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Anxiety and depression in Multiple Sclerosis (MS): Antecedents, consequences, and differential impact on well-being and quality of life
Open accessAbstract
Background Individuals with multiple sclerosis (MS) are often plagued by the unpredictability of their disease and have to contend with uncertainty in their life and significant life changes. This can lead to high levels of stress, perceived lack of control, helplessness, and anxiety. Despite these circumstances, anxiety disorders are often overshadowed by depression, which can result in its presence being overlooked and undertreated by many medical professionals. Methods One hundred and eighty three individuals with MS completed a comprehensive online survey assessing depression and anxiety and the demographic and disease risk factors of such, including social support and substance use. Participants also completed measures of MS symptomatology, disease management, psychological well-being, and quality of life to determine the impact of depression and anxiety on outcomes associated with MS. Results Findings suggest that both depression and anxiety are prevalent in MS and related to many outcomes. However, based on comparisons of the associations and group comparisons, with a few exceptions, anxiety proved to more impactful than depression when examining these outcomes. When evaluating the risk factors/contributors of anxiety and depression, social support was a consistent predictor. Younger age and shorter disease duration were also associated with anxiety, while lower education and substance use were predictors of depression. Conclusion Findings suggest that attention to anxiety be given as much as depression as it plays a large role in individuals' perceived health and well-being, which subsequently impacts the severity of symptoms and overall quality of life. Early identification of anxiety and potential substance use and increased social support also appear to be crucial for mitigating the impact of depression and anxiety.
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“Furthermore, individuals with MS are at a heightened risk for mental health disorders, such as depression and various forms of anxiety, including death anxiety (DA), which is characterized by intense feelings of terror, fear, or excessive worry regarding the process of dying, severing connection with the world, or uncertainties about what happens after death.”
From Comparing the Effects of Mindfulness-based Cognitive Therapy and Acceptance and Commitment Therapy on Quality of Life and Death Anxiety in Women With Multiple Sclerosis (2025) · cites this paper as [7]
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“These psychological disorders contribute to declined quality of life (QOL), which encompasses an individual's well-being, including physical, psychological, social, and environmental factors.”
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Vong, V., Simpson, S., Phaiju, S., Davenport, R. A., Neate, S. L., Pisano, M. I., & Reece, J. C. (2023) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2023.104501 · Cited by 31
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Management of multiple sclerosis in older adults: review of current evidence and future perspectives
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“Anxiety tends to occur in younger patients and has been associated with shorter disease duration, though with notable overlap with depression [106].”
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The emotional disorders associated with multiple sclerosis
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Factors that influence quality of life in patients with multiple sclerosis in Saudi Arabia
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“0/) volved in the processing and perception of emotions [11] supports the notion that symptoms of anxiety and depression, as well as the decline in psychological well-being observed among PwMS, have a biological etiology [12].”
BackgroundMachine learning approaches to anxiety detection: trends, model evaluation, and future directions
Taskynbayeva, M., & Gutoreva, A. (2025) · Frontiers in Artificial Intelligence · doi:10.3389/frai.2025.1630047 · Cited by 20
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“MS affects, indeed, many spheres of functioning associated with physiological and psychological change that reduces physical function and leads to disability with a substantial impact on the sense of identity and redefinition of self-image [37].”
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“For instance, symptoms of anxiety, depression, and fatigue are highly prevalent among PwMS [3–5]; with prevalence rates of 30.5% for depression and 22.1% for anxiety reported in a recent meta-analysis [6].”
InfluentialScandurra, C., Rosa, L., Carotenuto, A., Moccia, M., Arena, S., Ianniello, A., Nozzolillo, A., Turrini, M., Streito, L. M., Abbadessa, G., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12062215 · Cited by 13
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“This component is increasingly considered as an important indicator of the effectiveness of health interventions in the field of health policymaking.[13] In this regard, the results of previous studies have shown that patients with MS have significantly lower quality of life compared to healthy people in the community…”
ResultAutoimmune demyelination alters hypothalamic transcriptome and endocrine function
Carver, J. J., Lau, K. M., Puckett, A. E., & Didonna, A. (2024) · Journal of Neuroinflammation · doi:10.1186/s12974-023-03006-2 · Cited by 13
“Consistently, MS patients are more likely to report depression, anxiety, and chronic fatigue at prevalence rates at least 2–3 times higher than the general population average [13–15] .”
