Assessment of depression in patients with motor neuron disease and other neurologically disabling illness

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Abstract

Motor neuron disease (MND) is a severely disabling, relentlessly progressive neurological condition with a marked reduction in life expectancy which might be expected to be associated with significant depression and psychological dysfunction following diagnosis. There is very little data on the incidence of depression in MND and most of the published evidence would suggest that depression is rare in patients with MND, especially when compared to other neurologically disabling illnesses. We have studied 40 patients with MND and compared them to a group of 92 patients with multiple sclerosis (MS) attending a neurology clinic. Depression was assessed using the Beck Depression Index (BDI) and the Hospital Anxiety and Depression Scale (HAD). There was no difference in incidence or severity of depression in these two patient groups. For the whole study group there was no difference in depression scores when compared by age, gender or marital status. Depression scores showed a weak association with increasing physical disability measured by the SF36 Physical Function scale for the MS group but there was no association between depression levels and SF36 physical function for the MND group. The MND group did, however, show a significant association between depression scores and pain measured by the SF36 scale. Anxiety levels (HAD scale) were shown to be significantly higher in females and married (versus single, widowed or divorced) subjects for the group as a whole. We conclude that depression is at least as common in MND patients as other neurologically disabled patients with MS and may often be associated with significant pain. Physicians and others involved in the care of patients with MND should be aware that depression and pain may be significant problems irrespective of the level of physical disability.

Introduction

Motor neuron disease (MND) is a severely disabling, relentlessly progressive neurological condition with a marked reduction in life expectancy. As such it might be expected that many patients diagnosed with this disorder would exhibit significant depression and other disturbances of mental health. We have noted in our previous studies (Young et al., 1992Young et al., 1995), using the SF36 mental health scales, and also anecdotally in clinics, that significant depression appears to be rare in patients suffering from MND. There is a very limited amount of data on the incidence of depression in MND but most studies suggest the incidence of depression is low. Bak et al. (1994)noted a reduced rate of suicide amongst patients with MND, although the level was not statistically significant in a small study. In a much earlier paper describing 42 patients with MND, Newrick and Langton Hewer (1984)noted that “appreciable depression was notably absent” (p. 540). More recently, in a survey assessing the psychological impact of MND in 59 patients, Hogg et al. (1994)did find that 44% of patients with MND could be classified as depressed.

To investigate the incidence of depression in MND and compare it with other disabling neurological conditions, patients attending the neurological disability clinic at the Walton Centre for Neurology and Neurosurgery over a 9-month period were assessed for levels of depression. Questionnaires were administered by the consultant medical staff or the health psychologist supporting the clinic. Patients with MS attending the same clinic were also recruited to the study to allow a comparison of the incidence of depression in the two groups. The patients attending the disability clinic usually have definite diagnoses and are broadly representative of disabled MND and MS patients as a whole. However, complete case ascertainment of all patients with either MND or MS was not undertaken and therefore the data presented here is not a true prevalence or incidence study.

Section snippets

Methods

The purpose of this study was to compare mental health characteristics across different diagnostic groups, therefore generic rather than diagnostic specific questionnaires were used. Depression was assessed using two widely accepted scales; the Beck Depression Inventory (BDI) (Beck et al., 1961) and the Hospital Anxiety Depression Scale (HAD) (Zigmond and Snaith, 1983). The Medical Outcomes Study SF36 questionnaire developed by John Ware and colleagues (Ware and Sherbourne, 1992) was used to

Results

There were 40 patients with MND (28 male, 12 female, mean age 63.9 years, S.D. 12.7 years), and 92 patients with MS (25 male, 67 female, mean age 45.7 years, S.D. 10.9 years). The gender ratio and age profile are different for the two groups but reflect their different population substrates. Mean Barthel scores were lower in the MND Group than for the MS group (64 vs. 71) but the difference was not statistically significant. (The maximum Barthel score is 100 and represents full self care). The

Discussion

The two generic measures of depression, BDI and HAD (depression), showed significant correlation between patient scores but each measure contained questions that may artificially elevate depression scores in patients with physical disabilities.

In our population there was no significant difference between depression scores for neurologically disabled groups of patients with either MS or MND. Whilst no patients in the MND group had severe depression, depression appears to be at least as common in

Acknowledgements

We would like to acknowledge the help provided by Dr Stephen Smith and the MND association case workers Susheela Lourie and Sue Taylor for their help in collecting the data.

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