MS Diagnosis Disclosure and Concealment Associated With Anxiety, Depression


Higher concealment behavior for patients with multiple sclerosis was associated with higher anxiety, but not depression.

Anne Kever, PhD

Anne Kever, PhD

Using a newly developed questionnaire, the DISCO-MS, researchers found that diagnosis disclosure and concealment attitudes and behaviors are related to anxiety and depression in persons with multiple sclerosis (MS).

Presented by Anne Kever, PhD, postdoctoral researcher, Columbia University, at the ACTRIMS Forum 2021, February 25–27, the research included 107 patients with MS (mean age, 49 years; 81% women; disease duration, 1–40 years) who completed the 39-item DISCO-MS survey, which measured frequency of concealment behaviors (Part 1) and expected consequences of diagnosis disclosure (Part 2).

Following the collection of data, Kever et al found that greater perceived emotional burden was associated with worse depression (r = .236; P <.05) and higher anxiety (r = .518; P <.001), while greater perceived negative consequences of disclosure were linked to worse depression (r = .433; P <.001) and higher anxiety (r = .518; P <.001) as well.

"Disclosure and concealment may contribute to functional variability and may represent a tractable treatment target for novel interventions,” the study authors wrote.

READ MORE: TNFαi-Associated CNS Demyelination Persists After Treatment Discontinuation

Part 1 of the survey yielded factors of concealment behavior and emotional burden while Part 2 yielded factors of negative and positive consequences of disclosure. Relationships of these factors to mood were assessed using a Hospital Anxiety and Depression Scale.

Patients who demonstrated higher concealment behavior also were associated with higher anxiety (r = .222; P <.05), but not depression. Using multivariate analysis of variance in a comparison of high vs low depression and anxiety via median split revealed that patients with high anxiety experience greater emotional burden (F[1,102] = 16.24; P <.001) and demonstrated higher concealment behavior (F[1,102] = 15.14; P <.001), whereas no significant differences were observed for any factors between high and low depression groups.

A study published in the International Journal of MS in 2016 touched upon some of the similar themes that Kever et al were examining. Led by Jonathan E. Cook, PhD, the research explored the dimensions of social stigma and their relation to disease concealment in patients with MS.2

Cook, an associate professor at Pennsylvania State University, used an online survey that assessed anticipated, internalized, and isolation stigma, as well as concealment, in 53 adults with MS in the United States. Responses to all the scales were relatively low, on average, but above scale minimums (P <.001). The ratings of isolation stigma and concealment were highest, as well as anticipated stigma strongly predicting concealment.

There are a number of comorbidities that patients with MS face daily. At the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), ­NeurologyLive caught up with Amy B. Sullivan, PsyD, ABPP about her presentation on the topic of comorbidities within MS. Sullivan, director of behavioral medicine at Cleveland Clinic’s Mellen Center for MS, urged for increased screening of these patients and offered advice to neurologists on how to implement these screenings when there is no collaborative model in place

For more coverage of ACTRIMS Forum 2021, click here.

1. Kever A, Leavitt VM. DISCO-MS survey of disclosure and concealment in MS: associations with anxiety and depression. Presented at ACTRIMS 2021 Forum; February 25–27, 2021. Abstract P031.
2. Cook JE, Germano AL, Stadler G. An exploratory investigation of social stigma and concealment in patients with multiple sclerosis. Int J MS Care. Published online March 18, 2016. doi: 10.7224/1537-2073.2015-021
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