Philip A. Jones

A Large-Scale Study of Anxiety and Depression in People with Multiple Sclerosis: A Survey via the Web Portal of the UK MS Register

Introduction Studies have found that people with Multiple Sclerosis experience relatively high rates of anxiety and depression. Although methodologically robust, many of these studies had access to only modest sample sizes (N<200). The aims of this study were to use responses gained via the web portal of the UK MS Register (N>4000) to: describe the depression and anxiety profiles of people with MS; to determine if anxiety and depression are related to age or disease duration; and to assess whether the levels of anxiety and depression differ between genders and types of MS. Methods From its launch in May 2011 to the end of December 2011, 7786 adults with MS enrolled to take part in the UK MS Register via the web portal. The responses to the Hospital Anxiety and Depression Scale (HADS) were collated with basic demographic and descriptive MS data provided at registration and the resulting dataset was analysed in SPSS (v.16). Results The mean HADS score among the 4178 respondents was 15.7 (SE 0.117, SD 7.55) with a median of 15.0 (IQR 11). Anxiety and depression rates were notably high, with over half (54.1%) scoring ≥8 for anxiety and 46.9% scoring ≥8 for depression. Women with relapsing-remitting MS were more anxious than men with this type (p<0.001), and than women with other types of MS (p = 0.017). Within each gender, men and women with secondary progressive MS were more depressed than men or women with other types of MS (p<0.001, p<0.001). Conclusions This largest known study of its kind has shown that anxiety and depression are highly prevalent in people with MS, indicating that their mental health needs could be better addressed. These findings support service planning and further research to provide the best care for people with MS to help alleviate these debilitating conditions.

How People with Multiple Sclerosis Rate Their Quality of Life: An EQ-5D Survey via the UK MS Register

Introduction The EQ-5D is a widely-used, standardised, quality of life measure producing health profiles, indices and states. The aims of this study were to assess the role of various factors in how people with Multiple Sclerosis rate their quality of life, based on responses to the EQ-5D received via the web portal of the UK MS Register. Methods The 4516 responses to the EQ-5D (between May 2011 and April 2012) were collated with basic demographic and descriptive MS data and the resulting dataset was analysed in SPSS (v.20). Results The mean health state for people with MS was 59.73 (SD 22.4, median 61), compared to the UK population mean of 82.48 (which is approximately 1SD above the cohort mean). The characteristics of respondents with high health states (at or above +1SD) were: better health profiles (most predictive dimension: Usual Activities), higher health indices, younger age, shorter durations of MS, female gender, relapsing-remitting MS, higher educational attainment and being in paid employment (all p-values<0.001). Conversely, the characteristics of respondents with low health states (at or below -1SD) were: poorer health profiles (most predictive dimension: Mobility), lower health indices, older age, longer durations of MS, male gender, progressive MS, lower educational attainment and having an employment status of sick/disabled (p = 0.0014 for age, all other p-values<0.001). Particular living arrangements were not associated with either the high or low health status groups. Conclusions This large-scale study has enabled in-depth analyses on how people with MS rate their quality of life, and it provides new knowledge on the various factors that contribute to their self-assessed health status. These findings demonstrate the impact of MS on quality of life, and they can be used to inform care provision and further research, to work towards enhancing the quality of life of people with MS.

Physical Disability, Anxiety and Depression in People with MS: An Internet-Based Survey via the UK MS Register

Introduction People with Multiple Sclerosis are known to have a relatively high prevalence of both anxiety and depression. Studies of the relationship between physical disability and mental health in people with MS have reported mixed results, showing the need for further work. Methods Between May 2011 and April 2012, 4516 people completed the MSIS-29 (v.1) and HADS scales via the dedicated internet site of the UK MS Register within a 7 day time window. These responses were linked with basic demographic and descriptive data and analysed in SPSS (v.20). Results The proportions of people experiencing anxiety or depression increased with physical disability such that 38.0% of respondents with low, and 66.7% with high disability reported at least mild anxiety, and 17.1% of people with low, and 71.7% with high disability experienced at least mild depression. The multiple regression model explained 18.4% of the variance in anxiety with MSIS-29-PHYS score being the strongest predictor of anxiety. The model for depression explained 37.8% of the variance with MSIS-29-PHYS score being the strongest predictor. Some of the other variables included showed negative associations with anxiety and depression, indicating that the influence of physical disability on mental wellbeing could be underestimated. Conclusions This study indicates that there is a positive relationship between physical disability and anxiety and depression, that physical disability impacts on anxiety and depression to differing extents, and that the effects vary with gender, age, disease course and disease duration. We have shown that physical disability is a predictor of anxiety and depression, and that other factors may mask the extent of this effect. Whether the causes of anxiety and depression are reactive, organic or a combination, it is essential that mental wellbeing is given due attention in caring for people with MS so that all their health needs can be met.

