Prevalence of depression and anxiety in Multiple Sclerosis: A systematic review and meta-analysis
Open accessAbstract
Objective Prevalence rates of depression and anxiety in patients with Multiple Sclerosis (MS) vary widely across studies. Aim of this systematic review and meta-analysis was to a) estimate the prevalence of depression and anxiety in MS, and specifically b) explore sources of heterogeneity (assessment method, prevalence period, study quality, recruitment resource, region) by extensive analyses.Methods A computerized search in PubMed, EMBASE, and PsycINFO for studies on depression and anxiety in MS was performed up to December 2014.Results Fifty-eight articles with a total sample size of 87,756 MS patients were selected. Pooled mean prevalence was 30.5% (95% CI=26.3%-35.1%) for depression, and 22.1% (95% CI=15.2%-31.0%) for anxiety. Prevalence of clinically significant depressive or anxiety symptoms was higher (35% and 34%) compared with disorders (21%; p=0.001 and 10%; p<0.001). Prevalence of a depressive disorder was relatively lower in studies from Europe. Anxiety disorder was more prevalent in community-based samples. Sources of high heterogeneity were not revealed.Conclusions Data of a large number of patients indicate increased prevalence of depression and anxiety in MS. Further research is needed to identify sources of heterogeneity. Issues to consider are the definition of depression and anxiety, patient recruitment, and patient characteristics.
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The four common upper motor neuron disorders cause significant decline in physical function and often lead to secondary complications affecting quality of life, including cognitive impairment, fatigue, chronic pain, depression, and anxiety.
“These 4 common UMNDs result in a significant decline in physical function5,7,8,17,18 and often develop secondary complications that affect their quality of life (QOL), including cognitive impairment,19–21 fatigue,22 chronic pain,23,24 depression,25–27 and anxiety.25–27”
From Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review (2022) · cites this paper as [26]
The Introduction (page not provided) says depression and anxiety are common in multiple sclerosis and are related to lower quality of life. The citation is attached to depression and anxiety, not the other listed complications, but this paper does not establish that all four upper motor neuron disorders develop them or that the disorders cause them. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPhysical health difficulties such as cancer, diabetes, and multiple sclerosis are highly comorbid with anxiety symptoms.
“Previous meta-analyses have found strong evidence to suggest physical health difficulties such as cancer, diabetes, and multiple sclerosis are highly comorbid with anxiety symptoms (Nikbakhsh et al., 2014; Janzen Claude et al., 2014; Boeschoten et al., 2017).”
From Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis (2022) · cites this paper as Boeschoten et al., 2017
Rates of emotional disorders are high among people with multiple sclerosis.
“R ates of emotional disorders (EDs) are high among people with multiple sclerosis (MS). 1-4”
From Two Sides of the Same Coin: A Randomized Clinical Trial of the Unified Protocol for Addressing Depression and Anxiety in People With Multiple Sclerosis. (2026) · cites this paper as [2]
MS patients show increased levels of anxiety and depression compared to healthy participants, and these conditions affect more than 20% of patients.
“MS patients show increased levels of anxiety and depression compared to healthy participants, and these conditions affect more than 20% of patients [8,21,22,23].”
