Psychiatric morbidity during the multiple sclerosis prodrome is associated with future disability
Bibliographic record
Abstract
BACKGROUND: Evidence suggests a prodromal phase in multiple sclerosis (MS) identifiable via healthcare use, including psychiatric symptoms. The association between psychiatric morbidity in this phase and future outcomes remains unclear. OBJECTIVES: We investigated the association between psychiatric morbidity in the 5-years pre-MS onset and subsequent disability (EDSS) scores. METHODS: We identified MS patients who visited an MS clinic in British Columbia, Canada (1991-2018) and linked their clinical and population-based health administrative data. Psychiatric morbidity was identified using physician/hospital visits in the 5-years pre-MS onset. Multivariable generalized linear models examined the association between psychiatric morbidity and subsequent EDSS scores. We explored effect modification by sex, age, and MS course and investigated if high psychiatric-related physician visits (>median) or hospitalizations (measures of "psychiatric morbidity burden") were associated with EDSS scores. RESULTS: Among 2212 MS patients, 481 (21.7%) had psychiatric morbidity in the 5-years pre-MS onset. Follow-up averaged 5.2 (SD: 4.9) years (first-to-last EDSS assessment). Psychiatric morbidity pre-MS onset was associated with higher post-diagnosis EDSS scores (covariate-adjusted[adj) β = 0.17; 95% confidence interval (CI): 0.03-0.30). Associations were more pronounced in males (adjβ = 0.43; 95% CI: 0.04-0.83), <30 years (adjβ = 0.44; 95% CI: 0.15-0.73), relapsing-onset-MS (adjβ = 0.22; 95% CI: 0.08-0.37) and high psychiatric-related physician visit burden (adjβ = 0.23; 95% CI: 0.05-0.41), or hospitalizations (adjβ = 0.48; 95% CI: 0.002-0.96). CONCLUSIONS: Psychiatric morbidity before MS recognition was associated with increased future disability, particularly in males, younger individuals, relapsing-onset-MS, and high pre-MS onset psychiatric morbidity burden.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".