Social Anxiety Among Patients with Multiple Sclerosis: A Population-Based

Controlled Study in Ecuador

Joyce Jiménez-Zambrano, MD,1,2 Roberto Rodríguez-Díaz, MD,2,3 María Gabriela Acuña-Chong, MD.2,3
1
Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador; 2Department of Neurology, Hospital Teodoro Maldonado Carbo, Guayaquil, Ecuador; 3Universidad Estatal de Guayaquil, Guayaquil, Ecuador

INTRODUCTION RESULTS • We found significant and moderate correlations between SPIN and DASS-21-Depression, DASS-
21-General Anxiety and DASS-21-Stress scores; however, there was not a significant correlation
What is multiple sclerosis? The mean age in the MS group was 41.9 + 13.7 and it was 41.4 + 13.2 years for the control group between the neurologic disability measured by the EDSS and SPIN scores. DASS-21-
(P = 0.85). The frequency of distribution of sex, civil status, social habits (alcohol and tabaco) and Depression scores were significant correlated with neurologic disability.
Multiple sclerosis (MS) is an autoimmune degenerative disease of the central nervous system education in the 2 groups of MS and GP did not differ significantly (P > 0.05). The results showed
linked to significant behavioral and emotional sequelae. that there was a significant difference in employment status between the two groups (P = 0.003).
MS and psychiatric comorbidities
• Neuropsychiatric symptoms, such as depression and anxiety, are common in patients with MS, Table 1. DASS and SPIN scores of MS patients and general population CONCLUSIONS
and they have important implications for functioning and quality of life.
MSP (n = 50) GP (n = 50) OR (95% CI) P value
• Social anxiety disorder (SAD), also known as social phobia, is a chronic, disabling disorder in
which patients suffer with considerable morbidity that often precedes the development of other DASS, n (%) • To the best of our knowledge, the current investigation is the first epidemiological study to
psychiatric disorders. • Depression compare rates of social anxiety and coexisting psychiatric comorbid disorders with a sample of
Normal/mild 31 (62%) 43 (86%) 3.76 (1.41-10.1) 0.006* multiple sclerosis patients and the general population. Patients with MS had a higher risk of
• In this study we focused on assessing the prevalence of SAD in patients with MS, and its Moderate/severe 19 (38%) 7 (14%) presenting social anxiety symptoms than a matched control group in a Hispanic population.
association with psychiatric comorbidities such as depression, general anxiety and stress, and • Stress
we established a comparison between MS patients and the general population in Ecuador. Normal/mild 30 (60%) 40 (80%) 2.67 (1.09 - 6.52) 0.029*
• This condition is unrelated to neurological disability and subtype of MS, but it is associated with
Moderate/severe 20 (40%) 10 (20%) coexisting psychiatric comorbidities.
• General anxiety • These factors should be considered simultaneously when evaluating the effects of treatments in
OBJECTIVES Normal/mild
Moderate/severe
23 (46%)
27 (54%)
40 (80%)
10 (20%)
4.70 (1.93 - 11.4) <0.001*
this population.
SPIN, n (%)
• Social Anxiety
To analyze the prevalence of social phobia and other psychiatric comorbidities, such as SPIN < 19 34 (68%) 47 (94%) 7.37 (1.99 - 27.3) <0.001*
depression, general anxiety, and stress, in MS patients compared to matched controls. SPIN > 19
*P value is < 0.05
16 (32%) 3 (6%)
FUTURE RESEARCH
METHODS MSP, Multiple Sclerosis Patients; GP, General Population; CI, Confidence Interval; DASS, Depression Anxiety and
Stress Scales; SPIN, Social Phobia Inventory
• Future studies are required to determine the effects of receiving psychological therapy on the
rate of improving quality of life in people with multiple sclerosis.
SUBJECTS Figure 1. Spearman correlation coefficients between DASS-21, SPIN and EDSS on MS
• Not only depression, but also social anxiety, general anxiety and stress should be studied as a
• A total of 50 patients with confirmed diagnose of MS seen in a large safety net hospital and 50 population
potential risk for relapses and neurological disability progression.
sex- and age- matched participants from the general population (GP) during November 2018 –
June 2019 were invited to participate in this study.
• Confidentiality and anonymity were assured.
* REFERENCES
TOOLS
• Social Phobia Inventory (SPIN), Depression, Anxiety and Stress Scale – 21 (DASS-21), * 1. Dobson R, et al. Multiple Sclerosis - a review. Eur J Neurol. 2018
Expanded disability Status Scale (EDSS). 2. José Sá M. Psychological aspects of multiple sclerosis. Clin Neurol Neurosurg 2008;110:868–
877.
• Sociodemographic data sheet and clinical history including age, gender, social habits and MS
3. Poder K, et al. Social anxiety in a multiple sclerosis clinic population. Mult Scler. 2009
history. * * * Mar;15(3):393-8.
DATA ANALYSIS 4. Lecrubier Y. Comorbidity in social anxiety disorder: impact on disease burden and
management. J Clin Psychiatry. 1998;59 Suppl 17:33-8.
• The data was analyzed using SPSS version 25 and JAMOVI version 0.9.2.3
• Cross tabulations were conducted to estimate the prevalence of social anxiety and psychiatric
*
comorbidities, such as, depression, general anxiety and stress in individuals diagnosed with MS DISCLOSURE
compared with the general population. Odds ratios were subsequently calculated.
• We used Chi2 tests for qualitative data, t-tests and Mann and Whitney tests for quantitative
Dr. Jiménez-Zambrano has nothing to disclose. Dr. Rodríguez-Díaz has nothing to disclose.
variables. * Correlation is significant at the 0.05 level (2-tailed). Dr. Acuña-Chong has nothing to disclose.
• Spearman correlation coefficients. SPIN, Social Phobia Inventory; EDSS, Expanded Disability Status Scale