DEPRESSION AND ANXIETY IN AMYOTROPHIC LATERAL SCLEROSIS: CORRELATIONS BETWEEN THE DISTRESS OF PATIENTS AND CAREGIVERS DEZHI CHEN, BM, XIAOYAN GUO, MD, ZHENZHEN ZHENG, MD, QIANQIAN WEI, MD, WEI SONG, MD, BEI CAO, MD, RUI HUANG, MD, RONG YANG, BM, and HUIFANG SHANG, MD Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China Accepted 21 June 2014 ABSTRACT: Introduction: Depression and anxiety are common in amyotrophic lateral sclerosis (ALS) patients and caregivers. Methods: In this study we investigated 93 ALS patients and their 93 caregivers. Depression and anxiety were quantified by the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, respectively. Results: Very strong correlations between depression and anxiety were found among patients and their caregivers. The severity of depression and anxiety of patients correlated moderately with that of their caregivers. No correlations were found between the severity of depression and anxiety and ALS Functional Rating Scale–Revised (ALSFRS-R) score or for disease duration among patients and caregivers. However, severity of depression and anxiety in caregivers correlated with their age. Conclusions: Depression and anxiety in ALS patients and their caregivers were associated closely with each other but not with physical disability or disease duration in our Chinese population. Muscle Nerve 51: 353–357, 2015

Amyotrophic lateral sclerosis (ALS) is a common fatal neurodegenerative disorder characterized by progressive weakness and atrophy of limb and bulbar muscles. Most patients die of respiratory failure 3–5 years after onset.1 As patients proceed from the onset of symptoms to diagnosis, progressive disability, and death, the burden on caregivers increases.2,3 Some ALS patients and caregivers present with depression and anxiety during each stage of the disease,4–8 a situation that can affect the health-related quality of life of both.5,9–12 Many studies have been conducted to evaluate the prevalence, determinants, and potential modifiers of depression and anxiety of ALS patients and caregivers.7,13–17 Studies from the United States and Greece have indicated that depression is more pronounced in ALS patients than in normal controls,5 with prevalence ranging from 13.5% to 51%.7,16,18 Some studies have shown that the severity of depres-

sion is associated with greater functional impairment14 and that the severity of anxiety progresses with disease duration in ALS patients.19 However, other studies have found that depression is not correlated with physical disability in ALS patients.15,18,20 Furthermore, an increasing number of studies have shown that depression and anxiety are also common in the caregivers of ALS patients,4,21 and there is a correlation with the loss of physical function in patients.3 Other studies, however, have indicated that the frequency and severity of depression and anxiety in ALS caregivers were not correlated with the physical disability of the ALS patients,22 or did not increase significantly with disease duration.23,24 Although many investigations have focused on depression and anxiety in ALS patients and their caregivers, information on an association between them is limited. A Swedish study focusing on differences in quality of life, anxiety, and depression in ALS patients and their next of kin showed that anxiety in ALS patients is correlated with anxiety and depression in their caregivers, and that depression in patients is also correlated with anxiety in caregivers.22 However, the sample size of this study22 was relatively small. Furthermore, differences in genetic, cultural, and economic backgrounds and healthcare systems among different races may also affect the features of depression and anxiety. No study of the association of depression and anxiety between ALS patients and their caregivers is available from China. Therefore, we conducted a cross-sectional study to explore the association of depression and anxiety between ALS patients and their caregivers and the features of depression and anxiety in ALS patients and their caregivers in a Chinese population. METHODS

Abbreviations: ALS, amyotrophic lateral sclerosis; ALSFRS-R, ALS Functional Rating Scale–Revised; HARS, Hamilton Anxiety Rating Scale; HDRS, Hamilton Depression Rating Scale; MMSE, Mini-Mental State Examination Key words: amyotrophic lateral sclerosis; anxiety; caregiver; depression; Hamilton Depression Rating Scale; Hamilton Anxiety Rating Scale The first 2 authors (D.C. and X.G.) contributed equally to this work. The present study was supported by grant from the National Science Fund of China (81371394). Correspondence to: R. Yang; e-mail: [email protected] and Huifang Shang; e-mail: [email protected] C 2014 Wiley Periodicals, Inc. V

Published online 26 June 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/mus.24325

Depression and Anxiety in ALS

This cross-sectional study included 93 ALS patients and their 93 caregivers. All patients were admitted to the Department of Neurology, West China Hospital of Sichuan University, between June 2012 and July 2013. All ALS patients were diagnosed as definite or probable ALS according to the El Escorial revised criteria.25 Patients who were unable to complete the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) assessments because of severe dysarthria or severe respiratory insufficiency were MUSCLE & NERVE

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excluded from the study. We used the Mini-Mental State Examination (MMSE) to assess cognition in all participants, and individuals with cognitive impairment were excluded. Based on a previous Chinese study, cognitive impairment was defined as a score of 24 for individuals with junior high to high school or higher education, 20 for those with grade school education, and 17 for illiterate subjects.26 Paid caregivers were excluded from the study. The patients and caregivers were not treated with antidepressants or anti-anxiety drugs. Demographic characteristics of all participants were recorded. Education levels were classified into low (years of schooling

Depression and anxiety in amyotrophic lateral sclerosis: correlations between the distress of patients and caregivers.

Depression and anxiety are common in amyotrophic lateral sclerosis (ALS) patients and caregivers...
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