Table 4.

Included references

Author, year	Symptom or disorder category	MS population	Diagnostic assessment tools	Main findings	Comments
Tarrants et al. 2011 [52]a	Depression, QoL	n = 436 Age: NA Female (n): 381 USA	ICD-9-CM code	MS patients with comorbid depression were approximately half as likely to be adherent to their DMT relative to patients with MS without depression. Although treatment with antidepressant therapy generally did not improve the likelihood of adherence, treatment with antidepressants for at least 6 months was associated with better adherence to DMT	None
Zimmerman et al. 2011 [77]b	Bipolar disorder	NA	MDQ, DSM-IV, CIDI, SCID, MINI	Across all studies the sensitivity of the MDQ was 61.3%; specificity, 87.5%; positive predictive value, 58.0%; and negative predictive value, 88.9%. Compared to the studies using the MDQ for psychiatric outpatients, studies using it in the general population found it to have much lower sensitivity and positive predictive value, and higher specificity and negative predictive value. The MDQ’s sensitivity was higher in detecting bipolar I disorder than bipolar II disorder (66.3% vs. 38.6%). Lowering the threshold to identify cases markedly improved the MDQ’s sensitivity, with only a modest reduction in specificity	Studies of the best symptom cutoff to identify cases have produced inconsistent findings. Based on current available evidence, routine clinical use of the MDQ cannot be recommended because of the absence of studies simultaneously examining both the potential benefits and costs of screening
Jones et al. 2012 [29]a	Depression, anxiety	n = 7786 Age: 50.9 ± 11.5 Female (n): 3253 United Kingdom	HADS	Anxiety and depression rates were notably high, with over half (54.1%) scoring ≥ 8 for anxiety and 46.9% scoring ≥ 8 for depression. Women with relapsing–remitting MS were more anxious than men with this type, and then women with other types of MS. Within each gender, men and women with secondary progressive MS were more depressed than men or women with other types of MS	Anxiety and depression are highly prevalent in people with MS, indicating that their mental health needs could be better addressed to provide the best care for people with MS
Leonavičius et al. 2012 [2]a	Depression, QoL	n = 270 Age: 42.4 ± 11.7 Female (n): 187 Lithuania	ICD-10	Depression was present in 20.7% of patients, with a similar prevalence between the sexes. Patients who indicated that MS interfered with their family life were at significantly increased risk of depression. Patients who identified the need to pay more attention to MS, and to include more medications in reimbursement lists, as factors that would improve the management of MS, were more likely to be diagnosed with depression	The negative impact of MS on family life is an important factor contributing to the risk of depression
Wood et al. 2012 [36]a	Anxiety, depression	n = 198 Age: 48.2 ± 11.4 Female (n): 137 Australia	HADS, FSS	Prevalence of anxiety was 44.5%, depression 18.5%, and fatigue 53.7%. Prevalence of anxiety (but not depression or fatigue) decreased by 8.1% per year of cohort observation, with the effect more pronounced in women (14.6%) than men (2.6%). There was no apparent seasonal variation in the prevalence of any of the three factors	All three factors (anxiety, depression and fatigue) occurred contemporaneously at cohort entry in a higher proportion of the cohort than expected by chance
Carta et al. 2013 [43]a	Depression, bipolar disorder	n = 201 Age: 38.9 ± 10.0 Female (n): 140 Italy	DSM-IV, ANTAS-SCID, MDQ, SF-12	Compared to controls, MS patients had a higher lifetime prevalence of DSM-IV. Major depressive disorder; Bipolar disorder I, Bipolar disorder II and Cyclothymia. As people with MS had a higher risk of depressive and bipolar spectrum disorders, ratio MDD/bipolar spectrum disorders was lower among cases indicating a higher association with Bipolar Spectrum Disorders and MS	The results suggest a risk of under-diagnosis of Bipolar disorder in MS and caution in prescribing Adjustment disorders to people with depressive episodes in MS without prior excluding Bipolar disorder

The selected studies are sorted chronologically by year and alphabetically by author name. Types of articles: ^aEmpirical article; ^bReview article; Definition papers were not included in the table. n = sample size; age: mean ± standard deviation; NA = Not applicable/reported

Abbreviations: ANTAS Advanced Neuropsychiatric Tools and Assessment Schedule, CIDI Composite International Diagnostic Interview, CIS Clinical Interview Schedule, DMT Disease-modifying therapy, DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th ed, FSS Fatigue Severity Scale, HADS (-A/-D) Hospital Anxiety and Depression Scale (-Anxiety Scale/-Depression Scale), ICD-9/-10 International Classification of Disease, MDQ Mood Disorders Questionnaire, MINI Mini–International Neuropsychiatric Interview, MS Multiple Sclerosis, QoL quality of life, SCID (-IV) Structured Clinical Interview for the (for DSM-IV), SF-12 Short-Form-Health Survey