title: Prevalence of depression and anxiety in Multiple Sclerosis: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Prevalence rates of depression and anxiety in patients with Multiple Sclerosis (MS) vary widely across studies. Aim of this systematic review and meta-analysis was to a) estimate the prevalence of depression and anxiety in MS, and specifically b) explore sources of heterogeneity (assessment method, prevalence period, study quality, recruitment resource, region) by extensive analyses.
  
  
  METHODS
  A computerized search in PubMed, EMBASE, and PsycINFO for studies on depression and anxiety in MS was performed up to December 2014.
  
  
  RESULTS
  Fifty-eight articles with a total sample size of 87,756 MS patients were selected. Pooled mean prevalence was 30.5% (95% CI=26.3%-35.1%) for depression, and 22.1% (95% CI=15.2%-31.0%) for anxiety. Prevalence of clinically significant depressive or anxiety symptoms was higher (35% and 34%) compared with disorders (21%; p=0.001 and 10%; p<0.001). Prevalence of a depressive disorder was relatively lower in studies from Europe. Anxiety disorder was more prevalent in community-based samples. Sources of high heterogeneity were not revealed.
  
  
  CONCLUSIONS
  Data of a large number of patients indicate increased prevalence of depression and anxiety in MS. Further research is needed to identify sources of heterogeneity. Issues to consider are the definition of depression and anxiety, patient recruitment, and patient characteristics.
authors.affiliation: Department of Psychiatry, VU University Medical Center and GGZinGeest, Amsterdam, Netherlands; EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands. Electronic address: r.boeschoten@ggzingeest.nl.
authors.forename: Rosa E
authors.initials: RE
authors.lastname: Boeschoten
authors.affiliation: Department of Psychiatry, VU University Medical Center and GGZinGeest, Amsterdam, Netherlands; EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands.
authors.forename: Annemarie M J
authors.initials: AMJ
authors.lastname: Braamse
authors.affiliation: Department of Psychiatry, VU University Medical Center and GGZinGeest, Amsterdam, Netherlands; EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands.
authors.forename: Aartjan T F
authors.initials: ATF
authors.lastname: Beekman
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands; Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Department of Psychiatry, VU University Medical Center and GGZinGeest, Amsterdam, Netherlands; EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands.
authors.forename: Patricia
authors.initials: P
authors.lastname: van Oppen
authors.affiliation: Department of Psychiatry, VU University Medical Center and GGZinGeest, Amsterdam, Netherlands; EMGO+ Institute for Health and Care Research, VU University, Amsterdam, Netherlands; Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.affiliation: Department of Neurology, Multiple Sclerosis Center, VU University Medical Center, Amsterdam, Netherlands.
authors.forename: Bernard M J
authors.initials: BMJ
authors.lastname: Uitdehaag
mesh_terms: D001007:Anxiety / Q000150:complications / Q000453:epidemiology*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000453:epidemiology; D015995:Prevalence
keywords: Anxiety; Depression; Epidemiology; Multiple Sclerosis; Prevalence