Abstract
Dysphagia and symptoms of depression, anxiety and stress are common in persons with multiple sclerosis (MS). We posited a relationship between dysphagia and increased frequency of psychological symptoms. Therefore, the aim of the present study was to examine associations between symptoms of psychological difficulties, use of emotional suppression and cognitive reappraisal strategies, and dysphagia status in persons with MS. One hundred persons with MS were prospectively assessed in multiple domains of functioning: cognitive, psychological, and dysphagia-related. Participants underwent cognitive screening with the Mini Mental State Examination and completed two psychological inventories: The depression, anxiety and stress scale (DASS)-21 and the Emotion Regulation Questionnaire. Further, they completed the dysphagia in Multiple Sclerosis questionnaire. A speech-language pathologist evaluated persons suspected of having dysphagia with the Mann Assessment of Swallowing Ability. Dysphagia was present in 29 persons with MS, and the sample was split accordingly. The two groups differed at baseline with respect to Expanded Disability Status Scale scores. There were significant between-group differences for mental health symptoms and for use of emotional regulation strategies. Accordingly, multivariate logistic regressions showed that increased symptoms of psychological stress, decreased use of cognitive reappraisal strategies, and increased indicators of emotional suppression independently predicted the presence of dysphagia. There was a clear pattern towards poorer psychological well-being in persons with dysphagia compared to those without. Psychological difficulties may contribute to the manifestation or worsening of dysphagia and should be addressed in treatment planning and future investigations. Therapeutic interventions that promote improvement in mental state alongside swallowing function may be highly beneficial.
Similar content being viewed by others
References
World Health Organization. Atlas: multiple sclerosis resources in the world 2008. Geneva: World Health Organization; 2008.
Guan X-L, Wang H, Huang H-S, Meng L. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci. 2015;36(5):671–81.
Marchese-Ragona R, Restivo D, Marioni G, Ottaviano G, Masiero S, Staffieri A. Evaluation of swallowing disorders in multiple sclerosis. Neurol Sci. 2006;27(4):s335–7.
Calcagno P, Ruoppolo G, Grasso M, De Vincentiis M, Paolucci S. Dysphagia in multiple sclerosis–prevalence and prognostic factors. Acta Neurol Scand. 2002;105(1):40–3.
Tassorelli C, Bergamaschi R, Buscone S, Bartolo M, Furnari A, Crivelli P, et al. Dysphagia in multiple sclerosis: from pathogenesis to diagnosis. Neurol Sci. 2008;29(4):360–3.
Prosiegel M, Schelling A, Wagner-Sonntag E. Dysphagia and multiple sclerosis. Int MS J. 2004;11:22–31.
Abraham SS, Yun PT. Laryngopharyngeal dysmotility in multiple sclerosis. Dysphagia. 2002;17(1):69–74.
Boeschoten RE, Braamse AM, Beekman AT, Cuijpers P, van Oppen P, Dekker J, et al. Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci. 2017;372:331–41.
Gold SM, Irwin MR. Depression and immunity: inflammation and depressive symptoms in multiple sclerosis. Immunol Allergy Clin N Am. 2009;29(2):309–20.
Feinstein A, Roy P, Lobaugh N, Feinstein K, O’connor P, Black S. Structural brain abnormalities in multiple sclerosis patients with major depression. Neurology. 2004;62(4):586–90.
Group GC. The Goldman Consensus statement on depression in multiple sclerosis. Mult Scler J. 2005;11(3):328–37.
Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–37.
Gross JJ. Handbook of emotion regulation. New York: Guilford Publications; 2013.
Fernandes AM, Duprat Ade C, Eckley CA, Silva L, Ferreira RB, Tilbery CP. Oropharyngeal dysphagia in patients with multiple sclerosis: do the disease classification scales reflect dysphagia severity? Braz J Otorhinolaryngol. 2013;79(4):460–5.
Folks DG, Kinney FC. The role of psychological factors in gastrointestinal conditions: a review pertinent to DSM-IV. Psychosomatics. 1992;33(3):257–70.
Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.
Baijens LW, Koetsenruijter K, Pilz W. Diagnosis and treatment of phagophobia: a review. Dysphagia. 2013;28(2):260–70.
Verdonschot RJ, Baijens LW, Serroyen JL, Leue C, Kremer B. Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia. J Psychosom Res. 2013;75(5):451–5.
Verdonschot RJ, Baijens LW, Vanbelle S, van de Kolk I, Kremer B, Leue C. Affective symptoms in patients with oropharyngeal dysphagia: a systematic review. J Psychosom Res. 2017;97:102–10.
