Multiple Sclerosis Mortality Rates in Canada, 1975-2009.

BACKGROUND: This study examined mortality due to multiple sclerosis (MS) in Canada, 1975-2009 to determine whether there has been a change in age at death relative to the general population and decrease in MS mortality rates. METHODS: Mortality rates/100,000 population for MS and all causes were calculated using data derived from Statistics Canada, age-standardized to the 2006 population. RESULTS: The average annual Canadian MS mortality rate, 1975-2009 was 1.23/100,000. Five-year rates for 1975-79, 1980-84, 1985-89, 1990-94, 1995-99, 2000-04, 2005-09 were: 1.16, 0.94, 1.01, 1.16, 1.30, 1.43, 1.33. Trend analysis showed mortality rates over the entire 35 years were stable (average annual percent change of less than one percent). The average annual 1975-2009 rates for females and males were 1.45 and 0.99. Five-year female rates were always higher than males. Regardless of gender, there was a decrease in MS mortality rates in the 0-39 age group and increases in the 60-69, 70-79, and 80+ groups over time. In contrast, there were decreases in all-cause mortality rates across each age group. The highest MS mortality rates for 1975-2009 were consistently in the 50-59 and 60-69 groups for both genders, while the highest all-cause mortality rates were in the 80+ group. CONCLUSIONS: Changes in the age distribution of MS mortality rates indicate a shift to later age at death, possibly due to improved health care. However MS patients remain disadvantaged relative to the general population and changes in age at death are not reflected in decreased mortality rates.

Equine-Assisted Occupational Therapy: Increasing Engagement for Children With Autism Spectrum Disorder.

Engagement in meaningful activities is essential to development and is often reduced in children with autism spectrum disorder (ASD) who have limited engagement in activities or relationships. A multiple-baseline design was used with 7 children with ASD ages 4-8 yr to assess the effect of including a horse in occupational therapy intervention on task engagement. The children showed improvements in engagement. Including horses in occupational therapy sessions may be a valuable addition to conventional treatments to increase task engagement of children with ASD. Factors related to the environment, therapeutic strategies, and individual participation need to be considered in understanding why this intervention may be effective and developing a theoretical basis for implementation.

Workplace model for physical therapists and occupational therapists.

PURPOSE: The purpose of this paper is to test a model linking physical therapy (PT) and occupational therapy (OT) practitioners' perceptions of resonant leadership, structural empowerment and psychological empowerment to their experiences of spirit at work (SAW), job satisfaction and organizational commitment within the Canadian workplace. DESIGN/METHODOLOGY/APPROACH: The authors tested the model using LISREL 8.80 and survey data from 101 OTs and 169 PTs, randomly selected by the Alberta professional licensing associations. Content analysis of responses to the open-ended comments section provided additional depth and insight. FINDINGS: Analysis of results culminated in minor modifications to the original theoretical model, creating separate PT and OT models. Both models revealed a good fit with the observed data. Several SAW concepts accounted for moderate to large amounts of variance in both PT and OT models, indicating that SAW is a comprehensive workplace outcome. RESEARCH LIMITATIONS/IMPLICATIONS: Theory was derived from business and nursing research literature due to limited rehabilitation research literature. Discussion of OT results must consider the small sample size. This study is initial exploratory research. PRACTICAL IMPLICATIONS: Each discipline-specific model provides professionals, health care leaders and policy makers with a rich body of information upon which to base beneficial workplace decisions. SAW will guide leaders in the holistic development and enrichment of the work environment. ORIGINALITY/VALUE: This research contributes to the substantive knowledge of the OT and PT disciplines, particularly in the areas of leadership, workplace structural organization and indicators of healthy work environments such as SAW, empowerment, job satisfaction and organizational commitment.

The utility of administrative data for surveillance of comorbidity in multiple sclerosis: a validation study.