From Biopsychosocial Correlates of Quality of Life in Multiple Sclerosis Patients (2022) · cites this paper as [21]
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Simpson, R., McLean, G., Guthrie, B., Mair, F. S., & Mercer, S. W. (2014) · BMC Neurology · doi:10.1186/1471-2377-14-128 · Cited by 54 · see citing works
Mattioli, F., Bellomi, F., Stampatori, C., Parrinello, G., & Capra, R. (2011) · Neurological Sciences · doi:10.1007/s10072-011-0624-2 · Cited by 50 · see citing works
Treatment of depression in people who have multiple sclerosis
Sollom, A. C., & Kneebone, I. (2007) · Multiple Sclerosis Journal · doi:10.1177/1352458507072384 · Cited by 48 · see citing works
Validation study of prevalence and correlates of depressive symptomatology in multiple sclerosis
Bamer, A. M., Cetin, K., Johnson, K., Gibbons, L. E., & Ehde, D. M. (2008) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2008.04.006 · Cited by 47 · see citing works
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Buchanan, R. J., Wang, S., & Ju, H. (2002) · Multiple Sclerosis Journal · doi:10.1191/1352458502ms823oa · Cited by 45 · see citing works
Clinical correlates of CES-D depressive symptom ratings in an MS population
Patten, S. B., Lavorato, D. H., & Metz, L. M. (2005) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2005.06.010 · Cited by 43 · see citing works
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Diagnostic accuracy for major depression in multiple sclerosis using self‐report questionnaires
Fischer, A., Fischer, M. M., Nicholls, R. A., Lau, S., Poettgen, J., Patas, K., Heesen, C., & Gold, S. M. (2015) · Brain and Behavior · doi:10.1002/brb3.365 · Cited by 40 · see citing works
Point prevalence and correlates of depression in a national community sample with multiple sclerosis
Viner, R., Fiest, K. M., Bulloch, A. G. M., Williams, J. V. A., Lavorato, D. H., Berzins, S. A., Jetté, N., Metz, L. M., & Patten, S. B. (2014) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.12.011 · Cited by 36 · see citing works
Challenges in screening for depression in multiple sclerosis
Patten, S. B., Berzins, S., & Metz, L. M. (2010) · Multiple Sclerosis Journal · doi:10.1177/1352458510377770 · Cited by 33 · see citing works
The risk of developing depression when suffering from neurological diseases
Thielscher, C., Thielscher, S., & Kostev, K. (2013) · Europe PMC (PubMed Central) · doi:10.3205/000170 · Cited by 32 · see citing works
Pozzilli, C., Schweikert, B., Ecari, U., Oentrich, W., & Bugge, J. (2012) · Journal of Neurology · doi:10.1007/s00415-012-6492-8 · Cited by 32 · see citing works
Brenner, P., Alexanderson, K. A. E., Björkenstam, C., Hillert, J. A., Jokinen, J., Mittendorfer‐Rutz, E., & Tinghög, P. (2014) · PLoS ONE · doi:10.1371/journal.pone.0104165 · Cited by 31 · see citing works
Depression in Persons with Multiple Sclerosis
Ehde, D. M., & Bombardier, C. H. (2005) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2005.01.010 · Cited by 31 · see citing works
Long-term emotional state of multiple sclerosis patients treated with interferon beta
Porcel, J., Río, J., Sánchez-Betancourt, A., Arévalo, M. J., Tintoré, M., Téllez, N., Borrás, C., Nos, C., & Montalbán, X. (2006) · Multiple Sclerosis Journal · doi:10.1177/1352458506070748 · Cited by 30 · see citing works
Ostacoli, L., Carletto, S., Borghi, M., Cavallo, M., Rocci, E., Zuffranieri, M., Malucchi, S., Bertolotto, A., Zennaro, A., Furlan, P. M., et al. (2013) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-012-9323-2 · Cited by 29 · see citing works
Analyses of nursing home residents with multiple sclerosis and depression using the Minimum Data Set
Buchanan, R. J., Wang, S., Tai‐Seale, M., & Ju, H. (2003) · Multiple Sclerosis Journal · doi:10.1191/1352458503ms872oa · Cited by 28 · see citing works
Patient Health Questionnaire-9 to Screen for Depression in Outpatients With Multiple Sclerosis
Ferrando, S. J., Samton, J., Mor, N., Nicora, S., Findler, M., & Apatoff, B. (2007) · International Journal of MS Care · doi:10.7224/1537-2073-9.3.99 · Cited by 28 · see citing works
Depression in the medically ill
Creed, F. H., & Dickens, C. M. (2006) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544293.002 · Cited by 27 · see citing works
Smoking Status over Two Years in Patients with Multiple Sclerosis
Marrie, R. A., Cutter, G., Tyry, T. M., et al. (2008) · Neuroepidemiology · doi:10.1159/000170910 · Cited by 27 · see citing works
Dysregulation of affect in multiple sclerosis: New phenomenological approach
HAREL, Y., BARAK, Y., & ACHIRON, A. (2007) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2007.01616.x · Cited by 27 · see citing works
Descriptive Epidemiology of Affective Disorders in Multiple Sclerosis
Patten, S. B., Svenson, L. W., & Metz, L. M. (2005) · CNS Spectrums · doi:10.1017/s1092852900022732 · Cited by 25 · see citing works
Ensari, I., Motl, R., McAuley, E., Mullen, S., & Feinstein, A. (2014) · Multiple Sclerosis · doi:10.1177/1352458513504251 · Cited by 24 · see citing works
Moreau, T., Schmidt, N., Joyeux, O., Bungener, C., & Souvignet, V. (2009) · European Neurology · doi:10.1159/000222777 · Cited by 24 · see citing works
Influence of recruitment and participation bias in neuropsychological research among MS patients
DUQUIN, J. A., Parmenter, B. A., & Benedict, R. H. B. (2008) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617708080624 · Cited by 24 · see citing works
Progressive multiple sclerosis and mood disorders
Lorefice, L., Fenu, G., Trincas, G., Moro, M. F., Frau, J., Coghe, G., Cocco, E. E., Marrosu, M. G., & Carta, M. G. (2015) · Neurological Sciences · doi:10.1007/s10072-015-2220-3 · Cited by 21 · see citing works
Marrie, R. A., Fisk, J. D., Stadnyk, K., Tremlett, H. L., Wolfson, C. M., Warren, S., Bhan, V., Yu, B., & CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (2014) · Chronic diseases and injuries in Canada · doi:10.24095/hpcdp.34.2/3.09 · Cited by 21 · see citing works
Depression in Multiple Sclerosis: Reactive or Endogenous?
