The Effect of Depression on Health-Related Quality of Life Is Mediated by Fatigue in Persons with Multiple Sclerosis

Abstract

The interrelations between fatigue, depression and health-related quality of life (HRQoL) in persons with multiple sclerosis (PwMS) are complex, and the directionality of the effects is unclear. To address this gap, the current study used a longitudinal design to assess direct and indirect effects of fatigue and depression on HRQoL in a one-year follow-up survey. A sample of 210 PwMS from the nationwide Swiss MS Registry was used. HRQoL was assessed using the European Quality of Life 5-Dimension 5-Level questionnaire. Path analysis on HRQoL, with fatigue and depression as predictors, was applied. Fatigue was measured by the Modified Fatigue Impact Scale (MFIS), including physical, cognitive and psychosocial subscales, and non-somatic depressive symptomatology was examined with the Beck Depression Inventory-Fast Screen (BDI-FS). Fatigue acted as a fully mediating variable (B = −0.718, SE = 0.253) between non-somatic depressive symptomatology and HRQoL. This indirect effect became apparent in the physical (B = −0.624, SE = 0.250), psychosocial (B = −0.538, SE = 0.256) and cognitive subscales (B = −0.485, SE = 0.192) of fatigue. In contrast, non-somatic depressive symptomatology did not act as a mediator. Our findings provide novel and clinically relevant longitudinal evidence showing that the debilitating effect of non-somatic aspects of depression on HRQoL was fully mediated and therefore explainable via fatigue.

The mediating effect of sleep quality and fatigue between depression and renal function in nondialysis chronic kidney disease: a cross-sectional study

“…Fatigue and sleep disturbances are among the criteria that define depression [ 20 , 23 , 28 ]. Although their relationship is closely related and complex, our findings were supported by a longitudinal study by Rodgers et al who indicated that the impact of depression on health-related quality of life (HRQoL) would be mediated by fatigue [ 52 ]. Disappointed and depressed about illness, can worsen patients' emotional state, make them feel fatigued, decrease vitality and even affect their sleep quality [ 23 ].…”

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis

“…Patients with MS (PwMS) show a large variety of disabling symptoms that considerably reduce their health-related quality of life (QoL) in comparison to other neurological diseases [11]. MS evolves with different motor, somatosensory, and psychocognitive impairments that reduce a patient's functional capacity, such as muscle tone disorders [12] including spasticity, a decrease in range of motion and the body's mobility [13], and an increase in the level of physical fatigue.…”

The Cortical Silent Period and Its Association with Fatigue in Multiple Sclerosis: The Need for Standardized Data Collection

“…Fatigue, as one of the most prevalent "hidden symptoms" of multiple sclerosis, has a high impact on the quality of life, employment status, capacity to work, and sick leave [4]. Recent studies demonstrated not only a strong overlap of fatigue and depression but also a mutually reinforcing relationship between fatigue and depression contributing to a diminished quality of life [6,51]. Therefore, an objective diagnostic approach is crucial to identify fatigue and to enable patient monitoring and response to interventions.…”