 3,000 MG patients found that thymectomy was associated with higher health-related quality of life (HRQoL) scores compared to MG patients with no thymectomy. These results provide data to support that her thymectomy is unlikely to be a contributing factor to her depression as it has not been shown to lower HRQoL scores [ 2 ].…”

“…Despite these potential causes of the patient’s depression, the patient's MG disease itself is a consideration for the exacerbation of her depression. A large survey with over 1,500 MG patients found that women displayed more anxiety and depressive symptoms compared to males, and the study by Marbin et al with over 3,000 MG patients supported this finding, stating that women had significantly lower HRQoL scores compared to men [ 2 , 3 ]. These results suggest that the patient's female sex may have predisposed her to a diagnosis of depression comorbid with her MG.…”

“…Myasthenia gravis (MG) is a serious and debilitating autoimmune disease characterized by muscle weakness, most typically causing shortness of breath, as well as affecting the eyes, limbs, throat, and speech [ 1 ]. It is most prevalent in females aged around 40 years and males aged around 60 years [ 1 , 2 ]. While some MG patients may be able to function normally and carry out their typical daily activities, serious cases or a myasthenic crisis involve respiratory failure and require ventilation.…”

Myasthenia Gravis: Utilising cross-platform quantitative content analysis to uncover and validate unmet needs

“…While the use of these communities by the 61 unique users classi ed as "seeking diagnosis" is indicative of the diagnostic "odyssey" these individuals face [33], the use of these resources by the 656 users classi ed as "presumed diagnosed" further evinces the idea that the end of the diagnostic odyssey is the beginning of the therapeutic odyssey [34]. To wit, the 69 unique users identi ed as friends or family draws attention to the role of individual's support networks -a topic which remains under-researched -despite widespread acknowledgement of the debilitating nature of the disease and its impact upon employment [35] and caregivers [36,37].…”

Expert consensus recommendations for improving and standardising the assessment of patients with generalised myasthenia gravis

“…Inventory (MDI) and the SF-36 [32,[35][36][37][38]. Few studies report using depression and anxiety scales that patients can use on their own, such as the Centre for Epidemiologic Studies Depression Scale, Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Patient Health Questionnaire (PHQ ) [39,40].…”