Holden, K. E., & Isaac, C. (2011) · Clinical Neuropsychologist · doi:10.1080/13854046.2011.564208 · Cited by 20 · see citing works
for the Study Group, Zettl, U. K., Bauer-Steinhusen, U., Gläser, T., Hechenbichler, K., & Limmroth, V. (2013) · BMC Neurology · doi:10.1186/1471-2377-13-117 · Cited by 19 · see citing works
Depression as a predictor of occupational transition in a multiple sclerosis cohort.
Patten, S. B., Williams, J. V. A., Lavorato, D. H., Koch, M. W., & Metz, L. M. (2013) · Europe PMC (PubMed Central) · Cited by 13 · see citing works
Daily hassles reported by Dutch multiple sclerosis patients
van der Hiele, K., Kamminga, N. G. A., Ruimschotel, R. P., Middelkoop, H. A. M., & Visser, L. H. (2012) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2012.06.023 · Cited by 13 · see citing works
Depression screening in Black Americans with multiple sclerosis
Stepleman, L. M., Decker, M., Rollock, M. J. D., Casillas, R. S., & Brands, T. (2013) · Psychology Health & Medicine · doi:10.1080/13548506.2013.775466 · Cited by 13 · see citing works
A longitudinal study of cognition in nursing home residents with multiple sclerosis
Demakis, G. J., Buchanan, R. J., & DeWald, L. (2009) · Disability and Rehabilitation · doi:10.1080/09638280902738664 · Cited by 12 · see citing works
Coyle, P. K., Cohen, B. A., Leist, T. P., Markowitz, C., Oleen-Burkey, M. A., Schwartz, M., Tullman, M. J., & Zwibel, H. (2014) · BMC Neurology · doi:10.1186/1471-2377-14-49 · Cited by 10 · see citing works
Barbero (2014) · doi:10.1016/j · Cited by 1 · see citing works
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Berk, M., Köhler‐Forsberg, O., Turner, M., Penninx, B. W. J. H., Wrobel, A., Firth, J., Loughman, A., Reavley, N. J., McGrath, J. J., Momen, N. C., et al. (2023) · World Psychiatry · doi:10.1002/wps.21110 · Cited by 336 · see citing works
Hanna, M., & Strober, L. B. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.102261 · Cited by 202 · see citing works
Dupont, A.-C., Largeau, B., Santiago Ribeiro, M., Guilloteau, D., Tronel, C., & Arlicot, N. (2017) · International Journal of Molecular Sciences · doi:10.3390/ijms18040785 · Cited by 182 · see citing works
Henry, A., Tourbah, A., Camus, G., Deschamps, R., Mailhan, L., Castex, C., Gout, O., & Montreuil, M. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2018.09.039 · Cited by 95 · see citing works
Psychological consequences of COVID-19 pandemic in Italian MS patients: Signs of resilience?