BACKGROUND: Although comorbidity is important in multiple sclerosis (MS), few validated methods for its assessment exist. We validated and applied administrative case definitions for several comorbidities in MS. METHODS: Using provincial administrative data we identified persons with MS and a matched general population cohort. Case definitions for chronic lung disease (CLD), epilepsy, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and migraine were developed using administrative data, and validated against medical records. We applied these definitions to estimate the age-standardized prevalence of these comorbidities in the MS and matched cohorts. RESULTS: Versus medical records, administrative case definitions showed moderate agreement for CLD (ĸ = 0.41), migraine (ĸ = 0.51), and epilepsy (ĸ = 0.44), fair agreement for IBS (ĸ = 0.36) and could not be calculated for IBD (small sample size). The 2005 prevalence of CLD was similar in the MS (15.6%) and general populations (14.4%). The prevalence of the remaining comorbidities was higher in the MS than the general populations: epilepsy (4.12 vs. 1.12%), IBD (0.78 vs. 0.65%), IBS (12.2 vs. 6.80%) and migraine (23.0 vs. 16.5%). CONCLUSIONS: Administrative data are valid for tracking CLD, epilepsy, and migraine in MS. The prevalence of epilepsy, IBD, IBS and migraine is increased in MS versus the general population.

Mental comorbidity and multiple sclerosis: validating administrative data to support population-based surveillance.

BACKGROUND: While mental comorbidity is considered common in multiple sclerosis (MS), its impact is poorly defined; methods are needed to support studies of mental comorbidity. We validated and applied administrative case definitions for any mental comorbidities in MS. METHODS: Using administrative health data we identified persons with MS and a matched general population cohort. Administrative case definitions for any mental comorbidity, any mood disorder, depression, anxiety, bipolar disorder and schizophrenia were developed and validated against medical records using a a kappa statistic (k). Using these definitions we estimated the prevalence of these comorbidities in the study populations. RESULTS: Compared to medical records, administrative definitions showed moderate agreement for any mental comorbidity, mood disorders and depression (all k ≥ 0.49), fair agreement for anxiety (k = 0.23) and bipolar disorder (k = 0.30), and near perfect agreement for schizophrenia (k = 1.0). The age-standardized prevalence of all mental comorbidities was higher in the MS than in the general populations: depression (31.7% vs. 20.5%), anxiety (35.6% vs. 29.6%), and bipolar disorder (5.83% vs. 3.45%), except for schizophrenia (0.93% vs. 0.93%). CONCLUSIONS: Administrative data are a valid means of surveillance of mental comorbidity in MS. The prevalence of mental comorbidities, except schizophrenia, is increased in MS compared to the general population.

Traumatic injury and multiple sclerosis: a systematic review and meta-analysis.

A systematic review/meta-analysis of literature addressing a possible association between traumatic injury and onset of multiple sclerosis was conducted. Medline, Embase, Cochrane DSR, Ovid HealthStar, CINAHL, ISI Web of Science and Scopus were searched for analytical studies from 1950 to 2011. Two investigators independently reviewed articles for inclusion, assessing their quality using the Newcastle-Ottawa Scale. Of the 13 case-control studies included, 8 were moderate quality and 5 low; of the 3 cohort studies 2 were high and 1 moderate. Meta-analysis including moderate and low quality case-control studies produced a modest but significant odds ratio: 1.41 (95% confidence interval: 1.03, 1.93). However, when low quality studies were excluded, the resulting odds ratio was non-significant. Cohort studies produced a non-significant standardized incidence ratio of 1.00 (95% confidence interval: 0.86, 1.16). These findings support the conclusion that there is no association between traumatic injury and multiple sclerosis onset; more high quality cohort studies would help to confirm this observation.

The incidence and prevalence of multiple sclerosis in Nova Scotia, Canada.

BACKGROUND: Estimates of incidence and prevalence are needed to determine disease risk and to plan for health service needs. Although the province of Nova Scotia, Canada is located in a region considered to have a high prevalence of multiple sclerosis (MS), epidemiologic data are limited. OBJECTIVE: We aimed to validate an administrative case definition for MS and to use this to estimate the incidence and prevalence of MS in Nova Scotia. METHODS: We used provincial administrative claims data to identify persons with MS. We validated administrative case definitions using the clinical database of the province's only MS Clinic; agreement between data sources was expressed using a kappa statistic. We then applied these definitions to estimate the incidence and prevalence of MS from 1990 to 2010. RESULTS: We selected the case definition using ≥7 hospital or physician claims when >3 years of data were available, and ≥3 claims where less data were available. Agreement between data sources was moderate (kappa = 0.56), while the positive predictive value was high (89%). In 2010, the age-standardized prevalence of MS per 100,000 population was 266.9 (95% CI: 257.1- 277.1) and incidence was 5.17 (95% CI: 3.78-6.56) per 100,000 persons/year. From 1990-2010 the prevalence of MS rose steadily but incidence remained stable. CONCLUSIONS: Administrative data provide a valid and readily available means of estimating MS incidence and prevalence. MS prevalence in Nova Scotia is among the highest in the world, similar to recent prevalence estimates elsewhere in Canada.Incidence et prévalence de la sclérose en plaques en Nouvelle-Écosse, Canada.

