The research, led by Dr. Anibal S. Chertcoff from the Department of Internal Medicine (Neurology) at the Health Sciences Centre, Max Rady College of Medicine, University of Manitoba, Canada, and colleagues, highlights the importance of identifying and managing psychiatric conditions early in the MS trajectory.
The findings shed light on the
prodromal phase of MS — a period before clinical diagnosis during which early symptoms, including psychiatric manifestations, may occur. While earlier studies have indicated that increased healthcare use and psychiatric symptoms can precede MS onset, their connection with long-term disability outcomes had not been clearly understood until now.
For this investigation, the researchers analyzed data from 2,212 MS patients who had attended MS clinics in British Columbia, Canada, between 1991 and 2018. Using linked clinical and population-based health administrative records, they identified individuals who had psychiatric morbidity—defined through physician or hospital visits related to psychiatric conditions—during the five years before MS onset.
The key findings of the study were as follows:
- Among the total participants, 481 individuals (21.7%) had psychiatric morbidity during the five years preceding MS onset.
- The patients were followed for an average of 5.2 years, with repeated evaluations of disability progression using the Expanded Disability Status Scale (EDSS).
- Participants with psychiatric morbidity before MS onset showed significantly higher disability scores after diagnosis (adjusted β = 0.17).
- The association between pre-onset psychiatric morbidity and disability was stronger in men (β = 0.43).
- Younger adults under 30 years exhibited a greater association with higher disability scores (β = 0.44).
- Those with relapsing-onset multiple sclerosis also demonstrated higher disability levels (β = 0.22).
- Individuals with a higher frequency of psychiatric-related medical visits had increased post-diagnosis disability (β = 0.23).
- Greater disability was also observed among participants with a history of psychiatric hospitalizations (β = 0.48).
According to the authors, these findings emphasize that psychiatric conditions—such as depression and anxiety—may not only represent early signs of MS but also serve as indicators of more severe future neurological impairment. They suggest that psychiatric morbidity may reflect underlying neurobiological changes occurring during the MS prodrome.
The study highlights the urgent need for clinicians to recognize and treat psychiatric symptoms in individuals at risk of MS or at the time of diagnosis. Despite the availability of effective treatments, psychiatric disorders in MS patients are often underdiagnosed and inadequately managed.
The researchers propose that early intervention through counseling, psychotherapy, or pharmacological treatment could potentially mitigate the accumulation of disability over time. They recommend further studies to determine whether timely psychiatric management before or soon after MS onset can positively influence long-term neurological outcomes.
"Overall, the study highlights psychiatric morbidity as a key component of the MS prodromal phase, reinforcing the importance of integrating mental health assessment and care into early MS management strategies," the authors concluded.
Reference:
Chertcoff, A. S., Ruiz-Algueró, M., Yusuf, F., Zhao, Y., Zhu, F., Marrie, R. A., & Tremlett, H. (2025). Psychiatric morbidity during the multiple sclerosis prodrome is associated with future disability. Multiple Sclerosis Journal. https://doi.org/10.1177_13524585251382801
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