Capuano, R., Altieri, M., Bisecco, A., d’Ambrosio, A., Docimo, R., Buonanno, D., Matrone, F., Giuliano, F., Tedeschi, G., Santangelo, G., et al. (2021) · Journal of Neurology · doi:10.1007/s00415-020-10099-9 · Cited by 88 · see citing works
Pilot evaluation of a resilience training program for people with multiple sclerosis
Pakenham, K. I., Mawdsley, M., Brown, F. L., & Burton, N. W. (2018) · Rehabilitation Psychology · doi:10.1037/rep0000167 · Cited by 71 · see citing works
Heidari, M. E., Nadali, J., Parouhan, A., Azarafraz, M., tabatabai, S. M., Irvani, S. S. N., eskandari, F., & Gharebaghi, A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.03.015 · Cited by 69 · see citing works
Sadeghi Bahmani, D., Razazian, N., Motl, R. W., Farnia, V., Alikhani, M., Pühse, U., Gerber, M., & Brand, S. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.101380 · Cited by 65 · see citing works
Social support in multiple sclerosis: associations with quality of life, depression, and anxiety
Ratajska, A., Glanz, B. I., Chitnis, T., Weiner, H. L., & Healy, B. C. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110252 · Cited by 66 · see citing works
Valentine, T. R., Alschuler, K. N., Ehde, D. M., & Kratz, A. L. (2022) · Multiple Sclerosis Journal · doi:10.1177/13524585211023352 · Cited by 55 · see citing works
Carletto, S., Tesio, V., Borghi, M., Francone, D., Scavelli, F., Bertino, G., Malucchi, S., Bertolotto, A., Oliva, F., Torta, R., et al. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.02083 · Cited by 49 · see citing works
Grech, L. B., Kiropoulos, L. A., Kirby, K. M., Butler, E., Paine, M., & Hester, R. (2018) · International Journal of MS Care · doi:10.7224/1537-2073.2016-008 · Cited by 49 · see citing works
Gill, S., Santo, J., Blair, M., & Morrow, S. A. (2019) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/appi.neuropsych.18010011 · Cited by 46 · see citing works
Giovannetti, A. M., Solari, A., & Pakenham, K. I. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1960441 · Cited by 40 · see citing works
Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis
Staines, A. C., Broomfield, N., Pass, L., Orchard, F., & Bridges, J. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13451 · Cited by 37 · see citing works
Perinatal Depression and Anxiety in Women With Multiple Sclerosis: A Population-Based Cohort Study
Eid, K., Torkildsen, Ø. F., Aarseth, J., Flemmen, H. Ø., Holmøy, T., Lorentzen, Å. R., Myhr, K.-M., Riise, T., Simonsen, C., Torkildsen, C. F., et al. (2021) · Neurology · doi:10.1212/wnl.0000000000012062 · Cited by 35 · see citing works
Carletto, S., Cavalera, C., Sadowski, I., Rovaris, M., Borghi, M., Khoury, B., Ostacoli, L., & Pagnini, F. (2020) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000819 · Cited by 29 · see citing works
Han, A. (2021) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2021.03.011 · Cited by 29 · see citing works
Proctor, B. J., Moghaddam, N. G., Evangelou, N., & das Nair, R. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.07.006 · Cited by 26 · see citing works
“MS can have diverse and unpredictable effects on psychological wellbeing (Wilkinson & das Nair, 2013) reflected in high prevalence-estimates for depression (30%) and anxiety (22%) (Boeschoten et al., 2017).”
BackgroundThompson, B., Moghaddam, N., Evangelou, N., Baufeldt, A., & das Nair, R. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.103862 · Cited by 25 · see citing works
“Prevalence rates for depression and anxiety for pwMS vary from >20% for anxiety and depression diagnoses and >34% for symptoms (Hauer et al., 2020); Marrie et al., 2015;; Boeschoten et al., 2017).”
BackgroundSadeghi-Bahmani, D., Esmaeili, L., Mokhtari, F., Sadeghi Bahmani, L., Afsharzadeh, M., Shaygannejad, V., Mirmosayyeb, O., Goldstein-Piekarski, A. N., & Gross, J. J. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.104029 · Cited by 22 · see citing works
Biopsychosocial Correlates of Quality of Life in Multiple Sclerosis Patients
Batista, A. R., Silva, S., Lencastre, L., & Guerra, M. P. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192114431 · Cited by 20 · see citing works
Death Anxiety and Attitudes towards Death in Patients with Multiple Sclerosis: An Exploratory Study
Francalancia, J., Mavrogiorgou, P., Juckel, G., Mitrovic, T., Kuhle, J., Naegelin, Y., Kappos, L., & Calabrese, P. (2021) · Brain Sciences · doi:10.3390/brainsci11080964 · Cited by 19 · see citing works
“5%) were below the estimated prevalence values for MS patients in the literature [3,5].”
