title: Disentangling Multiple Sclerosis and depression: an adjusted depression screening score for patient-centered care.
abstract: Screening for depression can be challenging in Multiple Sclerosis (MS) patients due to the overlap of depressive symptoms with other symptoms, such as fatigue, cognitive impairment and functional impairment, for MS patients. The aim of this study was to understand these overlapping symptoms and subsequently develop an adjusted depression screening tool for better clinical assessment of depressive symptoms in MS patients. We evaluated 3,507 MS patients with a self-reported depression screening (PHQ-9) score using a multiple indicator multiple cause modeling approach. Our models showed significant differential item functioning effects denoting significant overlap of depressive symptoms with all MS symptoms under study and good model fit. The magnitude of the overlap was especially large for fatigue. Adjusted depression screening scales were formed based on factor scores and loadings that will allow clinicians to understand the depressive symptoms separate from other symptoms for MS patients for improved patient care.
authors.affiliation: Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109-1998, USA, dgunzler@metrohealth.org.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Gunzler
authors.forename: Adam
authors.initials: A
authors.lastname: Perzynski
authors.forename: Nathan
authors.initials: N
authors.lastname: Morris
authors.forename: Robert
authors.initials: R
authors.lastname: Bermel
authors.forename: Steven
authors.initials: S
authors.lastname: Lewis
authors.forename: Deborah
authors.initials: D
authors.lastname: Miller
mesh_terms: D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis; D003863:Depression / Q000150:complications* / Q000175:diagnosis*; D005221:Fatigue / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis*; D018802:Patient-Centered Care; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D057566:Self Report