title: Adverse health behaviours are associated with depression and anxiety in multiple sclerosis: A prospective multisite study.
abstract: BACKGROUND
  Depression and anxiety are common among people with multiple sclerosis (MS), as are adverse health behaviours, but the associations between these factors are unclear.
  
  
  OBJECTIVE
  To evaluate the associations between cigarette smoking, alcohol use, and depression and anxiety in MS in a cross-Canada prospective study.
  
  
  METHODS
  From July 2010 to March 2011 we recruited consecutive MS patients from four MS clinics. At three visits over two years, clinical and demographic information was collected, and participants completed questionnaires regarding health behaviours and mental health.
  
  
  RESULTS
  Of 949 participants, 75.2% were women, with a mean age of 48.6 years; most had a relapsing-remitting course (72.4%). Alcohol dependence was associated with increased odds of anxiety (OR: 1.84; 95% CI: 1.32-2.58) and depression (OR: 1.53; 95% CI: 1.05-2.23) adjusting for age, sex, Expanded Disability Status Scale (EDSS), and smoking status. Smoking was associated with increased odds of anxiety (OR: 1.29; 95% CI: 1.02-1.63) and depression (OR: 1.37; 95% CI: 1.04-1.78) adjusting for age, sex, EDSS, and alcohol dependence. Alcohol dependence was associated with an increased incidence of depression but not anxiety. Depression was associated with an increased incidence of alcohol dependence.
  
  
  CONCLUSIONS
  Alcohol dependence and smoking were associated with anxiety and depression. Awareness of the effects of adverse health behaviours on mental health in MS might help target counselling and support for those 'at risk'.
authors.affiliation: Department of Neurology, Faculty of Medicine, University of British Columbia, Canada.
authors.forename: Kyla A
authors.initials: KA
authors.lastname: McKay
authors.affiliation: Department of Neurology, Faculty of Medicine, University of British Columbia, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Tremlett
authors.affiliation: Departments of Psychiatry, Psychology, & Neuroscience, Dalhousie University, Canada.
authors.forename: John D
authors.initials: JD
authors.lastname: Fisk
authors.affiliation: Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.affiliation: Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Canada.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Fiest
authors.affiliation: Department of Psychology, St. Francis Xavier University, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Berrigan
authors.affiliation: Health Sciences Centre, College of Medicine, University of Manitoba, Canada rmarrie@hsc.mb.ca.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Marrie
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology*; D003863:Depression / Q000503:physiopathology*; D004185:Disability Evaluation; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000523:psychology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Multiple sclerosis; anxiety; cohort; depression; health behaviour