Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis.

Humans Multiple Sclerosis / epidemiology Prodromal Symptoms British Columbia / epidemiology Comorbidity Prevalence

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
14 11 2023
Historique:
received: 15 03 2023
accepted: 03 08 2023
pmc-release: 14 11 2024
medline: 15 11 2023
pubmed: 26 9 2023
entrez: 25 9 2023
Statut: ppublish

Résumé

Psychiatric morbidity is common after a multiple sclerosis (MS) diagnosis. However, little is known about psychiatric comorbidity during the prodromal phase (before MS onset). To compare the prevalence and relative burden of psychiatric morbidity in individuals with MS with matched controls before MS onset. Using linked administrative and clinical data from British Columbia, Canada, we identified cases with MS through a validated algorithm or from neurologist-diagnosed MS clinic attendees. Cases were matched by age, sex, and geographical location with up to 5 general population controls. We identified psychiatric morbidity through a validated definition and determined its prevalence in cases/controls in the 5 years before the first demyelinating claim of cases with MS ("administrative cohort") or symptom onset ("clinical cohort") and estimated case/control prevalence ratios with 95% CIs. We also compared the yearly number of physician visits for psychiatric morbidity, visits to psychiatrists, psychiatric-related admissions, and psychotropic dispensations pre-MS onset in cases/controls regardless of whether psychiatric morbidity algorithm was fulfilled using negative binomial regression fitted through generalized estimating equations; results were reported as adjusted rate ratios with 95% CIs. We assessed yearly trends through interaction terms between cases/controls and each year pre-MS onset. The administrative cohort comprised 6,863/31,865 cases/controls; the clinical cohort comprised 966/4,534 cases/controls. Over the entire 5-year period pre-MS onset, 28.0% (1,920/6,863) of cases and 14.9% (4,738/31,865) of controls (administrative cohort) had psychiatric morbidity, as did 22.0% (213/966) of clinical cases and 14.1% (638/4,534) controls. Psychiatric morbidity prevalence ratios ranged from 1.58; 95% CI 1.38-1.81 (clinical cohort) to 1.91; 95% CI 1.83-2.00 (administrative cohort). In the administrative cohort, health care use was higher for cases in each year pre-MS onset (all 95% CIs >1); physician visits were 78% higher in year 5 pre-MS onset and 124% 1 year before; visits to psychiatrists were 132% higher in year 5 and 146% in year 1; hospitalizations were 129% higher in year 5 and 197% in year 1; and prescription dispensations were 72% higher in year 5 and 100% in year 1. Results were not significant in the clinical cohort. Psychiatric morbidity represents a significant burden before MS onset and may be a feature of the MS prodrome.

Sections du résumé

BACKGROUND AND OBJECTIVES
Psychiatric morbidity is common after a multiple sclerosis (MS) diagnosis. However, little is known about psychiatric comorbidity during the prodromal phase (before MS onset). To compare the prevalence and relative burden of psychiatric morbidity in individuals with MS with matched controls before MS onset.
METHODS
Using linked administrative and clinical data from British Columbia, Canada, we identified cases with MS through a validated algorithm or from neurologist-diagnosed MS clinic attendees. Cases were matched by age, sex, and geographical location with up to 5 general population controls. We identified psychiatric morbidity through a validated definition and determined its prevalence in cases/controls in the 5 years before the first demyelinating claim of cases with MS ("administrative cohort") or symptom onset ("clinical cohort") and estimated case/control prevalence ratios with 95% CIs. We also compared the yearly number of physician visits for psychiatric morbidity, visits to psychiatrists, psychiatric-related admissions, and psychotropic dispensations pre-MS onset in cases/controls regardless of whether psychiatric morbidity algorithm was fulfilled using negative binomial regression fitted through generalized estimating equations; results were reported as adjusted rate ratios with 95% CIs. We assessed yearly trends through interaction terms between cases/controls and each year pre-MS onset.
RESULTS
The administrative cohort comprised 6,863/31,865 cases/controls; the clinical cohort comprised 966/4,534 cases/controls. Over the entire 5-year period pre-MS onset, 28.0% (1,920/6,863) of cases and 14.9% (4,738/31,865) of controls (administrative cohort) had psychiatric morbidity, as did 22.0% (213/966) of clinical cases and 14.1% (638/4,534) controls. Psychiatric morbidity prevalence ratios ranged from 1.58; 95% CI 1.38-1.81 (clinical cohort) to 1.91; 95% CI 1.83-2.00 (administrative cohort). In the administrative cohort, health care use was higher for cases in each year pre-MS onset (all 95% CIs >1); physician visits were 78% higher in year 5 pre-MS onset and 124% 1 year before; visits to psychiatrists were 132% higher in year 5 and 146% in year 1; hospitalizations were 129% higher in year 5 and 197% in year 1; and prescription dispensations were 72% higher in year 5 and 100% in year 1. Results were not significant in the clinical cohort.
DISCUSSION
Psychiatric morbidity represents a significant burden before MS onset and may be a feature of the MS prodrome.

Identifiants

DOI: 10.1212/WNL.0000000000207843 PMID: 37748884 PMC: PMC10662981
pubmed: 37748884
pii: WNL.0000000000207843
doi: 10.1212/WNL.0000000000207843
pmc: PMC10662981
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e2026-e2034

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

© 2023 American Academy of Neurology.

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Auteurs

Anibal S Chertcoff (AS)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
ORCID: 0000-0002-8645-6134

Fardowsa L A Yusuf (FLA)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
ORCID: 0009-0009-9693-9111

Feng Zhu (F)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Charity Evans (C)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

John D Fisk (JD)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Yinshan Zhao (Y)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Ruth Ann Marrie (RA)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

Helen Tremlett (H)

From the Faculty of Medicine (Neurology) (A.S.C., F.L.A.Y., F.Z., Y.Z., H.T.), University of British Columbia and The Djavad Mowafaghian Center for Brain Health; School of Population and Public Health (F.L.A.Y.), University of British Columbia, Vancouver; College of Pharmacy and Nutrition (C.E.), University of Saskatchewan, Saskatoon; Nova Scotia Health and the Departments of Psychiatry, Psychology & Neuroscience, and Medicine (J.D.F.), Dalhousie University, Halifax; and Departments of Internal Medicine and Community Health Sciences (R.A.M.), Health Sciences Center, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. helen.tremlett@ubc.ca.
ORCID: 0000-0001-5804-2535

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Psychiatric Comorbidity During the Prodromal...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Maladies démyélinisantes auto-immunes du SNC › Sclérose en plaques › Psychiatric Comorbidity During the Prodromal...
questionsmedicales.fr › Diagnostic › Symptômes prodromiques › Psychiatric Comorbidity During the Prodromal...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Colombie-Britannique › Psychiatric Comorbidity During the Prodromal...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Comorbidité › Psychiatric Comorbidity During the Prodromal...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Prévalence › Psychiatric Comorbidity During the Prodromal...