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. 2019 Jan;16(1):59-64.
doi: 10.30773/pi.2018.10.22.3. Epub 2019 Jan 7.

Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors

So Hee Lee  1 , Hyoung-Shik Shin  2 , Hye Yoon Park  3 , Jeong Lan Kim  4 , Jung Jae Lee  5 , Haewoo Lee  6 , Sung-Doo Won  7 , Woori Han  1
Affiliations

Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors

So Hee Lee et al. Psychiatry Investig. 2019 Jan.

Abstract

Objective: The relationship among chronic fatigue, depressive symptoms, and post-traumatic stress symptoms (PTSSs) among Middle East respiratory syndrome (MERS) survivors is poorly understood.

Methods: Of 148 survivors who consented to be registered and underwent assessments at 12 months (T1) and 18 months (T2) after the MERS outbreak, 72 (48.65%) were evaluated for chronic fatigue, depressive symptoms, and PTSSs based on the Impact of Event ScaleRevised (IES-R), the Patient Health Questionnaire-9 (PHQ-9), and the Fatigue Severity Scale (FSS). Data from 52 subjects, who completed both assessments, were analyzed using a regression-based serial multiple mediation model (PROCESS Model 6).

Results: Bootstrap analyses indicated no direct effects of T1 FSS on T2 IES-R but significant positive indirect effects of T1 FSS on T2 IESR through T1 PHQ-9 and T2 PHQ-9 (B=2.1601, SE=1.3268, 95% confidence interval=0.4250-6.1307). In other words, both T1 PHQ-9 and T2 PHQ-9 fully mediated the relationship between T1 FSS and T2 IES.

Conclusion: Chronic fatigue 12 months after MERS had indirect effects on prolonged PTSSs 18 months after MERS via persisting depression in MERS survivors. This finding supports the need to promote interventional programs for emerging infectious disease survivors with chronic fatigue to reduce depression and prevent prolonged PTSSs.

Keywords: Chronic fatigue; Depression; Emerging infectious diseases; Middle East respiratory syndrome; Post-traumatic stress symptoms; Survivors.

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Figures

Figure 1.
Figure 1.
Model depicting the effect of severe fatigue, depression on post-trauma of MERS. **p<0.01, ***p<0.001. FSS: Fatigue Severity Scale, PHQ: Patient Health Quetionnaire-9, IES: Impact of Event Scale, T1: 12 months after MERS, T2: 18 months after MERS, c’: direct effect of X on Y (X=T1 FSS; Y=T2 IES), ns: not significant. MERS: Middle East respiratory syndrome.
See this image and copyright information in PMC

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