title: Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis.
abstract: BACKGROUND
  Depression is the most common co-morbidity for people with Multiple Sclerosis (MS); irrespective of disease severity, depression has the greatest impact on quality of life. An emerging paradigm in the treatment of depression is lifestyle medicine. There is significant potential to prevent and treat depression through modification of lifestyle risk factors for people with MS. This study sought to understand the association between lifestyle risk factors, medication and depression risk through the analysis of self-reported data from a large international sample of people with MS.
  
  
  METHODS
  This cross-sectional analysis recruited a total of 2459 participants via Web 2.0 platforms. Survey data included socio-demographics; a range of lifestyle risk factors; medication; disease variables and depression risk using the Patient Health Questionnaire-2 (PHQ-2).
  
  
  RESULTS
  In total approximately one fifth (19.3%) of our sample screened positive for depression (PHQ-2 score ≥3). Several demographic factors were significantly associated with this depression risk in bivariate analysis. Regression analyses showed that poor diet, low levels of exercise, obesity, smoking, marked social isolation and taking interferon were associated with greater depression risk. Participants who supplemented with omega 3s, particularly flaxseed oil, had frequent fish consumption, supplemented with vitamin D, meditated, and had moderate alcohol consumption had significantly reduced depression risk.
  
  
  CONCLUSIONS
  This study demonstrates a significant association between modifiable lifestyle factors and depression risk. Planned longitudinal follow up may clarify causality. Clinicians and people with MS should be aware of the wide range of modifiable lifestyle factors that may reduce depression risk as part of a comprehensive secondary and tertiary preventive medical approach to managing MS.
authors.affiliation: Department of Psychiatry, St Vincent's Hospital Melbourne, Victoria, VIC, 3065, Australia. keryn.taylor@svha.org.au.|Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia. keryn.taylor@svha.org.au.
authors.forename: Keryn L
authors.initials: KL
authors.lastname: Taylor
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. emily.hadgkiss@hotmail.com.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Hadgkiss
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. george.jelinek@svha.org.au.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. george.jelinek@svha.org.au.
authors.forename: George A
authors.initials: GA
authors.lastname: Jelinek
authors.affiliation: Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia. tracey.weiland@svha.org.au.|Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. tracey.weiland@svha.org.au.
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.affiliation: Faculty of Medicine, Notre Dame University, Fremantle, Western Australia, Australia. naresh.pereira@gmail.com.
authors.forename: Naresh G
authors.initials: NG
authors.lastname: Pereira
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. claudia.marck@svha.org.au.
authors.forename: Claudia H
authors.initials: CH
authors.lastname: Marck
authors.affiliation: Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. dania.vandermeer@svha.org.au.
authors.forename: Dania M
authors.initials: DM
authors.lastname: van der Meer
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology*; D019587:Dietary Supplements; D006233:Persons with Disabilities; D004522:Educational Status; D004651:Employment; D015444:Exercise / Q000502:physiology; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D009765:Obesity / Q000523:psychology; D011788:Quality of Life; D012307:Risk Factors; D012907:Smoking / Q000523:psychology; D012944:Social Support; D011795:Surveys and Questionnaires; D014807:Vitamin D / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D015525:Fatty Acids, Omega-3; D014815:Vitamins; D014807:Vitamin D