Depression is a predictor for balance in people with multiple sclerosis


      • Balance impairments are common in people with MS.
      • Depression is a frequent disorder in individuals with MS.
      • Depression is a predictor for balance deficits in people with MS.
      • Management of persons with MS should cover both physical and psychological impairments.



      Balance impairments are common and multifactorial among people with multiple sclerosis (MS). Depression is the most common psychological disorder in MS population and is strongly correlated with MS disease. Depression might be one of the factors that contribute to balance deficits in this population. However, the relationship between depression and balance impairments has not been explored in people with MS.


      To investigate the association between depression and balance impairments in people with MS.


      Cross sectional design was used in patients with MS. The Activities-specific Balance Confidence scale (ABC) and Berg Balance Scale (BBS) was used to assess balance. Beck Depression Inventory (BDI-II) was used to quantify depression and Kurtizki Expanded Disability Status Scale (EDSS) was utilized for the evaluation of MS disability severity. Pearson correlation coefficient was used to examine the association between depression and balance measurements. Multiple linear stepwise regressions were also conducted to find out if depression is a potential predictor for balance deficits.


      Seventy-five individuals with MS (Female = 69%) with a mean age (SD) of 38.8 (10) and a mean (SD) EDSS score of 3.0 (1.4) were recruited in this study. Depression was present in 53% of the patients. Depression was significantly correlated with balance measurements and EDSS. However, multiple linear stepwise regressions found that only depression and age significantly predict balance.


      Depression and balance were found frequent and associated in people with MS. Importantly depression was a significant predictor for balance impairments in individuals with MS. Balance rehabilitation may be hindered by depression. Therefore, depression should be evaluated and treated properly in individuals with MS.


