title: Disability, depression and suicide ideation in people with multiple sclerosis.
abstract: Depressive symptoms occur frequently in people with Multiple Sclerosis (MS) and rates of suicide ideation are higher than the general population. There is evidence for a direct association between disability and depression, disability and suicide ideation, and depression and suicide ideation in MS. However, the relationship between all three, i.e. the mediating role of depression between disability and suicidal ideation, has not been investigated. Exploring this relationship could highlight risk factors, alerting clinicians to the need for timely intervention.
  
  
  
  Seventy five people with progressive MS attending two out-patient clinics took part in this cross-sectional study. Participants completed the Beck Suicide Scale, Beck Depression Inventory, Multiple Sclerosis Impact Scale and Guy's Neurological Disability Scale.
  
  
  
  Depressive symptoms mediated the relationship between perceived and actual disability and suicide ideation. Different types of disability were associated with suicidality, including: 'tremors' and 'taking longer to do things'. A small sub-group of participants were identified who reported suicide ideation in the presence of only mild levels of depression.
  
  
  
  There may be a sample bias in this study as all participants were attending out-patient clinics and receiving support which may not be available to everyone with MS.
  
  
  
  It is important for clinicians to screen regularly for both depression and suicide ideation, to be alert to specific types of disability for which a higher level of suicide ideation might be present and to consider the possibility of suicidal thoughts being present in people who show minimal or no depressive symptoms.
authors.affiliation: Department of Clinical Psychology, University of Birmingham, Birmingham, UK.
authors.forename: V M
authors.initials: VM
authors.lastname: Lewis
authors.affiliation: Department of Clinical Psychology, University of Birmingham, Birmingham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Williams
authors.affiliation: West Midlands Rehabilitation Service, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: KoKo
authors.affiliation: Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Woolmore
authors.affiliation: Department of Clinical Psychology, University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Jones
authors.affiliation: Department of Clinical Psychology, University of Birmingham, Birmingham, UK. Electronic address: t.powell@bham.ac.uk.
authors.forename: T
authors.initials: T
authors.lastname: Powell
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000706:statistics & numerical data
keywords: Multiple Sclerosis; depression; disability; suicide ideation; ‘rational’ suicide