Mental health of people with multiple sclerosis during the COVID-19 outbreak: A prospective cohort and cross-sectional case–control study of the UK MS Register

Abstract

Background: People with MS (pwMS) have had higher rates of anxiety and depression than the general population before the COVID-19 pandemic, placing them at higher risk of experiencing poor psychological wellbeing during the pandemic. Objective: To assess mental health and its social/lifestyle determinants in pwMS during the first wave of the outbreak in the United Kingdom. Methods: This is a community-based, prospective longitudinal cohort and cross-sectional case–control online questionnaire study. It includes 2010 pwMS from the UK MS Register and 380 people without MS. Results: The Hospital Anxiety and Depression Scale scores of pwMS for anxiety and depression during the outbreak did not change from the previous year. PwMS were more likely to have anxiety (using General Anxiety Disorder-7) and/or depression (using Patient Health Questionnaire-9) than controls during the outbreak (OR: 2.14, 95% CI: 1.58–2.91). PwMS felt lonelier (OR: 1.37, 95% CI: 1.04–1.80) reported worse social support (OR: 1.90, 95% CI: 1.18–3.07) and reported worsened exercise habits (OR: 1.65, 95% CI: 1.18–2.32) during the outbreak than controls. Conclusion: Early in the pandemic, pwMS remained at higher risk of experiencing anxiety and depression than the general population. It is important that multidisciplinary teams improve their support for the wellbeing of pwMS, who are vulnerable to the negative effects of the pandemic on their lifestyle and social support.

Sociodemographic and clinical factors associated with depression, anxiety, and general mental health in people with multiple sclerosis during the COVID-19 pandemic

“…While previous studies earlier in the pandemic found no differences in the mental health of PwMS who were COVID-19 positive versus not infected (Garjani et al, 2021), we found evidence of significant adverse mental health issues among PwMS who self-reported testing positive for COVID-19. In previous coronavirus outbreaks, high rates of depression and anxiety symptomatology have been found during the acute illness and post-illness stage among the general population (Rogers et al, 2020).…”

“…Compared to PwMS in the United Kingdom in May-July 2020, the prevalence of moderate to severe depressive and anxiety symptoms in this U.S. cohort is marginally lower (27% versus 33% with moderate to severe depression and 15% versus 20% with moderate to severe anxiety) (Garjani et al, 2021). This may be due to differences in the baseline characteristics of the cohorts, differences in the study time frame, the societal and political response to the pandemic, and/or the announcement of the first COVID-19 vaccines in the U.S.…”

“…In April-May 2020, during the lockdown in Italy, PwMS had a significantly greater depressive symptom burden compared to healthy controls (Costabile et al, 2020). Similarly, PwMS in the United Kingdom experienced a greater burden of clinically significant depression and anxiety compared to controls (Garjani et al, 2021). Surveillance of the psychological well-being of PwMS living across the U.S. has not been well studied and remains important given the U.S. has the greatest number of COVID-19 cases and deaths to date, globally (CDC 2021).…”

A National Representative, Cross-Sectional Study by the Hellenic Academy of NeuroImmunology (HEL.A.NI.) on COVID-19 and Multiple Sclerosis: Overall Impact and Willingness Toward Vaccination

“…Depression as self-reported comorbidity exhibited a partial effect with respect to specific outcomes, such as the frequency of restricted access to appointments with MS specialists and behaviors, such as sexual dysfunction. Our findings are consistent with existing literature underlining a higher risk of anxiety and depression for PwMS relative to the general population and that these feelings are related to poor well-being during the pandemic ( 34 ). It should be stated, however, that in the frame of the present study, depression was not assessed by an online self-reported assessment tool, therefore a safe conclusion on the basis of discriminating the effect of current self-reported depressive feeling vs. a history of clinical diagnosis of depression on the reported outcomes is not possible.…”

Telemedicine as a strategic intervention for cognitive rehabilitation in MS patients during COVID-19

“…During the pandemic, MS patients may experience enhanced anxiety or depression [ 59 ], worrying about the effect of MS drugs on the severity of COVID-19, and also the possible negative impact of COVID-19 on their disease. The patients could become overwhelmed by stigmatization, complicated by grief due to restrictions, uncertainty about the future, frustration, and socioeconomic issues [ 58 , 60 ].…”