title: A longer diagnostic interval is a risk for depression in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  Recognizing depressive symptoms in patients with amyotrophic lateral sclerosis (ALS) remains problematic given the potential overlap with the normal psychological responses to a terminal illness. Understanding mental health and disease-related risk factors for depression is key to identifying psychological morbidity. The present study aimed to determine the prevalence of depressive symptoms in ALS and to explore mental health and disease-related risk factors for depression.
  
  
  METHODS
  Structured medical and psychiatric history questionnaires and a validated depression scale (Depression, Anxiety, Stress Scale-21) were completed by 27 ALS patients (60% female; 59% limb onset; age 65.11 ± SE 2.21) prior to their initial review at a multidisciplinary clinic. Physical function was assessed with the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R).
  
  
  RESULTS
  At the time of initial assessment, 44% of patients had a previous psychiatric history, although the majority (62%) reported no symptoms of depression. The mean ALSFRS-R score was 37.78 ± SE 1.22, with an average diagnostic interval of 16.04 ± SE 2.39 months. Logistic regression analysis revealed that the length of the diagnostic interval alone predicted depressive symptoms (χ²(3, n = 26) = 9.21, Odds Ratio (OR) = 1.12, p < 0.05.
  
  
  CONCLUSIONS
  The illness experiences of ALS patients rather than established mental health risk factors influence the manifestation of depressive symptoms in the early stages of the disease, with clinical implications for the assessment and treatment of psychological morbidity. Patients with lengthy diagnostic intervals may be prime targets for psychological assessment and intervention, especially in the absence of ALS-specific tests and biomarkers.
authors.affiliation: Neuroscience Research Australia,Randwick,New South Wales,Australia.
authors.forename: Jashelle
authors.initials: J
authors.lastname: Caga
authors.affiliation: Neuroscience Research Australia,Randwick,New South Wales,Australia.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Ramsey
authors.affiliation: Centre for Clinical Governance Research,Australian Institute of Health Innovation,University of New South Wales,Randwick,New South Wales,Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Hogden
authors.affiliation: Neuroscience Research Australia,Randwick,New South Wales,Australia.
authors.forename: Eneida
authors.initials: E
authors.lastname: Mioshi
authors.affiliation: Neuroscience Research Australia,Randwick,New South Wales,Australia.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Kiernan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Amyotrophic lateral sclerosis; Depression; Diagnostic interval; Grief; Risk factors