Quality of life in patients with multiple sclerosis: The impact of fatigue and depression

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Abstract

Quality of Life (QOL) is impaired in multiple sclerosis (MS) in part due to physical disability. MS-associated fatigue (MSF) and depression (MSD) are common and treatable features of MS, which could also impact on QOL, independent of physical disability. We prospectively studied 60 consecutive patients with MS. QOL was assessed using Multiple Sclerosis Quality of Life (MSQOL)-54. Group differences in QOL scores were assessed after adjusting for Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS) and Hamilton Depression Inventory scores. MS patients were grouped into relapsing–remitting (RR) or secondary-progressive (SP), MSF (FSS≥5) or MS-nonfatigue (MSNF) (FSS≤4), and MSD or MS-nondepression (MSND). After accounting for disability and depression, fatigue was associated with impaired QOL with respect to health perception (p=0.03) and limitations due to physical dysfunction (p=0.008). After accounting for disability and fatigue, depression was associated with lower QOL with respect to health perception (p=0.02), sexual dysfunction (p=0.03), health distress (p=0.03), mental health (p=0.006), overall QOL (p=0.006), emotional dysfunction (p=0.04), and limitations due to emotional dysfunction (p=0.03). This study demonstrates that fatigue and depression are independently associated with impaired QOL in MS, after accounting for physical disability, suggesting that their recognition and treatment can potentially improve QOL.

Introduction

Quality of life (QOL) is significantly impaired in patients with multiple sclerosis (MS) compared to the general population [1], [2]. Recent studies have attempted to correlate advancing neurologic disability with impaired QOL in MS patients [2], [3], [4], [5], [6], [7], [8], [9]. However, advancing neurologic disability has been shown to only partly explain impaired QOL [2], [4], [5], [6], [7], [8]. This supports the hypothesis that factors other than neurologic disability play a role in the QOL of MS patients.

Fatigue is one of the most common and disabling symptoms in MS and has been reported in 53–90% of patients [10], [11], [12], [13], [14]. Depression is also commonly associated with MS and occurs in as many as 60% of patients [14], [15]. The impact of MS-fatigue (MSF) and MS-depression (MSD) on QOL, independent of the severity of neurologic disability, has not been clearly defined. Recognition of MSF and MSD and understanding their relationship to QOL is important because both pharmacological [16], [17] and nonpharmacological treatments can be effective in treating MSF and MSD [18], [19], [20], [21]. Treatment of MSF and MSD could potentially help improve QOL of MS patients, regardless of neurologic disability.

Because the impact of MSF and MSD on QOL is unclear, we designed a prospective study of 60 MS patients in a community-based MS clinic to help elucidate the relative contributions of these potentially treatable factors on QOL.

Section snippets

Patients

We prospectively interviewed and examined a consecutive series of clinically definite MS patients [22] over a 2-year period. Of 106 patients ages 18–60, we excluded patients for any of the following reasons: (1) primary-progressive MS (n=3); (2) unwillingness to participate (n=6); (3) other major neurologic or systemic diseases (n=10); (4) pregnancy (n=1); (5) family history of major depression (n=2); (6) exacerbation in the past 4 weeks (n=5); or (7) substance abuse (n=5).

To study as directly

Results

The results of the study are summarized in Table 1, Table 2, Table 3 and Fig. 1. The MSQOL-54 scores did not show any significant relationship with age, sex or disease duration (data not shown).

Discussion

This study shows that fatigue and depression are independent predictors of impaired QOL in MS patients. Previous studies have shown that SP patients have lower QOL scores compared to RR patients [2], and that neurologic disability is related to QOL impairment [2], [3], [4], [5], [6], [7], [8]. However, physical disability status seems to be only partially related to impaired QOL [2], [4], [5], [6], [7], [8]. This study shows that in addition to neurologic disability, fatigue and depression are

Acknowledgements

This study was supported by NIH-NINDS 1 K23 NS42379-01 (R. Bakshi). We are grateful to Dr. Barbara G. Vickrey and Dr. Lauren Krupp for helpful suggestions. We thank Donna Czarnecki, PhD, Licensed Psychologist, Dent Neurologic Institute, Department of Physical Medicine and Rehabilitation, University at Buffalo, State University of New York, for performing the psychiatric interviews. We thank Elizabeth Lawler, MPH (Boston University) for statistical consultation.

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