Psychiatric co-morbidity in multiple sclerosis: The risk of depression and anxiety before and after MS diagnosis.

BACKGROUND: Studies of depression and anxiety in multiple sclerosis (MS) patients have reported higher rates in MS patients than the general population. OBJECTIVE: To estimate the risk of depression and anxiety and the use of tricyclic antidepressant and selective serotonin reuptake inhibitors (SSRI) prescriptions, in the pre-diagnostic and the post-diagnostic period of MS compared to the background population. METHODS: A cohort of 5084 MS patients was included and matched with a control population of 24,771 persons linked to nationwide registers. Logistic regression analyses were performed estimating odds ratios (OR). RESULTS: In the pre-diagnostic period, the OR for having a diagnosis of depression and anxiety is 1.4 (95% confidence interval (CI) =1.05-1.88), and the OR of redemption prescriptions of TCAs is 1.90 (CI=1.54-2.34) and OR is 1.34 (CI= 1.20-1.51) for SSRI. In the post-diagnostic period the OR is 1.23 (CI= 0.92-1.64) for depression and anxiety diagnosis. The OR is 6.70 (CI=5.81-7.72) for TCA and OR is 2.46 (CI= 2.25-2.69) for SSRI. CONCLUSION: During both the pre- diagnostic and post-diagnostic period, MS patient have increased risk of depression and anxiety diagnoses and redemption of antidepressant and anxiolytic prescriptions, compared to the background population.

[Disability retirement pension for patients with syndrome diagnoses. A registry study on the basis of data from the Social Appeal Board]. / Førtidspension til patienter med syndromesygdomme. En registerundersøgelse på basis of oplysninger fra Den Sociale Ankestyrelse.

INTRODUCTION: Since the early 1990s, disability retirement pension may be granted on the basis of a syndrome diagnosis. Before the pension can be granted, local public authorities collect information on health and social matters and report to The Social Appeal Board. In 1998, a new diagnostic tool was introduced based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnoses. The information available in The Social Appeal Board has made it possible to study the social consequences of a syndrome diagnosis. The purpose of the study was: 1) To estimate the incidence of patients granted disability retirement pension with the diagnoses whiplash, fibromyalgia, chronic pain disorder, chronic fatigue syndromee, chronic strain syndromee, and pelvic syndromee. 2) To estimate changes in the level of pension granted to patients with syndromee diagnosis. 3) To compare differences between patients with syndromee diagnosis granted disability retirement pension to patients with other diagnoses on the following parameters: sex, civil status, income when applying for pension, and attempts of rehabilitation. 4) To estimate comorbidity of psychiatric diagnosis in patients with syndromee diagnosis. MATERIAL AND METHODS: A register study of data on pension reported to The National Social Appeal Board in the period July 1st 1998 to December 31st, 2000. RESULTS: Of all patients granted pension in the period 8.3 per cent had a syndromee diagnosis, 11 per cent of the women and 5 per cent of the men. Both the relative and the absolute number of patients with syndromee diagnosis granted a pension were increasing. Comorbidity of psychiatric disorders was 3 per cent in the group with syndromee diagnosis. More patients with syndromee diagnosis than with other diagnoses had received sickness benefits and rehabilitation when pension was granted. DISCUSSION: The large number of patients with syndromee diagnosis granted pension calls for multidisciplinary prophylactic and treatment initiatives in order to reduce the number of patients in need of public support. The results are discussed in view of the new Pension's Act which will become effective as from January 1st, 2003.