The Physical and Psychological Impact of Multiple Sclerosis Using the MSIS-29 via the Web Portal of the UK MS Register

Introduction The MSIS-29 was developed to assess the physical and psychological impact of MS. The aims of this study were to use the responses to the MSIS-29 via the web portal of the UK MS Register to: examine the internal properties of the scale delivered via the internet, profile the cohort, and assess how well the scale measures impact of disability on the potential workforce. Methods Between May 2011 and April 2012, 4558 people with MS completed the MSIS-29(v.1). The responses were collated with basic demographic and descriptive MS data and the resulting dataset was analysed in SPSS(v.20). Results Internal consistency was high (Cronbachs alpha 0.97 MSIS-29-PHYS, 0.92 MSIS-29-PSYCH). The mean MSIS-29-PHYS score was 60.5 (50.6%) with a median of 62 and the mean MSIS-29-PSYCH score was 24.8 (43.8%) with a median of 24. Physical scores increased with age and disease duration (p<0.001, p<0.001), but there was a weak negative relationship between psychological scores and age (p<0.001). The odds of people having an employment status of sick/disabled were 7.2 (CI 5.5, 9.4, p<0.001) for people with a moderate physical score, and 22.3 (CI 17.0, 29.3, p<0.001) for people with a high physical score (relative to having a low physical score). Conclusions This largest known study of its kind has demonstrated how the MSIS-29 can be administered via the internet to characterise a cohort, and to predict the likely impact of disability on taking an active part in the workforce, as a reasonable proxy for the effects of MS on general activities. The findings examining MSIS-29-PHYS and MSIS-29-PSYCH scores against age support the use of two sub-scales, not a combined score. These results underline the importance of using a scale such as this to monitor disability levels regularly in guiding MS care to enable people to be as active as possible.

Researching the geography of mental wellbeing

Different disciplines have different methods of investigating the same phenomenon and truly multi-disciplinary research can bring added benefits to most areas of study. Geography is the study of any phenomenon at or near the earth’s surface, and as such it necessitates a multidisciplinary approach. This editorial highlights the role that can be played by professional geographers in mental health research, advocating more multi-disciplinary research and the broadening of research methods taught to all disciplines. Analytical methods used in geography have undergone many changes. One of the most notable and significant changes took place in the 1960s when geographical research went through what is now commonly referred to as the quantitative revolution. It was a major paradigm shift for the discipline seeing it largely move away from descriptive narrative to statistical analysis of space, place and society. Since that time geographical research methodology has continued to evolve, and so have the techniques used by geographers. Advances in micro-computing have facilitated the development of new quantitative techniques and more recently they have brought digital mapping and Geographic Information Systems (GIS) to the desk-top. Gatrell (2002) noted in his introductory book, Geographies of Health, that a good deal of spatial analytical work has been paralleled by the development of geographic information systems. GIS is a computer-based information system that enables capture, modelling, storage, retrieval, sharing, manipulation, analysis and presentation of geographically referenced data (Worboys & Duckham, 2004). Typically, GIS data have two elements. The first is the location of each instance of a phenomenon, and this is usually in the form of a map grid reference or a pair of latitude and longitude coordinates. The second element is associated with the attributes of each instance of the phenomenon. For example, a GIS of disease would have the spatial location of each incident together with information about the disease (disease name, age, gender, date, outcome, etc. of the sufferer). Openshaw et al. (1987) and colleagues analysed data on the incidence of cancer using information held in the regional cancer registry in northern England. The spatial references were produced from the postcode of each patient, which then allowed them to analyse for spatial clustering in cases. In GIS, data are stored in thematic layers with

A tall order: small area mapping and modelling of adult height among Swiss male conscripts

&NA; Adult height reflects an individuals socio‐economic background and offers insights into the well‐being of populations. Height is linked to various health outcomes such as morbidity and mortality and has consequences on the societal level. The aim of this study was to describe small‐area variation of height and associated factors among young men in Switzerland. Data from 175,916 conscripts (aged between 18.50 and 20.50 years) was collected between 2005 and 2011, which represented approximately 90% of the corresponding birth cohorts. These were analysed using Gaussian hierarchical models in a Bayesian framework to investigate the spatial pattern of mean height across postcodes. The models varied both in random effects and degree of adjustment (professional status, area‐based socioeconomic position, and language region). We found a strong spatial structure for mean height across postcodes. The range of height differences between mean postcode level estimates was 3.40 cm according to the best fitting model, with the shorter conscripts coming from the Italian and French speaking parts of Switzerland. There were positive socioeconomic gradients in height at both individual and area‐based levels. Spatial patterns for height persisted after adjustment for individual factors, but not when language region was included. Socio‐economic position and cultural/natural boundaries such as language borders and mountain passes are shaping patterns of height for Swiss conscripts. Small area mapping of height contributes to the understanding of its cofactors.