Journal of Behavioral Medicine

, Volume 38, Issue 2, pp 237–250 | Cite as

Disentangling Multiple Sclerosis and depression: an adjusted depression screening score for patient-centered care

  • Douglas D. Gunzler
  • Adam Perzynski
  • Nathan Morris
  • Robert Bermel
  • Steven Lewis
  • Deborah Miller


Screening for depression can be challenging in Multiple Sclerosis (MS) patients due to the overlap of depressive symptoms with other symptoms, such as fatigue, cognitive impairment and functional impairment, for MS patients. The aim of this study was to understand these overlapping symptoms and subsequently develop an adjusted depression screening tool for better clinical assessment of depressive symptoms in MS patients. We evaluated 3,507 MS patients with a self-reported depression screening (PHQ-9) score using a multiple indicator multiple cause modeling approach. Our models showed significant differential item functioning effects denoting significant overlap of depressive symptoms with all MS symptoms under study and good model fit. The magnitude of the overlap was especially large for fatigue. Adjusted depression screening scales were formed based on factor scores and loadings that will allow clinicians to understand the depressive symptoms separate from other symptoms for MS patients for improved patient care.


Multiple Sclerosis Fatigue Depression Structural equation modeling Factor analysis Multiple indicator multiple cause model 



Financial support for this study was provided by a Grant from NIH/NCRR CTSA KL2TR000440 and by a Grant from Novartis. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. We appreciate the contributions from Drs. Randall Cebul, Thomas Love, Irene Katzan, Neal Dawson, Center for Health Care Research and Policy, Drs. Richard Rudick, and Francois Bethoux, Mellen Center, and Dr. Martha Sajatovic, Departments of Psychiatry and Neurology at Case Western Reserve University School of Medicine.

Conflict of interest

Douglas Gunzler, Adam Perzynski, Nathan Morris, Steven Lewis and Deborah Miller declare that they have no conflict of interest. Robert Bermel has received research grants from Novartis.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Supplementary material

10865_2014_9574_MOESM1_ESM.doc (34 kb)
Supplementary material 1 (DOC 33 kb)


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Douglas D. Gunzler
    • 1
  • Adam Perzynski
    • 1
  • Nathan Morris
    • 2
  • Robert Bermel
    • 3
  • Steven Lewis
    • 1
  • Deborah Miller
    • 3
  1. 1.Center for Health Care Research and Policy, MetroHealth Medical CenterCase Western Reserve UniversityClevelandUSA
  2. 2.Department of Epidemiology and BiostatisticsCase Western Reserve UniversityClevelandUSA
  3. 3.Mellen Center for Multiple Sclerosis Treatment and ResearchCleveland Clinic Main CampusClevelandUSA

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