Anxiety and Depression in Multiple Sclerosis (MS): A Longitudinal and Cross-Sectional Study Using HADS, Demographics, and Clinical Data from the UK MS Register

Abstract

Aim: to examine the prevalence, course, and predictors of anxiety and depression in people with MS using longitudinal data from the UK MS Register (UKMSR).

Methods: The study involved 12,395 participants who submitted 96,939 repeated evaluations on the Hospital Anxiety and Depression Scale (HADS) from 2011 to 2023. Descriptive statistics compiled baseline, most recent, mean-per-participant, and peak scores across multiple sclerosis subtypes (RRMS, SPMS, PPMS). At baseline, correlations between HADS-A and HADS-D were analysed. We used linear mixed-effects models to look at how symptoms changed over time while taking into account gender, age at diagnosis, education, employment status, and disease duration.

Results: Depression increased gradually over time (+0.14 points/year, p < 0.001), whereas anxiety declined (−0.04/year, p < 0.001). At baseline, nearly half of the participants scored in the clinical range, with 50.9% above the cut-off for anxiety and 40.5% above the cut-off for depression. More than 70% of participants crossed the clinical cut-off (≥8) at least once during follow-up. Severe depression was most frequent in progressive forms (PPMS 17.3%, SPMS 14.5%), while severe anxiety was more common in RRMS (20.9%) during the follow-up. Anxiety and depression were strongly correlated at baseline (ρ = 0.61). After adjustment, subtype effects weakened, and education and employment emerged as the strongest predictors: being sick or disabled was associated with +3.3 points for depression and +1.8 for anxiety compared with those in active work, while postgraduate education predicted lower scores (−1.3, −1.4, respectively).

Conclusion: Anxiety and depression are common in MS, but they change in opposite ways over time. Social determinants, especially education and employment, accounted for greater variance than MS subtype, highlighting the necessity for integrated psychosocial support in MS care.