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newly diagnosed ones, is strongly advised in order to ensure a better quality of life. It is recommended to conduct a
nationwide study to explore severity of depression among MS patients in Saudi Arabia.

Keywords: Depression, multiple sclerosis, Saudi Arabia

INTRODUCTION
Multiple sclerosis (MS) is a chronic autoimmune disease, with variable severity and evolution . It is a
[1]
disease that affects the central nervous system, especially the brain, optic nerves and the spinal cord . Most
[2,3]
commonly, MS evolves in relapses during symptoms recur or new symptoms occur . After a few years, the
[4]
[5]
relapses leave sequelae (i.e. permanent symptoms), which can become severe disability. The disease can affect
[2]
many functions, e.g. movement control, sensory perception, memory, speech, etc. .
[6]
In term of MS epidemiology, there were few studies about the situation in Arabian Gulf countries. Bohlega et al.
[7]
reported an increasing incidence of MS, designating the Gulf region as a moderate to high-prevalence zone.
The results from studies that focused on MS patients showed an increasing incidence of the pathology .
[7-9]
Prevalence of MS was estimated by Bohlega et al. to be 40/100,000, who also stated that MS may be under-
[7]
diagnosed.
Depression has been reported as one of the most common symptoms of MS with a risk of major depressive
disorder of 13%-30% and about 50% of lifetime prevalence . A direct physical link between depression and
[10]
multiple sclerosis has been reported. By studying atrophied areas of the brain of MS patients and healthy people
by magnetic resonance imaging, researchers could establish a concrete link. It seems that the hippocampus was
of lower volume in patients with MS. By analyzing saliva samples, the researchers also noticed that the level of
cortisol was particularly high in people with MS. Atrophy of the hippocampus and a high level of cortisol in the
body are biological parameters frequently associated with major depressive episodes .
[11]
The importance of depression among MS patients is unquestionable , as this symptom influences the
[12]
general health and the quality of life of MS patients . Therefore, focusing on studying the association
[13]
between MS and depression seems quite important.

This study aimed to assess the severity of depression and its predictors among multiple sclerosis patients in
Saudi Arabia.

METHODS
This study followed a cross-sectional study which design to test the hypothesis that some patients'
sociodemographic (e.g. age, gender, nationality, marital status, monthly income) and other characteristics
(e.g. received treatment or grade of disability) may be associated with higher grades of severity of depression
among MS patients.

Study area
During the period from November 2016 to May 2017, this study has been conducted by all geographical
regions of Saudi Arabia (i.e. the Southern, Northern, Eastern, Western, and Middle regions).

Study population and sampling
According to the Saudi Arabian National Multiple Sclerosis Registry , there are 2313 MS patients in Saudi Arabia.
[14]
Following a simple random sample, with a sampling fraction of 1/3, we invited 763 patients (coverage = 33%),
only 598 MS patients participated in this study (response rate = 78.4%).