Author(s): Granger N.; Schluter D.K.; Bredin A.; Mills R.J.; Young C.A.
Source: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration; 2018; vol. 19 ; p. 311
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Background: Previous work in ALS/MND showed correlations between depression and restrictions of everyday functioning, using the Barthel Index, as well as sleep and eating scores, using the Sickness Impact Profile (1). Literature search shows no published analyses of the relationships between depression and disability using current conceptual frameworks of disability assessment. Objective(s): To examine the relationship of disability to depression in ALS/MND. Method(s): As part of the ongoing UK wide Trajectories of Outcomes in Neurological Conditions (TONiC) study, a questionnaire pack was completed by people with ALS/MND, including the Depression subscale from the modified Hospital Anxiety and Depression Scale-MND (HADS-D) (2) and the World Health Organisation Disability Assessment Scale (WHODAS-2.0). The WHODAS-2.0 measures disability in six life domains: Understanding and communication, Getting around, Selfcare, Getting along with people, Life activities, and Participation in society. Work related items were omitted from analysis as most of the respondents were not working, and each domain was scored using WHO complex method (3). Factors were then added to a multifactor model using a ‘forwards’ method to determine the most parsimonious model. Result(s): From 465 participants at the time of this analysis, most were male (60.6%) with mean age 64.9 years and mean duration since diagnosis 26.2 months; 60% had limb onset, 24.7% bulbar onset, and 15.3% unknown onset type. Using published cut-offs for possible and probable depression, 7.1% had probable depression, 22.3% had possible depression. Multiple linear regression revealed the most parsimonious model to incorporate WHODAS-2.0 domains Participation in society, Getting along with people, and Understanding and communicating. Interaction terms for these domains were not significant. The final model accounted for 38.2% of the variance in HADS-D scores. Discussion and conclusions: This study highlights the main disability drivers for depression in ALS/MND to be related to social interaction rather than physical function. Causation cannot be determined with this cross-sectional data; it may be that higher levels of depression cause patients to struggle to communicate, get along with people and participate in society, or that these disabilities drive increased depression. Equally, the interaction may be bidirectional. Disability assessment in routine neurological practice often emphasises mobility and self-care; clinicians should recognise the importance of including disabilities of social interaction in their assessments.