      To read this article in full you will need to make a payment


        • Abdel-Khalek A.M.
        Internal consistency of an Arabic adaptation of the beck depression inventory in four Arab countries.
        Psychol. Rep. 1998; 82: 264-266
        • Alghwiri A.A.
        The correlation between depression, balance, and physical functioning post stroke.
        J. Stroke Cerebrovasc. Dis. 2016; 25: 475-479
        • Alghwiri A.A.
        • Alghadir A.H.
        • Al-Momani M.O.
        • Whitney S.L.
        The activities-specific balance confidence scale and berg balance scale: reliability and validity in Arabic-speaking vestibular patients.
        J. Vestibular Res. 2016; 25: 253-259
        • Alghwiri A.A.
        • Marchetti G.F.
        • Whitney S.L.
        Content comparison of self-report measures used in vestibular rehabilitation based on the international classification of functioning, disability and health.
        Phys. Ther. 2011;
        • Amato M.P.
        • Ponziani G.
        • Rossi F.
        • Liedl C.L.
        • Stefanile C.
        • Rossi L.
        Quality of life in multiple sclerosis: the impact of depression, fatigue and disability.
        Mult. Scler. 2001; 7: 340-344
        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch. Gen. Psychiatry. 1961; 4: 561-571
        • Burschka J.M.
        • Keune P.M.
        • Oy U.H.
        • Oschmann P.
        • Kuhn P.
        Mindfulness-based interventions in multiple sclerosis: beneficial effects of Tai Chi on balance, coordination, fatigue and depression.
        BMC Neurol. 2014; 14: 165
        • Cameron M.H.
        • Lord S.
        Postural control in multiple sclerosis: implications for fall prevention.
        Curr. Neurol. Neurosci. Rep. 2010; 10: 407-412
        • Cattaneo D.
        • De Nuzzo C.
        • Fascia T.
        • Macalli M.
        • Pisoni I.
        • Cardini R.
        Risks of falls in subjects with multiple sclerosis.
        Arch. Phys. Med. Rehabil. 2002; 83: 864-867
        • Cavanaugh J.T.
        • Gappmaier V.O.
        • Dibble L.E.
        • Gappmaier E.
        Ambulatory activity in individuals with multiple sclerosis.
        J. Neurol. Phys. Ther. 2011; 35: 26-33
        • Chwastiak L.
        • Ehde D.M
        • Gibbons L.E.
        • Sullivan M.
        • Bowen J.D.
        • Kraft G.H.
        Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample.
        Am. J. Psychiatry. 2002; 159: 1862-1868
        • Comber L.
        • Galvin R.
        • Coote S.
        Gait deficits in people with multiple sclerosis: a systematic review and meta-analysis.
        Gait Posture. 2017; 51: 25-35
        • Fritz N.E.
        • Marasigan R.E.
        • Calabresi P.A.
        • Newsome S.D.
        • Zackowski K.M.
        The impact of dynamic balance measures on walking performance in multiple sclerosis.
        Neurorehabilit. Neural Repair. 2015; 29: 62-69
        • Frzovic D.
        • Morris M.E.
        • Vowels L.
        Clinical tests of standing balance: performance of persons with multiple sclerosis.
        Arch. Phys. Med. Rehabil. 2000; 81: 215-221
        • Huffman J.C.
        • Doughty C.T.
        • Januzzi J.L.
        • Pirl W.F.
        • Smith F.A.
        • Fricchione G.L.
        Screening for major depression in post-myocardial infarction patients: operating characteristics of the Beck Depression Inventory-II.
        Int. J. Psychiatry Med. 2010; 40: 187-197
        • Huisinga J.M.
        • Yentes J.M.
        • Filipi M.L.
        • Stergiou N.
        Postural control strategy during standing is altered in patients with multiple sclerosis.
        Neurosci. Lett. 2012; 524: 124-128
        • Kasser S.L.
        • Jacobs J.V.
        • Foley J.T.
        • Cardinal B.J.
        • Maddalozzo G.F.
        A prospective evaluation of balance, gait, and strength to predict falling in women with multiple sclerosis.
        Arch. Phys. Med. Rehabil. 2011; 92: 1840-1846
        • Klevan G.
        • Jacobsen C.O.
        • Aarseth J.H.
        • Myhr K.M.
        • Nyland H.
        • Glad S.
        • et al.
        Health related quality of life in patients recently diagnosed with multiple sclerosis.
        Acta Neurol. Scand. 2014; 129: 21-26
        • Kornetti D.L.
        • Fritz S.L.
        • Chiu Y.P.
        • Light K.E.
        • Velozo C.A.
        Rating scale analysis of the Berg Balance Scale.
        Arch. Phys. Med. Rehabil. 2004; 85: 1128-1135
        • Kose N.
        • Cuvalci S.
        • Ekici G.
        • Otman A.S.
        • Karakaya M.G.
        The risk factors of fall and their correlation with balance, depression, cognitive impairment and mobility skills in elderly nursing home residents.
        Saudi Med. J. 2005; 26: 978-981
        • Kurtzke J.F.
        Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).
        Neurology. 1983; 33: 1444-1452
        • Larocca N.
        Impact of walking impairment in multiple sclerosis: perspectives of patients and care partners.
        Patient. 2011; 4: 189-201
        • LaRocca N.
        • Scheinberg L.
        • Kaplan S.
        Disease characteristics and psychological status in multiple sclerosis.
        J. Neurol. Rehabil. 1987; 1: 171-178
        • Martin C.L.
        • Phillips B.A.
        • Kilpatrick T.J.
