Key result
MS with comorbid depression linked to ~5-fold greater 10-year mortality risk versus controls without depression.
Why the study?
It was unclear whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis compared with matched controls.
Does comorbid depression increase the risk of incident vascular disease and mortality in people with multiple sclerosis compared to matched controls?
Cohort (n=84,823)
Does comorbid depression increase the risk of incident vascular disease and mortality in people with multiple sclerosis compared to matched controls?
Hazard Ratio: 5.43 (95% CI 4.88–5.96)
Depression and multiple sclerosis have a synergistic effect on increasing the risk of all-cause mortality and incident vascular disease.
BACKGROUND AND OBJECTIVES: To assess whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis (MS) compared with age-, sex-, and general practice-matched controls. METHODS: We conducted a population-based retrospective matched cohort study between January 1, 1987, and September 30, 2018, that included people with MS and matched controls without MS from England, stratified by depression status. We used time-varying Cox proportional hazard regression models to test the association among MS, depression, and time to incident vascular disease and mortality. Analyses were also stratified by sex. RESULTS: We identified 12,251 people with MS and 72,572 matched controls. At baseline, 21% of people with MS and 9% of controls had depression. Compared with matched controls without depression, people with MS had an increased risk of incident vascular disease regardless of whether they had comorbid depression. The 10-year hazard of all-cause mortality was 1.75-fold greater in controls with depression (95% confidence interval [CI] 1.59-1.91), 3.88-fold greater in people with MS without depression (95% CI 3.66-4.10), and 5.43-fold greater in people with MS and depression (95% CI 4.88-5.96). Overall, the interaction between MS status and depression was synergistic, with 14% of the observed effect attributable to the interaction. Sex-stratified analyses confirmed differences in hazard ratios. DISCUSSION: Depression is associated with increased risks of incident vascular disease and mortality in people with MS, and the effects of depression and MS on all-cause mortality are synergistic. Further studies should evaluate whether effectively treating depression is associated with a reduced risk of vascular disease and mortality.
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Palladino et al. (2021) conducted a cohort in Multiple Sclerosis and Depression (n=84,823). Multiple sclerosis with comorbid depression vs. Matched controls without depression was evaluated on All-cause mortality (HR 5.43, 95% CI 4.88-5.96). Multiple sclerosis with comorbid depression was associated with a 5.43-fold greater 10-year hazard of all-cause mortality compared to controls without depression (95% CI 4.88-5.96).
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