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Depression in multiple sclerosis (MS) is under-detected and undertreated, impacting quality of life. This study explored perspectives, practices, barriers, and facilitators to improve mental health care for people with MS. In the current study, participants, including 176 people with MS (M age = 48.4, 86.9% female) and 51 healthcare professionals (neurologists, MS nurses, allied health) from Australia, completed a 15-20-minute online survey on depression detection and management. Nearly half of participants with MS reported moderate-to-severe depressive symptoms, yet many had not been informed about depression in MS or assessed by their MS healthcare team. Clinicians acknowledged depression is common in MS and reported providing education routinely (51.0%) or sometimes (39.2%). While clinicians acknowledged a need for routine screening through MS healthcare services, this was rare (9.1%) and often deferred to general practitioners. Participants with MS and clinicians identified barriers, such as service access, limited time, role definition, stigma and need for brief clinician training and resources. This study highlights significant gaps in depression identification and management among people with multiple sclerosis (MS) emphasizing the need for integrated mental health support within MS healthcare services, including systematic assessment, monitoring and treatment procedures.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12622000543785.