        • Butzkueven H.
        • Tubridy N.
        • McDonald E.
        • et al.
        Gait and balance impairment in early multiple sclerosis in the absence of clinical disability.
        Mult. Scler. 2006; 12: 620-628
        • Millefiorini Enrico
        • Padovani A
        • Pozzilli C
        • Loriedo C
        • Bastianello S
        • Buttinelli C
        • et al.
        Depression in the early phase of MS: influence of functional disability, cognitive impairment and brain abnormalities.
        Acta Neurol. Scand. 1992; 86: 354-358
        • Mills N.
        • Allen J.
        • Carey-Morgan S.
        Does Tai Chi/Qi Gong help patients with multiple sclerosis.
        J. Bodyw. Move. Ther. 2000; 4: 39-48
        • Minden S.L.
        • Orav J.
        • Reich P.
        Depression in multiple sclerosis.
        Gen. Hosp. Psychiatry. 1987; 9: 426-434
        • Mohr DavidC.
        • Goodkin DonaldE.
        • Likosky W.
        • Beutler L.
        • Gatto N.
        • Langan MicheleK
        Identification of Beck Depression Inventory items related to multiple sclerosis.
        J. Behav. Med. 1997; 20: 407-414
        • Myers A.M.
        • Fletcher P.C.
        • Myers A.H.
        • Sherk W.
        Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale.
        J. Gerontol. A Biol. Sci. Med. Sci. 1998; 53: M287-M294
        • National Multiple Sclerosis Society
        (Who gets MS? (Epidemiology). Retrieved June 30, 2017, from
        Date: 2017
        • Nilsagard Y.
        • Carling A.
        • Forsberg A.
        Activities-specific balance confidence in people with multiple sclerosis.
        Mult. Scler. Int. 2012; (2012)613925
        • Nilsagard Y.
        • Denison E.
        • Gunnarsson L.G.
        • Bostrom K.
        Factors perceived as being related to accidental falls by persons with multiple sclerosis.
        Disabil. Rehabil. 2009; 31: 1301-1310
        • Nilsagard Y.
        • Lundholm C.
        • Denison E.
        • Gunnarsson L.G.
        Predicting accidental falls in people with multiple sclerosis—a longitudinal study.
        Clin. Rehabil. 2009; 23: 259-269
        • Patten S.B.
        • Beck C.A.
        • Williams J.V.A.
        • Barbui C.
        • Metz L.M.
        Major depression in multiple sclerosis: a population-based perspective.
        Neurology. 2003; 61: 1524-1527
        • Powell L.E.
        • Myers A.M.
        The Activities-specific Balance Confidence (ABC) Scale.
        J. Gerontol. A Biol. Sci. Med. Sci. 1995; 50A: M28-M34
        • Rabins P.V.
        • Brooks B.R.
        • O'Donnell P.
        • Pearlson G.D.
        • Moberg P.
        • Jubelt B.
        • et al.
        Structural brain correlates of emotional disorder in multiple sclerosis.
        Brain. 1986; 109: 585-597
        • Sadovnick A.D.
        • Remick R.A.
        • Allen J.
        • Swartz E.
        • Yee I.M.L.
        • Eisen K.
        • et al.
        Depression and multiple sclerosis.
        Neurology. 1996; 46: 628-632
        • Sandroff B.M.
        • Hillman C.H.
        • Benedict R.H.
        • Motl R.W.
        Acute effects of walking, cycling, and yoga exercise on cognition in persons with relapsing-remitting multiple sclerosis without impaired cognitive processing speed.
        J. Clin. Exp. Neuropsychol. 2015; 37: 209-219
        • Sandroff B.M.
        • Pilutti L.A.
        • Benedict R.H.
        • Motl R.W.
        Association between physical fitness and cognitive function in multiple sclerosis: does disability status matter.
        Neurorehabilit. Neural Repair. 2015; 29: 214-223
        • Shumway-Cook A.
        • Baldwin M.
        • Polissar N.L.
        • Gruber W.
        Predicting the probability for falls in community-dwelling older adults.
        Phys. Ther. 1997; 77: 812-819
        • Siegert R.J.
        • Abernethy D.A.
        Depression in multiple sclerosis: a review.
        J. Neurol. Neurosurg. Psychiatry. 2005; 76: 469-475
        • Spain R.I.
        • St George R.J.
        • Salarian A.
        • Mancini M.
        • Wagner J.M.
        • Horak F.B.
        • et al.
        Body-worn motion sensors detect balance and gait deficits in people with multiple sclerosis who have normal walking speed.
        Gait Posture. 2012; 35: 573-578
        • Steffen T.
        • Seney M.
        Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism.
        Phys. Ther. 2008; 88: 733-746
        • Thomas P.W.
        • Thomas S.
        • Hillier C.
        • Galvin K.
        • Baker R.
        Psychological interventions for multiple sclerosis.
        Cochrane Lib. 2006;
        • Van Emmerik R.E.
        • Remelius J.G.
        • Johnson M.B.
        • Chung L.H.
        • Kent-Braun J.A.
        Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue.
        Gait Posture. 2010; 32: 608-614
        • Whitlock F.A.
        • Siskind M.M.
        Depression as a major symptom of multiple sclerosis.
        J. Neurol. Neurosurg. Psychiatry. 1980; 43: 861-865
        • Wolkorte R.
        • Heersema D.J.
        • Zijdewind I.
        Reduced dual-task performance in MS patients is further decreased by muscle fatigue.
        Neurorehabilit. Neural Repair. 2015; 29: 424-435
      1. World Health Organization. (2008). Atlas multiple sclerosis resources in the world.