Resonant leadership, workplace empowerment, and "spirit at work": impact on RN job satisfaction and organizational commitment.

Canadian researchers have developed the Spirit At Work (SAW) tool for identifying the experiences of individuals who are passionate about and energized by their work. This article describes (a) what registered nurses perceive as contributing to their personal SAW; and (b) the relationships among resonant leadership, structural empowerment concepts, psychological empowerment concepts, SAW concepts, job satisfaction, organizational commitment, and the demographic variables of experience, education, and rank in the RN workplace. The theoretical model was tested using LISREL 8.80 and survey data from 147 randomly selected RNs. Engaging work was found to account for 63% of the explained variance in the model's endogenous variables. Spiritual connection had a causal effect on organizational commitment, while resonant leadership and individual empowerment had significant causal influence on SAW, job satisfaction, and organizational commitment. These results strengthen those of previous studies reporting workplace structures/processes/contributions leading to superior care environments. Future studies will clarify the role of SAW in the workplace.

Rising prevalence of vascular comorbidities in multiple sclerosis: validation of administrative definitions for diabetes, hypertension, and hyperlipidemia.

BACKGROUND: Despite the importance of comorbidity in multiple sclerosis (MS), methods for comorbidity assessment in MS are poorly developed. OBJECTIVE: We validated and applied administrative case definitions for diabetes, hypertension, and hyperlipidemia in MS. METHODS: Using provincial administrative data we identified persons with MS and a matched general population cohort. Case definitions for diabetes, hypertension, and hyperlipidemia were derived using hospital, physician, and prescription claims, and validated in 430 persons with MS. We examined temporal trends in the age-adjusted prevalence of these conditions from 1984-2006. RESULTS: Agreement between various case definitions and medical records ranged from kappa (κ) =0.51-0.69 for diabetes, κ =0.21-0.71 for hyperlipidemia, and κ =0.52-0.75 for hypertension. The 2005 age-adjusted prevalence of diabetes was similar in the MS (7.62%) and general populations (8.31%; prevalence ratio [PR] 0.91; 0.81-1.03). The age-adjusted prevalence did not differ for hypertension (MS: 20.8% versus general: 22.5% [PR 0.91; 0.78-1.06]), or hyperlipidemia (MS: 13.8% versus general: 15.2% [PR 0.90; 0.67-1.22]). The prevalence of all conditions rose in both populations over the study period. CONCLUSION: Administrative data are a valid means of tracking diabetes, hypertension, and hyperlipidemia in MS. The prevalence of these comorbidities is similar in the MS and general populations.

The incidence and prevalence of thyroid disease do not differ in the multiple sclerosis and general populations: a validation study using administrative data.

BACKGROUND: Prior studies of a possible increased risk of autoimmune thyroid disease (AIT) in multiple sclerosis (MS) are inconsistent. We aimed to validate and apply administrative case definitions for the surveillance of AIT in MS. METHODS: We used administrative health data to identify 4,192 persons with MS and an age-, sex- and geographically matched general population cohort (n = 20,940). We developed case definitions for AIT using International Classification of Disease-9/10 codes and prescription claims, compared them to medical records and applied them to estimate the incidence and prevalence of AIT. RESULTS: When compared to medical records, the administrative case definition using ≥1 hospital or ≥2 physician or ≥2 prescription claims had a sensitivity of 73.5% and specificity of 98.4%. In 2005, the age-adjusted prevalence of AIT was 9.51% [95% confidence interval (CI) 8.46-10.6] in the MS population and 8.56% (95% CI 8.11-9.02) in the general population. The age-adjusted incidence of AIT per 100,000 persons per year was 422.8 (95% CI 204.4-641.3) in the MS population and 407.7 (95% CI 308.5-506.9) in the general population. From 1996 to 2005, the prevalence of AIT rose in both populations. CONCLUSION: Administrative data can be used for surveillance of AIT in MS. The incidence and prevalence of thyroid disease are similar in the MS and general populations.

Caller self-care decisions following teletriage advice.

