Prevalence of depression in a 12-month consecutive sample of patients with ALS P. Wicks a , S. Abrahams b , D. Masi a , S. Hejda-Forde a , P. N. Leigh c and L. H. Goldstein a a Department of Psychology, Institute of Psychiatry, King’s College London, London, UK; b Department of Psychology, PPLS, The University of Edinburgh, Edinburgh, UK; and c Department of Clinical Neuroscience, MRC Centre for Neurodegeneration Research, Institute of Psychiatry, King’s College London, London, UK Keywords: amyotrophic lateral sclerosis, anxiety, depression, motor neurone disease, prevalence study Received 23 January 2007 Accepted 10 April 2007 There is an impression both in clinical practice and in research literature that patients with amyotrophic lateral sclerosis (ALS) possess Ôheroic stoicism with a low frequency of depressionÕ. Reliance on specific interview methods may have contributed to dif- fering estimates of mood disorder in people with ALS. The objective of the current study was to compare prevalence rates of depression and anxiety in ALS using dif- ferent assessment tools. The Beck Depression Inventory (BDI), The Hospital Anxiety and Depression Scale (HADS) and the Spielberger State-Trait Anxiety Inventory (STAI) were sent to a 12-month consecutive sample of 190 patients with ALS attending a tertiary referral clinic in the UK. Data were collected from 104 patients with ALS. Using BDI scores, 44% were categorized as not depressed, 37% were mild- moderately depressed, 13% were moderately-severely depressed, and 6% were severely depressed. In contrast, the HADS depression subscale identified 75% as not de- pressed, 13% were in the borderline range, and 13% were categorized as meeting ÔcasenessÕ for depression. Twenty-five percent of the patients were using antidepressant medication. The estimated prevalence of mood disorder amongst patients with ALS may vary significantly depending on the measure used. Introduction Amyotrophic lateral sclerosis (ALS), a fatal neuro- degenerative disorder characterized by a relentlessly progressive loss of all motor function, is a rare disease with an incidence of around 2/100 000 person years [1]. The prognosis is poor, with a mean survival estimated at 4 years [2] and no prospect of a cure. Despite this, there appears to be an impression in both clinical practice and the research literature that patients with ALS possess Ôheroic stoicism with a low frequency of depressionÕ [3,4]. Few studies have investigated the prevalence of depression and anxiety in ALS and those that have often contain methodological limitations. One of the earliest studies concluded that ALS patients have a personality attribute of Õactive masteryÕ and that their low rate of depression is caused by considerable use of denial [5]. Whilst these findings have not been replicated [6], this study may continue to influence perceptions [7]. Previous studies of major depression in patients with ALS using clinical interview suggest a low prevalence; the two largest studies estimated it at 11–13% (n ¼ 100 and n ¼ 56 respectively)[4,8]. However, studies using self-report questionnaires such as the Beck Depression Inventory (BDI) [9] have suggested higher levels of depressive symptomology [3,10,11]. One larger longi- tudinal study found that despite the presence of tran- sient depression in some, a persistent depressive state occurred in only 8% of 63 patients with ALS [12]. Perhaps surprisingly, patients with a neurological illness associated with a better prognosis than ALS appear to exhibit a higher prevalence of depression. Studies have reported a major depression in 37–54% of the patients with multiple sclerosis (MS) [13] and 20–40% of the patients with Parkinson’s disease (PD) [14]. Depression is also common in other neurological illnesses such as epilepsy (30%) [15], stroke (38%) [16] and Huntington’s disease (38%) [17]. Non-neurological diseases such as cancer are frequently associated with depression, with prevalence ranging from 30% for gynaecological can- cers to 43% for lung cancer; however, it is worth noting that a poorer prognosis is not necessarily associated with a higher prevalence of depression [18]. Evidence of milder depressive symptoms have been reported in 22–75% of ALS patients [12], depending on the measure used. It has been suggested that some items on self-report questionnaires may be endorsed because of physical symptoms relating to the disease rather than mood state [3], for example the item ÔI feel slowed downÕ on the Hospital Anxiety and Depression Scale (HADS) Correspondence: Dr L. H. Goldstein, PO 77, Department of Psychology, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK (tel.: +44 (0)20 7848 0218; fax: +44 (0)20 7848 5006; e-mail: l.goldstein@iop.kcl.ac.uk). Ó 2007 EFNS 993 European Journal of Neurology 2007, 14: 993–1001 doi:10.1111/j.1468-1331.2007.01843.x