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. 2021 Jun 5;11(6):751.
doi: 10.3390/brainsci11060751.

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

Stephanie Rodgers  1 , Zina-Mary Manjaly  2   3 , Pasquale Calabrese  4 , Nina Steinemann  1 , Marco Kaufmann  1 , Anke Salmen  5 , Andrew Chan  5 , Jürg Kesselring  6 , Christian P Kamm  5   7 , Jens Kuhle  8 , Chiara Zecca  9   10 , Claudio Gobbi  9   10 , Viktor von Wyl  1 , Vladeta Ajdacic-Gross  1   11
Affiliations

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

Stephanie Rodgers et al. Brain Sci. .

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.

Keywords: depression; fatigue; longitudinal; multiple sclerosis; quality of life.

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Conflict of interest statement

The authors’ disclosed a receipt of the following financial support for the research, authorship, or publication of this article. Salmen A. received speaker honoraria and travel compensation for activities with Almirall Hermal GmbH, Biogen, Merck, Novartis, Roche, and Sanofi Genzyme and research support from the Swiss MS Society. Kamm C.P. has received honoraria for lectures as well as research support from Biogen, Novartis, Almirall, Bayer Schweiz AG, Teva, Merck, Sanofi Genzyme, Roche, Eli Lilly, Celgene and the Swiss MS Society (SMSG). Chan A. has served on advisory boards for and received funding for travel or speaker honoraria from Actelion-Janssen, Almirall, Bayer, Biogen, Celgene, Sanofi-Genzyme, Merck, Novartis, Roche, and Teva, all for hospital research funds, and research support from Biogen, Genzyme and UCB. A. Chan is an associate editor of the European Journal of Neurology, serves on the editorial board for Clinical and Translational Neuroscience and is a topic editor for the Journal of International Medical Research. Stephanie Rodgers, Zina-Mary Manjaly, Pasquale Calabrese, Nina Steinemann, Marco Kaufmann, Jürg Kesselring, Jens Kuhle, Chiara Zecca, Claudio Gobbi, Viktor von Wyl and Vladeta Ajdacic-Gross declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart describing the study sample of the Swiss Multiple Sclerosis Registry (numbers reflect numbers of persons; status quo: 8 June 2020). Abbreviations: SMSR = Swiss MS Registry and HRQoL = Health-related quality of life.
Figure 2
Figure 2
Path analysis of the psychological predictors of depression and fatigue for health-related quality of life (EQ-VAS) in persons with MS (n = 206). The values on the arrows are unstandardized parameter estimates with standard errors. Bold indicates significance (p < 0.05). Abbreviations: IV = independent variable; DV = dependent variable; M = mediator; CV = covariates; MS = multiple sclerosis; BDI-FS = Beck Depression Inventory-Fast Screen; MFIS = Modified Fatigue Impact Scale; HRQoL = health-related quality of life; EQ-VAS = European Quality of Life 5-Dimension 5-Level version visual analogue scale; and EDSS = Expanded Disease Status Scale.
See this image and copyright information in PMC

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