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PSU
Sports Concussion Neuropsychology Program |
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PSU
Neuropsychology of MS Program |
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research interests |
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select publications | |
lab pictures |
| Model of Depression in Multiple Sclerosis | ||||
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| Explanation of Model | ||||
| Prior to the onset of MS, there is
no elevated risk for depression among individuals who ultimately develop
the disease. Subsequent to developing MS, patients experience an elevated
risk for depression. We have developed this model to attempt to explain
in an integrated fashion what might account for that elevated risk,
because it must have something to do with having MS. All of the factors
included have some empirical support in being associated with depression.
That is, there is at least one study, and in most cases many studies,
that have shown that these variables are associated with depression.
Factors that are circled have been shown by at least one study to
be significantly and independently associated with depression in MS.
The proposed moderator variables are theorized to moderate the relationship
between the common MS sequelae and depression, but also have been
shown to be directly associated with depression in MS. The Biological
Changes variables have been shown to be associated with both physical/neurological
changes and cognitive dysfunction in MS, in addition to being directly
associated with depression. At the bottom of the figure is a “Risk
for Depression” line. Arrows depict whether the variables in
that column increase or decrease the risk for depression. In the case
of moderators, note that there are both up and down arrows. This is
to denote that, in the case of each variable, risk is either increased
or decreased depending on the nature of the variable identified. In
the case of social support, good social support has been shown to
be associated with reduced depression whereas poor social support
is associated with increased depression in MS. For coping, higher
levels of problem-focused/active coping and lower levels of emotion-focused/avoidance
coping have been shown to be associated with reduced depression whereas
the inverse of these has been shown to be associated with increased
depression. For “Cognitive Schemata,” positive schemata
are theorized to provide a buffer against depression whereas negative
schemata increase the risk for depression. In the case of the “Common
MS Sequelae,” the available literature is mixed in that some
studies show positive associations with depression and others no association.
The “Independent Contributors” could conceivably fit more directly into the model, but at this stage, they are simply noted to be directly associated with depression because the research literature supports such a direct association. The presence of these independent contributors further increases risk for depression when patients have a history of depression, are female, are early on in the disease process, and have problems with sleep. It is not intended for the model to be entirely linear and unidirectional. It is assumed that depression feeds back on the moderator variables, and possibly to other variables as well including fatigue, cognitive dysfunction, and sleep problems. |
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| back to research interests | ||||
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