AIM: To examine caller self-care decisions following teletriage advice provided by nurses. BACKGROUND: The use of teletriage is gaining popularity as one way of enhancing capacity for self-care. Research from several countries suggests that teletriage reduces the use of other healthcare services without compromising safety. However, there is little or no research related to how often self-care advice is provided and whether or not callers follow the advice. DESIGN: A descriptive survey design was used with a random sample of 312 callers who were advised by a teletriage nurse to engage in self-care. METHOD: Callers were randomly selected from all calls to a teletriage service each day of the month for nine months. Data were collected using a researcher-developed interview guide and analysed using a variety of inferential statistics for forced choice questions and content analysis for open-ended questions. RESULTS: The majority of callers who were advised to engage in self-care reported doing so. Callers with greater self-efficacy and satisfaction with the nurse interaction were more likely to follow advice to self-care. All callers would call the teletriage service again for the same or a different issue. CONCLUSION: Teletriage callers were confident in the advice provided and were willing to continue to use the service. RELEVANCE TO CLINICAL PRACTICE: This study indicates that teletriage programmes are a cost-effective way of addressing self-care needs of individuals who might otherwise visit an emergency department.

Head and cervical posture in patients with temporomandibular disorders.

AIM: To determine whether patients with myogenous or mixed (ie, myogeneous plus arthrogeneous) temporomandibular disorders (TMD) had different head and cervical posture measured through angles commonly used in clinical research settings when compared to healthy individuals. METHODS: One hundred fifty-four persons participated in this study. Of these, 50 subjects were healthy, 55 subjects had myogenous TMD, and 49 subjects had mixed TMD (ie, arthrogenous plus myogenous TMD). A lateral photograph was taken with the head in the self-balanced position. Four angles were measured in the photographs: (1) Eye-Tragus-Horizontal, (2) Tragus-C7-Horizontal, (3) Pogonion-Tragus-C7, and (4) Tragus-C7-Shoulder. Alcimagen software specially designed to measure angles was used in this study. All of the measurements were performed by a single trained rater, a dental specialist in orthodontics, blinded to each subject's group status. RESULTS: The only angle that reached statistical significance among groups was the Eye-Tragus-Horizontal (F = 3.03, P = .040). Pairwise comparisons determined that a mean difference of 3.3 degrees (95% confidence intervals [CI]: 0.15, 6.41) existed when comparing subjects with myogenous TMD and healthy subjects (P = .036). Postural angles were not significantly related to neck disability, jaw disability, or pain intensity. Intrarater and interrater reliability of the measurements were excellent, with intraclass correlation coefficient (ICC) values ranging between 0.996-0.998. CONCLUSION: The only statistically significant difference in craniocervical posture between patients with myogenous TMD and healthy subjects was for the Eye-Tragus-Horizontal angle, indicating a more extended position of the head. However, the difference was very small (3.3 degrees) and was judged not to be clinically significant.

Is maximal strength of the cervical flexor muscles reduced in patients with temporomandibular disorders?

OBJECTIVE: To determine whether there was a difference in maximal cervical flexor muscle strength in subjects with temporomandibular disorders (mixed and myogenous) compared with healthy subjects. DESIGN: Cross-sectional study. SETTING: Orthopedics/sports laboratory at the University of Alberta. PARTICIPANTS: Subjects (N=149) of whom 50 were healthy, 54 had myogenous temporomandibular disorders (TMD), and 45 had mixed TMD. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximal cervical flexor strength, pain. RESULTS: There was no statistically significant difference in maximal cervical flexor strength among groups (P>.05). Subjects' body weight was significantly associated with strength. No significant association between jaw disability with maximal cervical flexor strength was found. A significant but weak association between neck disability and maximal cervical flexors strength was found. CONCLUSIONS: These results indicated that strength evaluation is one of several assessment factors that need to be addressed when evaluating musculoskeletal painful conditions such as TMD and neck disorders, but strength evaluation cannot be considered as a direct measure of disability. Future studies should explore evaluation of strength in other muscular groups such as cervical extensors, rotators, and lateral flexors, and also under different conditions such as rapid movements, and in patients with more severe jaw disability.

The relationship between structural empowerment and psychological empowerment for nurses: a systematic review.

