Increased education is associated with decreased odds of depression in females, not males, with multiple sclerosis.

BACKGROUND: Contrasting with general population trends, there is no sex difference in rates of depression among people with multiple sclerosis (pwMS). Although increased education is protective against depression in the general population, data are equivocal in pwMS. OBJECTIVE: This study sought to evaluate whether sex moderates the relationship between education and depression in pwMS. METHODS: In a consecutively assessed sample of 1711 pwMS at a Canadian neuropsychiatry clinic, data were gathered regarding educational years, sex, age, Expanded Disability Status Scale (EDSS) scores, MS subtype, disease duration, and disease-modifying therapies (DMT). A logistic regression model was undertaken to assess whether sex interacted with education to predict depression (i.e., Hospital Anxiety and Depression Scale depression score ≥8), controlling for age, EDSS scores, MS subtype, disease duration, and DMT use (p < 0.05). A sex-stratified analysis clarified the interaction. RESULTS: Mean participant age was 43.1 years (SD = 10.6), 26.6% were male, mean education was 15.8 years (SD = 3.0), and median EDSS was 2.0 (IQR = 1.5-3.5). Controlling for covariates, sex moderated the link between education and depression (p = 0.001). Elevated schooling was linked to reduced odds of depression in females (OR = 0.92, 95% CI [0.88, 0.96], p < 0.001), but not in males (OR = 1.06, 95% CI [0.99, 1.13], p = 0.10). CONCLUSION: In summary, increased education predicts decreased odds of depression in female pwMS. No detected link between education and depression in males with MS differs from the general population, meriting further study.