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Cárdenas‐Robledo, S., Otero‐Romero, S., Passarell‐Bacardit, M. A., Carbonell‐Mirabent, P., Sastre‐Garriga, J., Montalbán, X., & Tintoré, M. (2021) · European Journal of Neurology · doi:10.1111/ene.15030 · Cited by 10
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ResultCoping with multiple sclerosis: reconciling significant aspects of health-related quality of life
Gil-González, I., Rodríguez, A. M., Conrad, R., & Pérez-San-Gregorio, M. Á. (2022) · Psychology Health & Medicine · doi:10.1080/13548506.2022.2077395 · Cited by 10
“In fact, social support has been related to improvements regarding fatigue (Mikula et al., 2020), pain (Alphonsus & D’Arcy, 2021), depression and anxiety (Hanna & Strober, 2020; Mikula et al., 2020; Ratajska et al., 2020), thereby also protecting employment (Iwanaga et al., 2018).”
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“On the other side, persistent weariness represents a prevalent and incapacitating symptom in MS patients, particularly those with comorbid anxiety disorders and depression, who suffer from more pronounced and protracted chronic fatigue [316].”
Not for everyone: Factors influencing who receives psychotherapy in people with multiple sclerosis
Freedman, D., Oh, J., & Feinstein, A. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.106245 · Cited by 10
Lucas, L., & Parker, J. C. (2022) · Archives of Physiotherapy · doi:10.1186/s40945-021-00124-z · Cited by 10
“However, despite this finding, anxiety is often overshadowed by depression, resulting in undertreatment and its presence being overlooked by many health professionals [7].”
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Chmiel, J., Kurpas, D., & Stępień–Słodkowska, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14020373 · Cited by 8
“For example, the severity of depression symptoms is correlated with education level; those who have completed college tend to have less depressive symptoms [110,111].”
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“Anxiety may have an even greater impact on psychological symptoms and QoL than depression alone, especially when both are present [53].”
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“However, given the wide-ranging impact that MS has on patients’ well-being [46], providing meaningful change thresholds on the different subscales broadens the utility of the PRO instruments and allows meaningful improvements in these symptoms to be captured from the patient’s perspective.”
BackgroundSzczęśniak, M., Potemkowski, A., Brola, W., Kroplewski, Z., Szałachowski, R. R., Žák, M., Wilski, M., Sobolewski, P. K., Bartosik-Psujek, H., Kapica-Topczewska, K., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095426 · Cited by 10
“Individuals diagnosed with MS often face the unpredictability of their illness [6,14,15] and challenges related to psychological, social, and economic functioning [6,7].”
BackgroundUnderstanding the Effect of Multiple Sclerosis on General and Dimensions of Mental Health
Kang, W. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11247483 · Cited by 8
“Second, neuroinflammation could explain the associations between MS and personality traits, with subclinical neuroinflammation predicting psychological change [38,39].”
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Aging and the neuropsychiatry of multiple sclerosis: a cross-sectional study
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“Furthermore, in the current study, MS patients with anxiety were more vulnerable to depression, consistent with previous findings [69], indicating considerable comorbidity.”
BackgroundResultBackwards walking speed reserve in persons with multiple sclerosis
Monaghan, P. G., VanNostrand, M., & Fritz, N. E. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105556 · Cited by 7
Fragkiadaki, E., Anagnostopoulos, F., & Triliva, S. (2023) · Counselling and Psychotherapy Research · doi:10.1002/capr.12615 · Cited by 9
Behavioral disorders in multiple sclerosis: a comprehensive review
Jellinger, K. A. (2024) · Journal of Neural Transmission · doi:10.1007/s00702-024-02816-9 · Cited by 6
“When evaluating the risk factors/contributors of anxiety (and depression), younger age and disease duration are consistent predictors (Hanna and Strober 2020), as is presence of exacerbation phase in MS (Uguz et al. 2008).”
Amaslidou, A., Ierodiakonou‐Benou, I., Bakirtzis, C., Nikolaidis, I., Tatsi, T., Grigoriadis, N., & Nimatoudis, I. (2023) · AIMS neuroscience · doi:10.3934/neuroscience.2023027 · Cited by 9
“The negative role of anxiety in maintaining good MHQoL was highlighted in our research and remains a common finding (STAI State scc: −0.423, p 0.001, ST AI Trait scc: −0.550, p 0.001) [21,22,27,94,105–110].”
