Objective:

To determine the prevalence of anxiety in Algerian patients with Multiple Sclerosis (MS) and investigate its association with psychological, demographic, and disease-related factors, following the American Academy of Neurology (AAN) guidelines for comprehensive neurological care. This study aims to provide insights that will inform multidisciplinary care strategies by identifying predictors of anxiety, such as depression, fatigue, and sexual dysfunction, thereby promoting patient-centered interventions to enhance the quality of life in MS populations.

Background:

Multiple Sclerosis (MS) is a complex disease characterized by a range of
symptoms, including motor, sensory, visual, cognitive, sexual, and psychiatric
impairments. Among psychiatric manifestations, anxiety and depression
frequently occur and significantly affect patients' quality of life. This study
aims to determine the prevalence of anxiety in MS patients within an Algerian
cohort and examine the associated contributing factors.

Design/Methods:

A cross-sectional study was carried out on 260 MS patients from the
Neurology Department at Sidi Bel Abbès University Hospital. Inclusion criteria
included patients over 18 with a confirmed MS diagnosis based on the 2017
McDonald criteria. Data on demographics, disease type, and duration were
collected. Assessments of disability, depression, anxiety, fatigue, cognitive
function, and sexual dysfunction were conducted using various validated
scales: Expanded Disability Status Scale (EDSS), Hospital Anxiety and
Depression Scale (HADS), Fatigue Scale for Motor and Cognitive Functions
(FSMCF), Symbol Digit Modalities Test (SDMT), 9-Hole Peg Test (9-HPT), and
the 25-Foot Walk Test (25-FWT). Sexual dysfunction was evaluated using the
Female Sexual Function Index (FSFI) and the International Index of Erectile
Function (IIEF). Statistical analysis was performed with SPSS 20, using Chi- square tests and binary logistic regression to explore correlations, with
significance set at p < 0.05.

Results:

Of the 260 participants, 192 were women (73.8%) and 68 were men (26.2%), with a female-to-male ratio of 2.81. The mean age was 38.9 ± 11.1 years, with an
average disease duration of 5.83 ± 5.11 years. Anxiety was identified in 38.5% of
patients, and 34% exhibited depression based on HADS scores. Fatigue was
reported by 77.7% of the cohort. Cognitive dysfunction, as measured by the
SDMT, showed a mean score of 42 ± 20. Sexual dysfunction was prevalent, with 55% of women reporting issues, and 76.1% of men experiencing erectile
dysfunction. Univariate analysis revealed significant correlations between anxiety, depression, and fatigue (p < 0.001), as well as between anxiety and sexual
dysfunction (p < 0.05). However, no significant correlation was found between
anxiety and demographic characteristics or motor disability as assessed by
EDSS, 9-HPT, or 25-FWT. Multivariate analysis confirmed that psychological
factors, including depression and fatigue, were significant predictors of
anxiety (p < 0.001).

Conclusions:

This study emphasizes that anxiety in MS patients is predominantly
associated with psychological factors such as depression and fatigue rather
than the severity of physical disability. The findings underscore the
importance of incorporating psychological assessments and addressing
sexual dysfunctions as part of a holistic care strategy for improving the quality
of life in MS patients.