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Page 6 of 10 Alhazzani et al. Neuroimmunol Neuroinflammation 2018;5:8 I http://dx.doi.org/10.20517/2347-8659.2017.55

Table 3. Distribution of participants by level of disability
Patient determined disease steps score Frequency Percent (%)
Mild (0-2) 318 53.2
Moderate (3-5) 212 35.5
Severe (6-8) 68 11.4
Total 598 100.0

Table 4. Distribution of participants by depression severity
Depression score and severity Frequency Percent (%)
No (0) 14 2.3
Minimal (1-4) 98 16.4
Mild (5-9) 184 30.8
Moderate (10-14) 148 24.7
Moderately severe (15-19) 90 15.1
Severe (20-27) 64 10.7
Total 598 100.0

DISCUSSION
Our study illustrated the severity MS disease among the surveyed patients using the PDDS score and the
depression severity using the PHQ score. Accordingly, almost half of participants had a PDSS score of 3 or
more (i.e. considered to have a moderate or severe disability, 35.5%, and 11.4%, respectively) and more than
one-fourth of them were considered to have moderately severe or severe depression.

These findings are in accordance with those of Siegert and Abernethy , who reported that depression is
[10]
one of the most frequently discovered psychiatric symptoms among MS patients. Moreover, Kister et al.
[19]
reported that the proportion of MS patients with PDDS score = 3 or more (i.e. moderate to severe disability)
reached 50% after 15 years of disease and 75% after 45 years.

Our study showed that about one-third of participants were males. About half of patients were married and
the monthly income of almost half of them (43.5%) was less than 3000 SR.

The female predilection observed among participants in the present study has been reported by Kingwell et al. , who
[20]
stated that, in the majority of studies, the prevalence of MS was higher in women, with gender ratios ranging
from 1.1 to 3. The high prevalence of MS-related disability among our patients may explain why only about
half of them are married and almost half of them have low monthly income (i.e. less than 3000 SR).

Results of the present study revealed that prevalence of depression differed significantly with our patients'
age and was significantly higher among women than men.

These findings are in accordance with those of Van de Velde et al. , who noted that depression is significantly
[21]
associated with gender and age. Women typically have a two-fold higher risk of major depression compared
to men. Moreover, Andrade et al. reported that prevalence of major depression is significantly associated
[22]
with younger age.

Findings of the present study revealed that severity of depression differed significantly according to patients’
educational level, being higher among those with higher education and lower among less educated patients.
Moreover, depression was significantly higher among patients with the lowest income (i.e. with monthly
income < 3000 SR).

[23]
Similarly, Kessler and Bromet reported that the poorest respondents in the WHO World Mental Health
surveys which were carried out in the USA and several European countries, showed about twofold increased