BackgroundResultInfluentialAlmarzouki, A. F., Alluhaibi, W., Salman, B., Almuhaiyawi, M., Alreemi, M., & Alsahafi, M. (2024) · Medicine · doi:10.1097/md.0000000000038982 · Cited by 6
“[45] It has been suggested that the psychological burden of IBD, including increased risk of anxiety and depression, may contribute to impaired cognitive function.”
BackgroundUncinate Fasciculus Lesion Burden and Anxiety in Multiple Sclerosis
Baller, E. B., Luo, A. C., Schindler, M., Cooper, E. C., Pecsok, M. K., Cieslak, M., Martin, M., Bar-Or, A., Elahi, A., Perrone, C., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.4751 · Cited by 6
Tavakoli Saleh, S., MA in Family Counselling, D. O. P., Ebrahimi, M. E., & Assistant Professor, D. O. P. (2021) · Avicenna Journal of Clinical Medicine · doi:10.52547/ajcm.28.2.126 · Cited by 6
Zare, L., Nayeri, N. D., Bahramnezhad, F., & Rasti, A. (2024) · Health Expectations · doi:10.1111/hex.70044 · Cited by 5
“Despite the prevalent focus in numerous studies on the adversities of living with MS [24 – 27], some studies, including the present one, also spotlight positive outcomes.”
BackgroundSalmani, S., Mousavi, S. H., Navardi, S., Hosseinzadeh, F., & Pashaeypoor, S. (2022) · BMC Neurology · doi:10.1186/s12883-022-03019-z · Cited by 6
“The prevalence rates of psychological and neurological changes, depression, and anxiety are 40–65% [9], 30–40%, and 36% in MS [10], respectively.”
BackgroundReece, J. C., Neate, S. L., Davenport, R. A., Milanzi, E., Nag, N., Bevens, W., Yu, M., Jelinek, G. A., & Simpson, S. (2023) · Acta Neurologica Belgica · doi:10.1007/s13760-023-02390-z · Cited by 6
“Despite evidence of biological aetiologies for depression in plwMS [28], our results support the contribution of psychological causes of depression [29], in particular family/ relationship situations perceived to have a negative impact.”
ResultKhoshsirat, N. A., Mokaram, R., Mahmoodi, Z., Shahrestanaki, E., & Ghavidel, N. (2024) · Brain and Behavior · doi:10.1002/brb3.70031 · Cited by 5
“Depression and anxiety are associated with progression of disability in MS. Social support is a predictor of anxiety and depression (Hanna & Strober, 2020; Vorobeychik et al., 2020).”
BackgroundFernández-Jiménez, E., Panyavin, I. S., Pérez-San-Gregorio, M. Á., & Schultheis, M. T. (2021) · Psicothema · doi:10.7334/psicothema2020.151 · Cited by 5
“Consequently, affective disorders such as depression and anxiety are very frequent comorbid conditions among patients with MS (Hanna & Strober, 2020), and both impact the disease course predicting future relapses (Salter et al., 2020).”
BackgroundNeuroimaging Correlates of Patient-Reported Outcomes in Multiple Sclerosis
Jakimovski, D., Wicks, T. R., Bergsland, N., Dwyer, M. G., Weinstock‐Guttman, B., & Zivadinov, R. (2023) · Degenerative Neurological and Neuromuscular Disease · doi:10.2147/dnnd.s384038 · Cited by 5
“Additionally, living with a chronic disease such as MS is associated with higher incidence of psychosocial consequences like anxiety, lower life satisfaction, lower self-esteem and reoccurring feelings of guilt.(4)”
BackgroundTaul-Madsen, L., Hvid, L. G., Sellebjerg, F. T., Christensen, J. R., Ratzer, R. L., Sejbæk, T., Svendsen, K. B., Papp, V., Chow, H. H., Lundbye‐Jensen, J., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-085241 · Cited by 6
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
Karegar, S. J., Mirzaei, A., Hajiluian, G., Aryaeian, N., Shidfar, F., Arabgol, S., Khosravifar, S., Moradiani, M., Aghcheli, M., Kayyal, M., et al. (2025) · Multiple Sclerosis Journal - Experimental Translational and Clinical · doi:10.1177/20552173251331524 · Cited by 4
Body image, sexual dysfunction and psychological distress in people with multiple sclerosis
Breheny, E., O’Keeffe, F. M., & Cooney, S. M. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2527959 · Cited by 4
“…[20]. additional psychological well-being variables that have consistently been shown to be more prevalent in people with Ms, including depression [21] and anxiety [22], will also be explored in the current study to better understand the role they play in the sexual and bodily experience. this…”
Pérez, E. R. P., López, M. L. B., Fernández, E. G., Arnés, M. D. R. M., Vázquez, M. F., Hernández, M., & García, E. G. (2025) · Neurology International · doi:10.3390/neurolint17120195 · Cited by 4
“Emerging evidence suggests that early interventions targeting emotional and social dimensions can significantly improve long-term outcomes in RRMS patients [12–14].”
