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In the article “Disability worsening among patients with multiple sclerosis and depression: A Swedish cohort study,” Dr. Binzer et al. explored the risk of disability worsening associated with depression in a nationwide longitudinal cohort of patients with multiple sclerosis (MS) using linked data from 3 Swedish registries (5,875 cases when using one set of criteria and 3,817 using another set). They found that persons with MS and comorbid depression had a higher risk of disability worsening, highlighting the need for early recognition and appropriate treatment of depression in this population. In response, Drs. Bsteh and Berge cite their previous study reporting that depression was an independent marker of long-term disability severity in MS. They contend that their Innsbruck MS database captures 96% of MS patients in Western Austria as compared to the Swedish registries capturing 34% of patients with MS in Sweden and that their definition of depression was more rigorously defined by a predetermined set of clinical symptoms. They caution against considering different definitions of depression to be equivalent. Responding to these comments, the authors disagree that the studies are very different with regards to capture rate, pointing out that their initial pool of 15,558 patients represented an 89% initial capture rate for patients with MS in Sweden and attributing the smaller final population to the inclusion/exclusion criteria and study time frame. They also contend that the final sample in the study by Dr. Bsteh and colleagues had a capture rate of closer to 40% and identify various methodological differences between the studies that make side-by-side comparison challenging. This exchange highlights the debates and complexities that can arise from different neuroepidemiological approaches, particularly when examining psychiatric manifestations of diseases such as multiple sclerosis.
In the article “Disability worsening among patients with multiple sclerosis and depression: A Swedish cohort study,” Dr. Binzer et al. explored the risk of disability worsening associated with depression in a nationwide longitudinal cohort of patients with multiple sclerosis (MS) using linked data from 3 Swedish registries (5,875 cases when using one set of criteria and 3,817 using another set). They found that persons with MS and comorbid depression had a higher risk of disability worsening, highlighting the need for early recognition and appropriate treatment of depression in this population. In response, Drs. Bsteh and Berge cite their previous study reporting that depression was an independent marker of long-term disability severity in MS. They contend that their Innsbruck MS database captures 96% of MS patients in Western Austria as compared to the Swedish registries capturing 34% of patients with MS in Sweden and that their definition of depression was more rigorously defined by a predetermined set of clinical symptoms. They caution against considering different definitions of depression to be equivalent. Responding to these comments, the authors disagree that the studies are very different with regards to capture rate, pointing out that their initial pool of 15,558 patients represented an 89% initial capture rate for patients with MS in Sweden and attributing the smaller final population to the inclusion/exclusion criteria and study time frame. They also contend that the final sample in the study by Dr. Bsteh and colleagues had a capture rate of closer to 40% and identify various methodological differences between the studies that make side-by-side comparison challenging. This exchange highlights the debates and complexities that can arise from different neuroepidemiological approaches, particularly when examining psychiatric manifestations of diseases such as multiple sclerosis.
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- © 2020 American Academy of Neurology
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