AIM: To describe the findings of a systematic review examining the relationship between structural empowerment and psychological empowerment for registered nurses (RNs). BACKGROUND: Workplace empowerment research reveals a link between empowerment and positive work behaviours and attitudes. Research demonstrating the essential relationship between structural empowerment and psychological empowerment will provide direction for future interventions aimed at the development of a strong and effective health care sector. METHODS: Published research articles examining structural empowerment and psychological empowerment for nurses were selected from computerized databases and selected websites. Data extraction and methodological quality assessment were completed for the included research articles. RESULTS: Ten papers representing six studies reveal significant associations between structural empowerment and psychological empowerment for RNs. IMPLICATIONS FOR NURSING MANAGEMENT: Creation of an environment that provides structural empowerment is an important organizational strategy that contributes to RNs' psychological empowerment and ultimately leads to positive work behaviours and attitudes. Critical structural components of an empowered workplace can contribute to a healthy, productive and innovative RN workforce with increased job satisfaction and retention.

National Human Resources Survey of Clinical Neurophysiologists in Canada.

BACKGROUND: Although electromyography (EMG), electroencephalography (EEG) and evoked potential (EP) studies are common investigation tools for patients with neurologic illnesses, no formal data on the manpower supply in Canada exists. Because of the importance of these on training requirements and future planning, the purpose of this study was to establish a comprehensive profile of the human resources situation in clinical neurophysiological services across Canada. METHODS: A questionnaire was sent to all clinical neurophysiologists in Canada. To capture the maximal number of respondents, a total of three rounds of mail out were done. In addition, to obtain accurate demographic data on supporting technologists, a separate survey was also carried out by the Association of Electrophysiological Technologists of Canada. RESULTS: Of the 450 clinical neurophysiologists identified and surveyed, the provincial response rate was 59 +/- 14% (mean +/- SD). Of these, the vast majority practiced in urban centres. There was substantial regional disparity in different provinces. While the wait time for most EEG and EP laboratories was less than six weeks, the wait time for EMG was substantially longer. With the age of the largest number of practitioners in their sixth decade, projected retirement over the next 15 years was 58%. The demographic distribution of the supporting technologists showed a similar trend. CONCLUSIONS: In addition to considerable regional disparity and urban/rural divide, a large percentage of clinical neurophysiologists and supporting technologists planned to retire within the coming decade. To ensure secure and high standard services to Canadians, solutions to fill this void are urgently needed.

The use of complementary and alternative medicine (CAM) by Canadian occupational therapists.

The purpose of this study was to describe the proportion of occupational therapists currently using complementary and alternative medicine (CAM), or providing referrals to CAM practitioners, as well as the purposes of use/referral in one Canadian region. A questionnaire survey on CAM was sent through e-mail and post to 1123 Canadian occupational therapists. Content, construct and face validity, as well as response, desirability/social, and instrument bias were considered and controlled through study design. A response rate of 17.1% was achieved. Overall, 31.2% of respondents have used at least one form of CAM, with 5.5% using > 1 form of CAM. Purposes for use focused on the treatment of symptoms. Reasons preventing CAM's use included lack of training (82.4%), interest (23%) and/or supporting evidence (22.3%). Considerations of incorporating CAM into occupational therapy focused on a client-centred and holistic approach to treatment (43-63.3%), ranking above legal/employer-related aspects (43-43.6%). Elaborations of negative responses indicated that further supporting evidence on forms of CAM and related research may result in changes of opinion. Therefore, further research on the use of CAM is needed, allowing for evidence-based decisions to be made.

Medicine-related questions handled by community pharmacists: an exploratory study.

OBJECTIVES: The objectives of this study were to determine what type of medicine-related questions community pharmacists were asked and to ascertain whether responses given were appropriate. METHODS: All community pharmacists from three Primary Care Trusts were invited to participate in a week-long exploratory study. Piloted data-collection forms were self-completed. Data were analysed descriptively using Microsoft Excel and statistical tests conducted with Minitab. KEY FINDINGS: Sixty-six medicines-related questions were answered by participating pharmacists. The type of questions asked were varied and asked by patients, the general public and health care professionals. Most answers (over 80%) were assessed as being appropriate; only four questions raised concern with assessors that possible patient harm may have resulted. Almost half (42%) of the questions were answered without consultation to any reference source. CONCLUSIONS: Despite the small-scale nature of the study the findings show that community pharmacists provide a good-quality service that is easily accessible to all people. However, the failure to use reference sources may impact on pharmacists' ability to answer medicine-related questions fully.

The burden of multiple sclerosis: a community health survey.

