A systematic review and qualitative analysis of anxiety among people with multiple sclerosis

Abstract

Background: Anxiety is common among people with Multiple Sclerosis (PwMS) but under-researched in the literature. We conducted 1) a systematic review of the factors associated with anxiety in PwMS 2) a qualitative study of PwMS who have clinically significant levels of anxiety in order to gain a richer perspective on their experience. Method: The systematic review was carried out in accordance with the Preferred Reporting Items for Systemic reviews (PRISMA). Twenty semi-structured interviews were conducted with PwMS recruited from the Neurology Department of Kings College Hospital who had scored 10 or above on the anxiety sub-scale of the Hospital Anxiety and Depression Scale (HADS). Responses were then analysed using inductive thematic analysis. Findings: 149 studies met inclusion criteria in the systematic review. Comorbid depression, severity of MS and lack of social support were associated with anxiety in PwMS. The main themes that emerged from the qualitative analysis were the impact of diagnosis, the negative effect on social functioning, feelings of worry and embarrassment, the use of coping strategies, and the need for psychological intervention. Discussion: This review confirms that anxiety is commonly reported by PwMS and can have many negative implications for them. The findings suggest that clinicians should evaluate all PwMS for anxiety disorders as they may represent a treatable cause of disability in MS. The insights gained from this research may be of particular interest to clinicians involved in designing, developing or delivering interventions for anxiety among PwMS, particularly for early intervention.