title: The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated.
abstract: BACKGROUND
  Mental comorbidity is common in multiple sclerosis (MS), but some studies suggest that mental comorbidity may be underrecognized and undertreated.
  
  
  OBJECTIVE
  Using the North American Research Committee on MS Registry, we assessed the frequency of mental comorbidities in MS and sociodemographic characteristics associated with diagnosis and treatment of depression.
  
  
  METHODS
  We queried participants regarding depression, anxiety, bipolar disorder, and schizophrenia. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD); a score>or=21 indicated probable major depression.
  
  
  RESULTS
  Mental comorbidity affected 4264 (48%) responders; depression most frequently (4012, 46%). Among participants not reporting mental comorbidity, 751 (16.2%) had CESD scores>or=21 suggesting undiagnosed depression. Lower socioeconomic status was associated with increased odds of depression (Income $15,000-30,000 vs >$100,000 OR 1.34; 1.11-1.62), undiagnosed depression (Income $15,000-30,000 vs >$100,000 OR 1.52; 1.08-2.13), and untreated depression (<high school vs postgraduate degree OR 3.13; 1.65-5.99).
  
  
  CONCLUSIONS
  Mental comorbidity remains underdiagnosed and undertreated in MS. Patients of lower socioeconomic status bear a disproportionate share of the burden of depression.
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. rmarrie@hsc.mb.ca
authors.forename: R A
authors.initials: RA
authors.lastname: Marrie
authors.forename: R
authors.initials: R
authors.lastname: Horwitz
authors.forename: G
authors.initials: G
authors.lastname: Cutter
authors.forename: T
authors.initials: T
authors.lastname: Tyry
authors.forename: D
authors.initials: D
authors.lastname: Campagnolo
authors.forename: T
authors.initials: T
authors.lastname: Vollmer
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D017281:Cost of Illness; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000523:psychology*; D015999:Multivariate Analysis; D012042:Registries; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012923:Social Class; D011795:Surveys and Questionnaires