Relapsing-remitting multiple sclerosis understanding the disability-depression connection

Abstract

Depression is a frequent comorbidity in Multiple Sclerosis (MS), significantly affecting cases’ quality of life and adherence to treatment. Relapsing-Remitting MS (RRMS), the most prevalent subtype of MS, is notably linked to psychiatric symptoms and impaired functioning resulting from physical disability. This study aimed to assess the relationship between disability severity and depression in RRMS cases, considering neurological symptoms and sociodemographic factors. A cross-sectional study was conducted at the Neuropsychiatry Inpatient and Outpatient MS Clinic, Benha University Hospital, from October to April 2025. Thirty patients with relapsing-remitting multiple sclerosis (RRMS) and 30 age- and sex-matched healthy controls were recruited. Inclusion criteria for RRMS patients were age 18–60 years and diagnosis according to the 2024 Revised McDonald Criteria; participants with significant psychiatric, neurological, or medical comorbidities were excluded. All participants underwent a detailed neuropsychiatric evaluation, including the Expanded Disability Status Scale (EDSS), Beck Depression Inventory-II (BDI-II), and Columbia-Suicide Severity Rating Scale (C-SSRS). Data were analyzed using SPSS v28; quantitative variables were compared with t-tests or ANOVA, categorical variables with Chi-square or Fisher’s exact test, and correlations were assessed using Spearman’s coefficient. Multivariate logistic regression was used to identify predictors of moderate-to-severe depression and suicidal ideation, with P < 0.05 considered significant. Depression was significantly elevated in MS cases than controls (P = 0.001). Moderate to very severe depression affected 73.3% of cases versus 23.3% of controls. Elevated EDSS scores were associated with greater depression severity (median EDSS: 2 vs. 0, P = 0.013). Visual (P = 0.031) and sensory symptoms (P = 0.046) were significantly linked to depression. Multivariate analysis identified EDSS as an independent predictor of moderate to severe depression (OR = 3.869, P = 0.042), while sociodemographic factors were not significant. Elevated disability levels in RRMS cases are significantly associated with increased depression severity, particularly in those with visual and sensory symptoms. Addressing disability-related psychological distress is essential for improving mental health outcomes in MS.