Depression and fatigue in patients with multiple sclerosis

Emily E Greeke; Alicia S Chua; Brian C Healy; David J Rintell; Tanuja Chitnis; Bonnie I Glanz

doi:10.1016/j.jns.2017.07.047

Depression and fatigue in patients with multiple sclerosis

J Neurol Sci. 2017 Sep 15:380:236-241. doi: 10.1016/j.jns.2017.07.047. Epub 2017 Jul 31.

Authors

Emily E Greeke¹, Alicia S Chua¹, Brian C Healy², David J Rintell³, Tanuja Chitnis⁴, Bonnie I Glanz⁵

Affiliations

¹ Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA.
² Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
³ Department of Neurology, Harvard Medical School, Boston, MA, USA.
⁴ Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
⁵ Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA. Electronic address: bglanz@bwh.harvard.edu.

PMID: 28870578
DOI: 10.1016/j.jns.2017.07.047

Abstract

Background: Previous research has examined the components of depression and fatigue in multiple sclerosis (MS), but the findings have been inconsistent. The aim of this study was to explore the associations between overall and subscale scores of the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Modified Fatigue Impact Scale (MFIS) as well as the longitudinal changes in scores in a large cohort of MS patients.

Methods: MS subjects who completed a battery of patient reported outcome (PRO) measures including the CES-D and MFIS (N=435) were included in our analysis. At the first available MFIS measurement, Pearson's correlation coefficient was used to estimate the association between the CES-D and MFIS in terms of both total scores and subscale scores. In addition, the longitudinal change in each total score and subscale score was estimated using a linear mixed model, and the association between the measures in terms of longitudinal change was estimated using Pearson's correlation coefficient and linear mixed models.

Results: At baseline, 15% of subjects were classified as high on both depression and fatigue scales, 16% were classified as high on the fatigue scale only, and 9% were classified as high on the depression scale only. There was a high correlation between CES-D and MFIS total scores (r=0.62). High correlations were also observed between the somatic and retarded activity subscales of the CES-D and each of the MFIS subscales (r≥0.60). In terms of longitudinal change, the change over the first year between the CES-D and MFIS total scores showed a moderate correlation (r=0.49). Subjects with high fatigue scores but low depression scores at baseline were more likely than subjects with low baseline fatigue and depression scores to develop high depression scores at follow-up.

Conclusions: Our study demonstrated that depression and fatigue in MS share several features and have a similar longitudinal course. But using cut-off scores to define depression and fatigue, our study also found that non-depressed subjects with high fatigue may be at a greater risk for developing depression.

Keywords: Depression; Fatigue; Multiple sclerosis; Patient reported outcomes; Quality of life.

MeSH terms

Adult
Depression / diagnosis
Depression / etiology*
Disability Evaluation
Fatigue / diagnosis
Fatigue / etiology*
Female
Humans
Linear Models
Male
Middle Aged
Multiple Sclerosis / complications*
Multiple Sclerosis / psychology
Psychiatric Status Rating Scales
Quality of Life
Severity of Illness Index
Surveys and Questionnaires