Betti, M., Masciulli, C., Addazio, I., Ballerini, C., Bonacchi, R., Caporali, A., Chiappetta, F., Meo, E. D., Fabbiani, C., Gerli, F., et al. (2026) · Neurological Sciences · doi:10.1007/s10072-026-08988-4 · Cited by 4
Vicente-Escudero, J. L. (2025) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-025-00488-0 · Cited by 4
Knowles, L. M., Tingey, J. L., Newman, A. K., von Geldern, G., & Alschuler, K. N. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.103918 · Cited by 4
Polick, C. S., Ploutz-Snyder, R. J., Braley, T. J., Connell, C. M., & Stoddard, S. A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0292233 · Cited by 4
The experience of stigma and concealment in multiple sclerosis.
Maguire, R., Ahern, A., Shrivastava, S., & Maguire, P. (2024) · Stigma and Health · doi:10.1037/sah0000599 · Cited by 6
Kiropoulos, L. A., Krug, I., & Dang, P. L. (2025) · Nutrients · doi:10.3390/nu17101609 · Cited by 5
“…this comorbid presentation are crucial, as the combination of DE [84], body dissatisfaction [79], low self-esteem [23], and affective symptoms [85] may compound distress and interfere with disease management and quality of life in those affected by MS. Multimodal psychological approaches that…”
COMORBID PSYCHIATRIC DISORDERS IN SOME COMMON NEUROLOGICAL DISEASES
Görgülü, Ü., Gürhan, N., AKMAN, Y. Y., Polat, Ü., ALTAY, K., Özen, Ş., Çoşar, B., & Kolcu, G. (2022) · SDÜ Tıp Fakültesi Dergisi · doi:10.17343/sdutfd.1048635 · Cited by 4
Psychiatric-Like Impairments in Mouse Models of Spinocerebellar Ataxias
Tichánek, F. (2022) · The Cerebellum · doi:10.1007/s12311-022-01367-7 · Cited by 4
“1 3 even higher burden for patients with other motor neurological diseases, such as multiple sclerosis [46].”
BackgroundCerebrospinal fluid interferon-γ and development of depression in multiple sclerosis
Menculini, G., Sperandei, S., Gaetani, L., Mancini, A., Cinesi, G., Sabatino, E. D., Bellingacci, L., Canonichesi, J., Guerrera, G., Battistini, L., et al. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106309 · Cited by 3
Trauma Burden Affected People with Multiple Sclerosis During SARS-CoV-2 Pandemic
Heidler, F., Hecker, M., Frahm, N., Baldt, J., Streckenbach, B., Meißner, J., Burian, K., Langhorst, S. E., Mashhadiakbar, P., Richter, J., et al. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14082665 · Cited by 4
“Furthermore, feelings of helplessness and dependence on others may contribute to a higher prevalence of depressive disorders [111].”
