Patients With MS Testing Positive for COVID-19 Saw Worse Depressive, Anxiety Symptoms

Among patients with multiple sclerosis (MS) during the COVID-19 pandemic prior to vaccine rollout, investigators found that many experienced symptoms of depression and impaired mental health, with those who tested positive for COVID-19 reporting a greater burden of depressive and anxiety symptoms.

The study, published in Multiple Sclerosis and Related Disorders, revealed the extent to which the pandemic has impacted the mental health of patients with MS and identified certain characteristics that are associated with a greater burden of depressive and anxiety symptoms, including age and gender.

“Our findings shed light on the mental health burden in this population during a critical time point in the COVID-19 pandemic...At-risk patient subgroups are identified and may benefit from multidisciplinary care teams and longitudinal mental health surveillance,” wrote the investigators.

The COVID-19 pandemic is known to have impacted the mental health of people worldwide and the unmet need for mental health care services increased from 9.2% in August 2020 to 11.7% in February 2021. The rise in mental illness has spotlighted the pandemic’s effect on the general population and vulnerable groups, including those white chronic diseases and preexisting mental illness.

Many people with MS are treated with immunosuppressive disease-modifying therapies, which were thought to increase the risk of COVID-19 infection and may be associated with a worse prognosis. There is also a high prevalence of depression and anxiety among patients with MS, suggesting that people with MS may be at a greater risk of psychological impacts as a result of the pandemic.

The investigators recruited patients with MS over the age of 20 years who lived in the United States and were registered on iConquerMS, an online platform used by the investigators to distribute a survey containing questions on disease activity, depressive symptoms, anxiety symptoms, COVID-19 positivity, and symptom burden. Enrollment occurred between December 18, 2020 and February 10, 2021.

Of the 1662 active users registered with iConquerMS, 773 people with MS responded, of whom 610 were analyzed for this study. The mean (SD) age of the participants was 56.2 (11.4) years. Also, 491 (80.5%) respondents were women and 214 (35.1%) had progressive MS.

Overall, 47 (7.7%) reported testing positive for COVID-19, of whom 43 (91.5%) experienced symptoms. New or worsening neurological symptoms were reported in 23 (48.9%) patients around the time that they had COVID-19, of whom 20 reported that they occurred at the same time or after their COVID-19 symptoms.

The prevalence of moderate-to-severe depressive symptom burden was 27.4%, 14.7% of the cohort experienced moderate-to-severe anxiety symptom burden, with 55.1% of the cohort endorsing fair or poor general mental health. Patients who tested positive for COVID-19 were found to have a higher depressive and anxiety symptom burdens (P < .05).

A multivariable linear regression analysis found that female sex and moderate-to-severe depressive symptom burden was associated with increased anxiety symptoms. In contrast, older age was associated with decreased anxiety symptoms. A sensitivity analysis, older age was associated with increased odds of good or better mental health (OR, 1.03; 95% CI, 1.02-1.05). Additionally, increased functional disability (OR, 0.82; 95% CI, 0.75-0.89), social determinants of health count of 1 or greater (OR, 0.60; 95% CI, 0.41-0.88), and comorbidity index of 1 or greater (OR, 0.60; 95% CI, 0.38-0.96) were associated with decreased odds of good or better mental health.

“Increased functional disability has been found to be associated with depression (but not anxiety) in PwMS during the pandemic in other research, specifically showing a moderating role of physical exercise; i.e., physical activity may play a role in pandemic depression, regardless of functional disability status,” noted the investigators.

The study had several limitations, including that the surveys were conducted anonymously, that a sampling bias may have occurred, and that the survey was web-based and only available in English. The investigators said that results should be interpreted with caution because lower-income populations, people with limited Internet access, and non-English speakers were likely left out of the analysis.

Reference

Uhr L, Rice DR, Mateen FJ. Sociodemographic and clinical factors associated with depression, anxiety, and general mental health in people with multiple sclerosis during the COVID-19 pandemic. Mult Scler Relat Disord. Published online October 11, 2021. doi: 10.1016/j.msard.2021.103327