None listed
Conditions
Brief summary
This research has direct translational value for people with MS, critical given the impact of depression on people with MS. Outcomes are aimed at supporting clinicians to improve detection and management of depression in people with MS through neurology services. It will provide recommendations and supports to improve detection and treatment and will enable submission of funding proposals to facilitate the next translational phase (years 4-5) through iterative feasibility and acceptability implementation across neurology settings, ensuring suitability for rollout. Results will: 1) fill a knowledge gap about barriers and required supports to improve assessment and treatment in Australian neurology practices, 2) provide Australian validation data to screen for depression in routine clinical practice; 3) characterise the depressive symptom profile in MS to identify whether it differs in presentation from depression in people without MS requiring specific patient and clinician education; 4) utilise this research, literature review and advisory committee expertise to develop recommendations and supports that improve detection, treatment and monitoring of depression in people with MS. It will result in high-quality peer review journal outputs and conference presentation outputs reporting each sub- study, as well as a report detailing overall program results that will be submitted to relevant MS healthcare, consumer, advocacy and research organisations. This research has potential to positively impact people with MS who experience depression, and their families, as well as to provide economic gains by reducing direct and indirect costs of the impact of depression on MS.
Interventions
Quantitative Survey and Clinical Interview
Rationale: Depression occurs in up to 50% of people living with Multiple Sclerosis (MS); 2-3 times higher than in the general population. Despite guidelines recommending screening for depression at each MS neurology review, and evidence for treatment efficacy, depression in MS remains under detected and undertreated. Studies have found reported rates of missed diagnosis to be around 23-30%, and up to 59% of patients with significant symptoms of depress
Quantitative Survey and Clinical Interview Rationale: Depression occurs in up to 50% of people living with Multiple Sclerosis (MS); 2-3 times higher than in the general population. Despite guidelines recommending screening for depression at each MS neurology review, and evidence for treatment efficacy, depression in MS remains under detected and undertreated. Studies have found reported rates of missed diagnosis to be around 23-30%, and up to 59% of patients with significant symptoms of depression not taking medication. Given this, it is important to improve depressive symptom screening, monitoring and treatment practices in MS. What: Patient-reported outcome measures will be administered via Qualtrics, a secure online data collection tool. There are four different surveys which will be distributed across the three parts. ValidSymp will also involve in person/telehealth clinician interview. 1. ValidQual This part of the study will include two different online questionnaires via Qualtrics: -People with MS depression: One custom questionnaire to quantify information identified from qualitative interviews assessing current practices and challenges faced in screening for and treating depression in people with MS. There are 48 questions in this survey, and it will take approximately 15 minutes to complete. This survey utilises the Depression Anxiety Stress Scales-21 (DASS-21) -MS Clinicians: The questionnaire is a 53-item survey to be administered to MS clinicians in order to obtain a national understanding about the current barriers, required supports and other challenges in the detection and treatment of depression in MS through MS specialist healthcare settings. This includes demographic/clinician related questions, knowledge about depression in MS, current practice in screening and treatment of depression, barriers and facilitators and required support and training needs. It is expected to take 10-15 minutes to complete.Clinicians will be provided with a participant information sheet, and can select whether they would like to receive the results of the study. 2. Valid2QS, 15-20 minute survey ± 30 minute interview. Validation of a 2 question measure of depression in individuals with MS. Depression evaluation: Three depression screens will be administered, namely the 2 Question Screen (2QS), Depression Anxiety Stress Scales-21 (DASS-21) and Patient Health Questionnaire 9 (PHQ-9). The Structured Clinical Interview for DSM-5 (SCID) is a clinical interview that will be used to compare the screens against. A subgroup of participants with MS who complete the survey in the clinic (i.e., via the iPad; 15-20 minutes) will also complete the clinician administered SCID-5 (approximately 30 minutes) at the clinic. This survey and interview may also be administered via telehealth. To enable data collection for these studies, participants will be randomly assigned to nurse or neurologist administration of the 2QS (2-items). To minimise the possibility of bias, the SCID-5 administrator will be blinded to the results of the 2QS, DASS-21 and PHQ-9. Administration of the 2QS will be randomised across neurologist and nurse. It will also be administered to all participants via in-clinic iPad and online facilitated questionnaires, and assessed between groups for validity differences. Other screens will be administered via iPad or paper-based delivery at the same appointment the 2QS is administered. Sensitivity and specificity of the 2QS to detect depression in people with MS will be calculated against clinical interview diagnosis for the subsample, and against the two depression screens for the entire sample. Clinical and online data will be analysed to identify any significant validation differences specific to administration setting. Participants will additionally be administered questionnaires required for the VALIDSYMP study, which utilises the same sample. 3. ValidSymp, 15-20 minute survey. There will be two versions, one for individuals with MS and individuals without. The depressive symptom profile of all participants will be assessed using: The Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress Anger – Short Form, Brief Irritability Test (BITe) and Difficulties in Emotion Regulation Scale (DERS-16) will be administered to characterise depressive symptom profile in people with and without MS. Who provided: MS Clinicians must have more than 1-year experience in treating MS patients in Australia. How: All consented participants: • Participant online questionnaires: Completed using Qualtrics data collection tool • Clinic data collection via online input using an electronic device and Qualtrics data collection platform Where: Online and MS clinics (Peninsula Health, Monash Health, The Talk Shop). When and how much: Study duration and critical time points: Quantitative recruitment for this study will run till the end of 2022.
Sponsors
Monash University
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
All of the following criteria must be satisfied for enrolment in the study: MS clinicians 1. Provides healthcare services to people with MS (does not need to be their main or only patient population) 2. Access to an internet connection and computer facilities, required to complete online survey People with MS 1. 18 years or older 2. A self-reported confirmed diagnosis of multiple sclerosis (any subtype) 3. Able to read and write in English language 4. Access to an internet connection and computer facilities, required to complete assessments, for online recruitment People without MS 1. 18 years or older 2. Able to read and write in English language 3. Access to an internet connection and computer facilities, required to complete assessments
Exclusion criteria
Presence of any of the following criteria will exclude the participant from enrolment in the study. People with MS and people without MS 1. Severe cognitive dysfunction deemed to interfere with the person’s ability to undertake study requirements. As determined by: a. the MS clinic team (neurologist; MS nurse) for clinic participation; b. the inability to participate in online assessments (implied).
Outcome results
None listed