title: Challenges in screening for depression in multiple sclerosis.
abstract: BACKGROUND
  Screening has frequently been proposed as a strategy for detection of depression in multiple sclerosis (MS). In a recent study, we found a minimal impact of screening, even when this was coupled with rapidly responsive and evidence-based depression care.
  
  
  METHODS
  In order to explore the challenges involved in screening we analyzed prospective data from the Canadian Impact of MS (CIMS) database, which provides annual ratings on a self-report depression rating scale, the Center for Epidemiologic Studies Depression Rating Scale (CES-D).
  
  
  RESULTS
  Approximately 30% of respondents screened positive at each visit. CES-D ratings correlated fairly strongly from year to year, Pearson's r ranged from 0.65 to 0.73. Approximately 10% of those below the CES-D cut-point at each assessment exceeded the cut-point when rated 1 year later, but only about half of these cases had large (≥10 points) increases in their scores.
  
  
  CONCLUSIONS
  Screening interventions are generally oriented towards early detection, whereas the longitudinal pattern of depressive symptoms in MS appears to be characterized more prominently by a persistent burden of depressive symptoms in a substantial proportion of the population. Resources invested in screening efforts can probably be more effectively deployed in other areas, such as improved long-term clinical management.
authors.affiliation: Department of Community Health Sciences and Hotchkiss Brain Institute, University of Calgary, Canada. patten@ucalgary.ca.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.forename: Sandy
authors.initials: S
authors.lastname: Berzins
authors.forename: Luanne M
authors.initials: LM
authors.lastname: Metz
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales