The role of affect on the perception of disability in multiple sclerosis

Objective: To determine the prevalence of depression in multiple sclerosis in the community and to assess how the presence of depression affects patients' perception of their disability. Design: Consecutive case series, Setting: The study was carried out at a regional multiple sclerosis (MS) clinic. Subjects: Eighty-eight patients with MS. Main outcome measures: Patients were asked to complete the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Rankin Scale of Disability/Handicap (completed by patient and physician to assess relative perceived disability) and two visual analogue scales (coping ability and perceived service adequacy). Results: Thirty-nine per cent were case level for depression using the BDI criteria of Sullivan; 17% were case level for depression (34% borderline case) and 34% case level for anxiety on HADS, Depressed patients using both BDI and HADS criteria were three times more likely than nondepressed patients to perceive their disability as being greater than the physicians' perception (p < 0.001). Conclusion: Depression is common in MS and adversely affects patients' perception of their disability.