Tarameshlu M, Azimi AR, Ghelichi L, Ansari NN. Prevalence and predictors of dysphagia in Iranian patients with multiple sclerosis. Med J Islam Repub Iran. 2017;31:133.
Poorjavad M, Derakhshandeh F, Etemadifar M, Soleymani B. Associated factors with swallowing disorders in patients with multiple sclerosis. J Isfahan Med School. 2010;28(104):40–6.
Solaro C, Rezzani C, Trabucco E, Amato M, Zipoli V, Portaccio E, et al. Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire). J Neurol Sci. 2013;331(1–2):94–7.
De Pauw A, Dejaeger E, D’hooghe B, Carton H. Dysphagia in multiple sclerosis. Clin Neurol Neurosurg. 2002;104(4):345–51.
Thomas FJ, Wiles C. Dysphagia and nutritional status in multiple sclerosis. J Neurol. 1999;246(8):677–82.
Manor Y, Balas M, Giladi N, Mootanah R, Cohen JT. Anxiety, depression and swallowing disorders in patients with Parkinson’s disease. Parkinsonism Relat Disord. 2009;15(6):453–6.
Han M, Ohnishi H, Nonaka M, Yamauchi R, Hozuki T, Hayashi T, et al. Relationship between dysphagia and depressive states in patients with Parkinson’s disease. Parkinsonism Relat Disord. 2011;17(6):437–9.
Lin BM, Starmer HM, Gourin CG. The relationship between depressive symptoms, quality of life, and swallowing function in head and neck cancer patients 1 year after definitive therapy. Laryngoscope. 2012;122(7):1518–25.
Holland G, Jayasekeran V, Pendleton N, Horan M, Jones M, Hamdy S. Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: a self-reporting questionnaire survey. Dis Esophagus. 2011;24(7):476–80.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
Ansari NN, Naghdi S, Hasson S, Valizadeh L, Jalaie S. Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study. Appl Neuropsychol. 2010;17(3):190–5.
Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther. 1997;35(1):79–89.
Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176.
Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J psychol. 2008;2(2):82–102.
Gloster AT, Rhoades HM, Novy D, Klotsche J, Senior A, Kunik M, et al. Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. J Affect Disord. 2008;110(3):248–59.
Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(2):227–39.
Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003;42(Pt 2):111–31.
Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Iran Psychol. 2005;4(1):299–313.
Samani S, Joukar B. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS-21). 2007.
Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Person Soc Psychol. 2003;85(2):348.
Hasani J. Persian version of the emotion regulation questionnaire: factor structure, reliability and validity. Int J Behav Sci. 2016;10(3):156–61.
Bergamaschi R, Crivelli P, Rezzani C, Patti F, Solaro C, Rossi P, et al. The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J Neurol Sci. 2008;269(1–2):49–53.
Jafari Z, Shahbodaghi MR, Maroufizadeh S, Moghadasi AN. Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. Iran J Neurol. 2018;17(3):99.
Asadollahpour F, Mehri A, Khatoonabadi A, Mohammadzaheri F, Ebadi A. Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis. J Res Med Sci J Isfahan Univ Med Sci. 2019;24:52.
Mann G. MASA: the Mann assessment of swallowing ability. Boston: Cengage Learning; 2002.
González-Fernández M, Sein MT, Palmer JB. Clinical experience using the Mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population. Am J Speech-Lang Pathol. 2011;20:331.
Mennin DS, Holaway RM, Fresco DM, Moore MT, Heimberg RG. Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behav Ther. 2007;38(3):284–302.
Campbell-Sills L, Barlow DH. Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. In: Gross JJ, editor. Handbook of emotion regulation. New York: Guilford Press; 2007. p. 2.
Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialog Clin Neurosci. 2011;13(1):7.
Kisely S, Smith M, Lawrence D, Maaten S. Mortality in individuals who have had psychiatric treatment: population-based study in Nova Scotia. Br J Psychiatry. 2005;187(6):552–8.
Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665–73.
Naragon-Gainey K, McMahon TP, Chacko TP. The structure of common emotion regulation strategies: a meta-analytic examination. Psychol Bull. 2017;143(4):384.
Acknowledgements
The authors would like to acknowledge the great contribution of the patients who participated in the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sadeghi, Z., Ghoreishi, Z.S., Flowers, H. et al. Depression, Anxiety, and Stress Relative to Swallowing Impairment in Persons with Multiple Sclerosis. Dysphagia 36, 902–909 (2021). https://doi.org/10.1007/s00455-020-10207-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-020-10207-x