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Table 6. Severity of depression among multiple sclerosis patients according to their received drugs and disability
level
Variables Severity of depression, n (%) P value
Absent Minimal Mild Moderate Moderately Severe
severe
Drugs < 0.001
Betaferon 8 (5.5) 28 (19.2) 44 (30.1) 32 (21.9) 22 (15.1) 12 (8.2)
Rebif 2 (1.8) 18 (15.8) 30 (26.3) 24 (21.1) 24 (21.1) 16 (14.0)
Avonex 0 (0.0) 24 (23.5) 28 (27.5) 20 (19.6) 16 (15.7) 14 (13.7)
Aubagio 0 (0.0) 0 (0.0) 6 (30.0) 12 (60.0) 2 (10.0) 0 (0.0)
Tecfidera 0 (0.0) 4 (22.2) 4 (22.2) 4 (22.2) 4 (22.2) 2 (11.1)
Gilenya 4 (3.8) 10 (9.4) 44 (41.5) 22 (20.8) 14 (13.2) 12 (11.3)
Tysabri 0 (0.0) 2 (4.3) 14 (30.4) 24 (52.2) 4 (8.7) 2 (4.3)
Rituxan 0 (0.0) 0 (0.0) 2 (50.0) 2 (50.0) 0 (0.0) 0 (0.0)
Lemetrada 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2 (100.0)
Disability level < 0.001
Mild 14 (4.4) 78 (24.5) 98 (30.8) 76 (23.9) 38 (11.9) 14 (4.4)
Moderate 0 (0.0) 16 (7.5) 74 (34.9) 60 (28.3) 28 (13.2) 34 (16.0)
Severe 0 (0.0) 4 (5.9) 12 (17.6) 12 (17.6) 24 (35.3) 16 (23.5)

The significant association between disability and depression has been emphasized by several studies. Noh
et al. noted that physical disability is significantly related to depressive symptoms. People with physical
[24]
disability experience multiple risk factors for depressive symptoms, including stereotypic social and personal
attitude, abuse, loss of roles, and stressors related to poverty, environmental barriers, and/or lack of access
[25]
to appropriate health care. Hughes et al. added that substantial evidence shows that people living with
physical disabilities are at least three times more likely to experience depression compared to the general
population.

In conclusion, the severity of depression is mostly mild among MS patients, while only some have severe
depression. Depression severity is significantly related to the level of MS patients’ disability. Early support of
MS patients, especially 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.

DECLARATIONS
Authors’ contributions
Conception: Alhazzani AA, Ogran H, Abuhawi OH, Al-Hanash AM
Design: Alhazzani AA, Alqahtani MS
Supervision: Alhazzani AA
Materials: Alqahtani MS, AlQahtany RA, Alfaifi AA, Asiri AA, Asiri MA,
Data collection and/or processing: Abuhawi OH, Asiri AY, Al-Hanash AM, AlQahtany RA, Alfaifi AA, Asiri
AA
Analysis and/or interpretation: Alqahtani MS, Ogran H, Abuhawi OH, Al-Hanash AM, AlQahtany RA, Asiri
AA, Asiri MA
Literature review: Ogran H, Asiri AY, Alfaifi AA, Asiri AA, Asiri MA
Manuscript writing: Alhazzani AA, Asiri AY, AlQahtani MS
Critical review: Alhazzani AA

Data source and availability
Corresponding author may be contacted for any data inquiries.

Financial support and sponsorship
None.