BACKGROUND: Health-related quality of life (HRQL) in persons with multiple sclerosis (MS) who reside within the community relative to the general population is largely unknown. Data from the Canadian Community Health Survey Cycle 1.1 (CCHS 1.1) were used to compare HRQL of persons with MS and the general population. METHODS: A representative sample of adults (18 years or older) from the cross sectional population health survey, CCHS 1.1, was examined to compare scores on the Health Utilities Index Mark 3 (HUI3), a generic preference-based HRQL measure, of respondents with (n = 302) and without (n = 109,741) MS. Selected sociodemographic covariates were adjusted for in ANCOVA models. Normalized sampling weights and bootstrap variance estimates were used in the analysis. RESULTS: The mean difference in overall HUI3 scores between respondents with and without MS was 0.25 (95% CI: 0.20, 0.31); eight times greater than the clinically important difference. The largest differences in scores were seen with the ambulation (0.26; 95% CI: 0.20, 0.32) and pain attributes (0.14; 95% CI: 0.09, 0.19). Clinically important differences with dexterity and cognition were also observed. CONCLUSION: While the proportion of the Canadian population with MS is relatively small in comparison to other diseases, the magnitude of the burden is severe relative to the general population.

Effects of physical comorbidities on disability progression in multiple sclerosis.

OBJECTIVE: To examine the association between physical comorbidities and disability progression in multiple sclerosis (MS). METHODS: We conducted a retrospective cohort study using linked health administrative and clinical databases in 2 Canadian provinces. Participants included adults with incident MS between 1990 and 2010 who entered the cohort at their MS symptom onset date. Comorbidity status was identified with validated algorithms for health administrative data and was measured during the 1 year before study entry and throughout the study period. The outcome was the Expanded Disability Status Scale (EDSS) score as recorded at each clinic visit. We used generalized estimating equations to examine the association between physical comorbidities and EDSS scores over time, adjusting for sex, age, cohort entry year, use of disease-modifying drugs, disease course, and socioeconomic status. Meta-analyses were used to estimate overall effects across the 2 provinces. RESULTS: We identified 3,166 individuals with incident MS. Physical comorbidity was associated with disability; with each additional comorbidity, there was a mean increase in the EDSS score of 0.18 (95% confidence interval [CI] 0.09-0.28). Among specific comorbidities, the presence of ischemic heart disease (IHD) or epilepsy was associated with higher EDSS scores (IHD 0.31, 95% CI 0.01-0.61; epilepsy 0.68, 95% CI 0.11-1.26). CONCLUSIONS: Physical comorbidities are associated with an apparent increase in MS disability progression. Appropriate management of comorbidities needs to be determined to optimize outcomes.

Diagnoses of Depression and Anxiety Versus Current Symptoms and Quality of Life in Multiple Sclerosis.

BACKGROUND: Studies assessing the prevalence of depression and anxiety in multiple sclerosis (MS) have used various ascertainment methods that capture different constructs. The relationships between these methods are incompletely understood. Psychiatric comorbidity is associated with lower health-related quality of life (HRQOL) in MS, but the effects of past diagnoses of depression and anxiety on HRQOL are largely unknown. We compared the prevalence of depression and anxiety in persons with MS using administrative data, self-reported physician diagnoses, and symptom-based measures and compared characteristics of persons classified as depressed or anxious by each method. We evaluated whether HRQOL was most affected by previous diagnoses of depression or anxiety or by current symptoms. METHODS: We linked clinical and administrative data for 859 participants with MS. HRQOL was measured by the Health Utilities Index Mark 3. We classified participants as depressed or anxious using administrative data, self-reported physician diagnoses, and the Hospital Anxiety and Depression Scale. Multivariable linear regression examined whether diagnosed depression or anxiety affected HRQOL after accounting for current symptoms. RESULTS: Lifetime prevalence estimates for depression were approximately 30% regardless of methods used, but 35.8% with current depressive symptoms were not captured by either administrative data or self-reported diagnoses. Prevalence estimates of anxiety ranged from 11% to 19%, but 65.6% with current anxiety were not captured by either administrative data or self-reported diagnoses. Previous diagnoses did not decrease HRQOL after accounting for current symptoms. CONCLUSIONS: Depression and, to a greater extent, anxiety remain underdiagnosed and undertreated in MS; both substantially contribute to reduced HRQOL in MS.