BackgroundInfluentialFerreira, A. M., Leal, B., Ferreira, I., Brás, S., Moreira, I., Samões, R., Sousa, A. P., Santos, E., Silva, B., Costa, P. P., et al. (2021) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2021.102982 · Cited by 17 · see citing works
Giovannetti, A. M., Pakenham, K. I., Presti, G., Quartuccio, M. E., Confalonieri, P., Bergamaschi, R., Grobberio, M., Di Filippo, M., Micheli, M., Brichetto, G., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0267245 · Cited by 11 · see citing works
“1% for anxiety symptoms in this population [13].”
BackgroundWang, N., Zhu, S., Chen, S., Zou, J., Zeng, P., & Tan, S. (2025) · Reviews in the Neurosciences · doi:10.1515/revneuro-2024-0147 · Cited by 12 · see citing works
Meek, C., das Nair, R., Evangelou, N., Middleton, R., Tuite-Dalton, K., & Moghaddam, N. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.104154 · Cited by 12 · see citing works
Han, A., Wilroy, J. D., & Yuen, H. K. (2023) · Clinical Psychologist · doi:10.1080/13284207.2022.2163158 · Cited by 12 · see citing works
Korupolu, R., Malik, A., Ratcliff, C., Robinson-Whelen, S., & Taylor, H. B. (2022) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2022.05.020 · Cited by 8 · see citing works
O'Keeffe, F., Cogley, C., McManus, C., Davenport, L., O'Connor, S., Tubridy, N., Gaughan, M., McGuigan, C., & Bramham, J. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105719 · Cited by 4 · see citing works
Department of Psychology, S. O. E. A. P., Mansouri Koryani, R., Basaak Nejad, S., Department of Psychology, S. O. E. A. P., Mehrabizadeh Honarmand, M., Department of Psychology, S. O. E. A. P., Majdinasab, N., & Department of Neurology, M. R. R. C. (2022) · Iranian Journal of Psychiatry and Clinical Psychology · doi:10.32598/ijpcp.28.2.3747.1 · Cited by 4 · see citing works
Goldsmith, K., Hudson, J. L., Chalder, T., Dennison, L., & Moss-Morris, R. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103594 · Cited by 2 · see citing works
Department of Culture and Society (IKOS), L. U., Afsharzada, M. S., Keshavarz, A., Department of Psychology, P. N. U., Keshavarz, A., Department of Psychology, P. N. U., Saadat, S., & Neuroscience Research Center, G. U. O. M. S. (2023) · Romanian Medical Journal · doi:10.37897/rmj.2023.4.7
Strober, L. B., Arbelaez, O., Vitale, L., & Boswell, J. F. (2026) · International Journal of MS Care · doi:10.7224/1537-2073.2025-008
- Authors
- Boeschoten, R. E., Braamse, A. M. J., Beekman, A. T. F., Cuijpers, P., van Oppen, P., Dekker, J., & Uitdehaag, B. M. J.
- Affiliations
- Amsterdam Public Health (NL)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Corresponding author
- Boeschoten, Rosa E.
- Venue
- Journal of the Neurological Sciences
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 372
- Pages
- 331-341
- ISSN
- 0022-510X (ISSN-L)
- OpenAlex
- W2558115423
- Semantic Scholar
- 0c6f11f599b04e9a8df7d04192c89fee54a7c162
- Cited by
- 713
- References
- 125
- Citations by year
- 2026: 87 · 2025: 70 · 2024: 83 · 2023: 100 · 2022: 92 · 2021: 110 · 2020: 89 · 2019: 40 · 2018: 32 · 2017: 9
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the Neurological Sciences (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Stichting MS Research (09-678)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- multiple sclerosis, depression, anxiety, prevalence, psychiatric comorbidity, depressive disorders, anxiety disorders, heterogeneity sources, community sample
- MeSH terms
- Anxiety, Depression, Humans, Multiple Sclerosis, Prevalence, Databases, Bibliographic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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