{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T01:05:06Z","timestamp":1793754306878,"version":"4.6.1"},"reference-count":35,"publisher":"SAGE Publications","issue":"14","license":[{"start":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T00:00:00Z","timestamp":1761436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T00:00:00Z","timestamp":1761436800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000890","name":"National MS Society","doi-asserted-by":"publisher","award":["RG5063A4\/1\/RFA-2103-37392"],"award-info":[{"award-number":["RG5063A4\/1\/RFA-2103-37392"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000261","name":"multiple sclerosis society of canada","doi-asserted-by":"publisher","award":["EGID:P002\/903124"],"award-info":[{"award-number":["EGID:P002\/903124"]}],"id":[{"id":"10.13039\/501100000261","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We investigated the association between psychiatric morbidity in the 5-years pre-MS onset and subsequent disability (EDSS) scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We identified MS patients who visited an MS clinic in British Columbia, Canada (1991\u20132018) 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 (&gt;median) or hospitalizations (measures of \u201cpsychiatric morbidity burden\u201d) were associated with EDSS scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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) \u03b2\u2009=\u20090.17; 95% confidence interval (CI): 0.03\u20130.30). Associations were more pronounced in males (adj\u03b2\u2009=\u20090.43; 95% CI: 0.04\u20130.83), &lt;30\u2009years (adj\u03b2\u2009=\u20090.44; 95% CI: 0.15\u20130.73), relapsing-onset-MS (adj\u03b2\u2009=\u20090.22; 95% CI: 0.08\u20130.37) and high psychiatric-related physician visit burden (adj\u03b2\u2009=\u20090.23; 95% CI: 0.05\u20130.41), or hospitalizations (adj\u03b2\u2009=\u20090.48; 95% CI: 0.002\u20130.96).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585251382801","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T04:57:49Z","timestamp":1761541069000},"page":"1619-1628","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Psychiatric morbidity during the multiple sclerosis prodrome is associated with future disability"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8645-6134","authenticated-orcid":false,"given":"Anibal S","family":"Chertcoff","sequence":"first","affiliation":[{"name":"Department of Internal Medicine (Neurology), Health Sciences Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-0684","authenticated-orcid":false,"given":"Marta","family":"Ruiz-Alguer\u00f3","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fardowsa","family":"Yusuf","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinshan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1855-5595","authenticated-orcid":false,"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine, Dalhousie University, Nova Scotia Health, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-2535","authenticated-orcid":false,"given":"Helen","family":"Tremlett","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30076-5"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2020.1746645"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458518783662"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207843"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2016-110"},{"key":"e_1_3_3_7_2","article-title":"Psychiatric comorbidity is associated with disability progression in multiple sclerosis","volume":"1090","author":"McKay KA","year":"2018","unstructured":"McKay KA, Tremlett H, Fisk JD, et al. 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