Neuroanatomical Correlates of Depressive Symptoms in Early Multiple Sclerosis
Silva, J. D. S., Rosa, F. L., Dereskewicz, E., Levy, S. A., Graney, R., Garcia, N., Galasso, J., Sumowski, J. F., & Beck, E. S. (2026) · Neurology Open Access · doi:10.1212/wn9.0000000000000050 · Cited by 3
Hoepner, R., Rodgers, S., Stegmayer, K., Steinemann, N., Haag, C., Calabrese, P., Manjaly, Z., Salmen, A., Kesselring, J., Zecca, C., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-22445-0 · Cited by 3
Göçmen, A., & Ethemoğlu, Ö. (2023) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2023.107888 · Cited by 4
Giossi, R., Mercenari, M., Filippi, M., Zanetta, C., Antozzi, C. G., Brambilla, L., Confalonieri, P. A., Crisafulli, S. G., Roldán, E. T., Annovazzi, P. O. L., et al. (2024) · Journal of Neurology · doi:10.1007/s00415-024-12472-4 · Cited by 3
Connolly, L. J., Chatfield, S., Freeman, J. A., Salter, A. R., Amato, M. P., Brichetto, G., Chataway, J., Chiaravalloti, N. D., Cutter, G., DeLuca, J., et al. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105798 · Cited by 3
“…correlations between fatigue and measures of depressive symptoms and anxiety have been found by some (Sparasci et al., 2022; Tarasiuk et al., 2021), with others identifying moderate statistically significant correlations with depressive symptoms (AlSaeed et al., 2022; Hanna and Strober, 2020).”
Chmiel, J., & Stępień–Słodkowska, M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13247793 · Cited by 3
“Depression affects approximately 30.5% of MS patients, while anxiety impacts around 22.1% [1,2].”
InfluentialFakorede, S., Peters, J., Murphy, T., Troung, E., & Abou, L. (2025) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2025.2518261 · Cited by 3
“These mental health conditions arise from a combination of psychosocial and biological factors, including inadequate coping mechanisms, insufficient social support, and MS-related changes in brain structure, immune function, and inflammatory pathways (Hanna and Strober, 2020; Mustač et al, 2021).”
Phillips, B., Morrow, S. A., Singh, H., Oh, J., Kolind, S., Lynd, L. D., Prat, A., Tam, R. C., Traboulsee, A. L., & Patten, S. B. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106761 · Cited by 3
The effect on the anxiety level of the social support given to multiple sclerosis patients
Yılmaz, T. A., & Özdelikara, A. (2021) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12807 · Cited by 3
Quality of Life and Its Predictors in Patients with Multiple Sclerosis
Sotoudeh, S., Maroufizadeh, S., Balasi, L. R., Esfandiari, A., Nouri, A., & Bakhtiari, F. (2023) · Jundishapur Journal of Chronic Disease Care · doi:10.5812/jjcdc-138840 · Cited by 3
Roman, M. S., González, F., Bardoneschi, L., Fernández, M. H., Eizaguirre, M., Cáceres, F., Benedict, R. H. B., Rivera, V. M., & Vanotti, S. (2024) · Sclerosis · doi:10.3390/sclerosis2010005 · Cited by 3
“…was included, which underlines the importance of studying this variable in PwMS and incorporating it into models when examining both employment and other self-reported questionnaires, in particular perceived social support, as they may be influenced by the presence of depressive symptoms [50].”
BackgroundResultThe Path from Personality to Anxiety and Depression Is Mediated by Cognition in Multiple Sclerosis
Schenk, A., Popa, C. O., Cojocaru, C. M., Marian, Ș., Maier, S., & Bălașa, R. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14070682 · Cited by 3
Özbek, M., Arıkanoğlu, A., & Aluçlu, M. U. (2025) · Medicina · doi:10.3390/medicina61081409 · Cited by 2
“The lifetime prevalence of depression in MS patients has been estimated at 30 to 40 percent [29,30] while anxiety prevalence ranges from 35 to 65 percent [31].”
Metadata
- Authors
- Hanna, M., & Strober, L. B.
- Affiliations
- Montclair State University (US)
- Rutgers, The State University of New Jersey (US)
- Corresponding author
- Strober, Lauren Beth
- ORCID
- Strober, Lauren Beth
- Venue
- Multiple Sclerosis and Related Disorders
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 44
- Pages
- 102261
- ISSN
- 2211-0348 (ISSN-L)
- PMC
- PMC7719086
- OpenAlex
- W3033947017
- Cited by
- 202
- References
- 64
- Citations by year
- 2026: 38 · 2025: 35 · 2024: 52 · 2023: 33 · 2022: 21 · 2021: 23
- FWCI
- 12.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Multiple Sclerosis and Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Clinical Neurology › 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, anxiety, depression, psychological well-being, quality of life, social support, substance use, disease duration, risk factors, symptom severity, early detection
- MeSH terms
- Anxiety, Anxiety Disorders, Depression, Humans, Multiple Sclerosis, Quality of Life
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