All ETDs from UAB

Advisory Committee Chair

Stacey S Cofield

Advisory Committee Members

Lloyd J Edwards

Mark Beasley

Hemant K Tiwari

Angela M Stowe

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


The aim of this dissertation is to determine whether depression is associated with clinical (relapses and disability worsening) and MRI outcomes in multiple sclerosis (MS) by conducting a secondary data analysis of the CombiRx clinical trial. Psychiatric comorbidities, including depression are common in people living with MS (PwMS), often underreported, and contribute to reduced quality of life and mortality associated with the disease. Most clinical studies that have examined the relationship between depression, depression medication usage, and MS outcomes have been small, excluded participants with relapsing-remitting subtypes and severe depressive symptoms, and had relatively short study periods—all shortcomings this thesis addresses. Here, we investigate the associations among depression history (prevalence), depression medication usage, depression reporting (by clinical exam or self-report scale) and MS outcomes. We also make recommendations for the improvement of health-related quality of life of PwMS. Each depression-related component and its association with disease activity was summarized using multivariable linear and Cox regression, along with generalized estimating equations (GEE) for repeated measures. Depression history and depression medication usage were associated with an increase in disability worsening. Self-reported depression was associated with a decrease in disability worsening and an increased hazard of disability worsening. Our results indicate the need for more consistent and systematic comorbidity tracking mechanisms in clinical trials and indicate that the presence of comorbid depression or history of depression medication usage is not sufficient to capture the scope of a psychiatric comorbidity. Participants must be asked about their mental health status. Access to participant health data will help healthcare practitioners identify and treat comorbidities in a timely and comprehensive manner, which may help slow disease worsening and improve quality of life for PwMS. Studies which investigate comorbidity severity and MS outcomes are warranted.

Included in

Public Health Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.