Advertisement

Depression, fatigue and disability are independently associated with quality of life in patients with multiple Sclerosis: Results of a cross-sectional study

      Highlights

      • Depression and fatigue are most closely associated with QoL in MS patients.
      • EDSS was only associated with QoL in patients with an EDSS ≤ 5.0.
      • Treatment of depression and physical exercise may improve QoL in MS patients.

      Abstract

      Background

      Quality of life (QoL) is significantly impaired in patients with Multiple Sclerosis (MS). As the expanded disability status scale (EDSS) inadequately reflects the impact of clinical symptoms on QoL, the present study aimed to identify factors associated with reduced QoL in MS patients.

      Design

      Single-center cross-sectional study in 260 MS patients.

      Methods

      QoL was assessed by the Multiple Sclerosis International QoL Questionnaire (MusiQoL), depression by the Center for Epidemiological Studies Depression Scale (CES-D scale), and fatigue by the Fatigue Scale for motor function and cognition (FSMC).

      Results

      79.6% patients were female and 21.4% male. The mean age was 44.5 ± 11.2 years and the median EDSS 3.0 (range 0.0–8.5). 35.8% had depression and 56.9% moderate to severe fatigue. The mean MusiQoL index score was 73.9 ± 11.3. Using linear regression, depression, fatigue, family status, physical activity, and occupation were associated with QoL. EDSS was only associated with QoL in patients with an EDSS 0.5.0.

      Conclusions

      Depression, fatigue, family status, physical activity, and occupational status were closely associated with QoL in MS patients. Potential measures to improve QoL include assessment and treatment of depression, physical exercise, and maintaining patients employed in accordance with their physical and mental disabilities.

      Keywords

      Abbreviations:

      MS (Multiple Sclerosis), EDSS (Expanded Disability Status Scale), QoL (Quality of life), HRQoL (Health related quality of life), SF-36 (36-Item short form survey), MuSIQoL (Multiple Sclerosis International QoL Questionnaire), RRMS (Relapsing-remitting Multiple Sclerosis), PPMS (Primary Progressive Multiple Sclerosis), SPMS (Secondary progressive MS), AMG (Medicinal Products Act), BfArM (Federal Institute for Drugs and Medical Devices), PEI (Paul Ehrlich Institute), CES-D scale (Center for Epidemiological Studies Depression Scale), FSMC (Fatigue Scale for motor function and cognition), ADL (Activity of daily living), PWB (Psychological well-being), SPT (Symptoms), RFr (Relationship with friends), RFa (Relationship with the family), SHCS (Satisfaction with health care), SSL (Sentimental and sexual life), COP (Coping), REJ (Rejection)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Baumstarck K.
        • Reuter F.
        • Boucekine M.
        • Aghababian V.
        • Klemina I.
        • Loundou A.
        • et al.
        Relevance of quality of life assessment for multiple sclerosis patients with memory impairment.
        PLoS ONE. 2012; 7: e50056
        • Baumstarck K.
        • Pelletier J.
        • Aghababian V.
        • Reuter F.
        • Klemina I.
        • Berbis J.
        • et al.
        Is the concept of quality of life relevant for multiple sclerosis patients with cognitive impairment? Preliminary results of a cross-sectional study.
        PLoS ONE. 2012; 7: e30627
        • Benito-León J.
        • Morales J.M.
        • Rivera-Navarro J.
        • Mitchell A.
        A review about the impact of multiple sclerosis on health-related quality of life.
        Disabil. Rehabil. 2003; 25: 1291-1303
        • Colosimo C.
        • Millefiorini E.
        • Grasso M.G.
        • Vinci F.
        • Fiorelli M.
        • Koudriavtseva T.
        et al. Fatigue in MS is associated with specific clinical features.
        Acta Neurol. Scand. 1995; 92: 353-355
        • Dalgas U.
        • Stenager E.
        • Ingemann-Hansen T
        Multiple sclerosis and physical exercise: recommendations for the application of resistance-, endurance- and combined training.
        Multiple Sclerosis. 2008; 14: 35-53
        • Dalgas U.
        • Stenager E.
        • Jakobsen J.
        • Petersen T.
        • Hansen H.J.
        • Knudsen C.
        • et al.
        Resistance training improves muscle strength and functional capacity in multiple sclerosis.
        Neurology. 2009; 73: 1478-1484
        • Dalgas U.
        • Stenager E.
        • Jakobsen J.
        • Petersen T.
        • Hansen H.J.
        • Knudsen C.
        • et al.
        Fatigue, mood and quality of life improve in MS patients after progressive resistance training.
        Multiple Sclerosis. 2010; 16: 480-490
        • Deutsche Gesellschaft für Neurologie
        Diagnose und therapie der multiplen sklerose Aus: hans-Christoph diener.
        in: Christian Weimar Leitlinien Für Diagnostik Und Therapie in Der Neurologie. Herausgegeben von Der Kommission "Leitlinien" Der Deutschen Gesellschaft Für Neurologie. Hrsg. Thieme Verlag, Stuttgart2012
        • Feinstein A.
        An examination of suicidal intent in patients with multiple sclerosis.
        Neurology. 2002; 59: 674-678
        • Fisk J.D.
        • Pontefract A.
        • Ritvo P.G.
        • Archibald C.J.
        • Murray T.J.
        The impact of fatigue on patients with multiple sclerosis.
        Canadian Journal of Neurological Sciences. 1994; 21: 9-14
        • Fisk J.D.
        • Brown M.G.
        • Sketris I.S.
        • Metz L.M.
        • Murray T.J.
        • Stadnyk K.J.
        A comparison of health utility measures for the evaluation of multiple sclerosis treatments.
        J. Neurol. Neurosur. Psychiatry. 2005; 76: 58-63
        • Flachenecker P.
        • Vogel U.
        • Simeoni M.C.
        MuSIQoL: international questionnaire investigating quality of life in multiple sclerosis: validation results for the german subpopulation in an international comparison.
        Nervenarzt. 2011; 82: 1281-1289
        • Flachenecker P.
        • Kobelt G.
        • Berg J.
        • Capsa D.
        • Gannedahl M.
        • European Multiple Sclerosis Platform
        New insights into the burden and costs of multiple sclerosis in Europe: results for Germany.
        Multiple Sclerosis. 2017; 23: 78-90
        • Göksel Karatepe A.
        • Kaya T.
        • Günaydn R.
        • Demirhan A.
        • Ce P.
        • Gedizlioğlu M.
        Quality of life in patients with multiple sclerosis: the impact of depression, fatigue, and disability.
        Int. J. Rehabilit. Res. 2011; 34: 290-298
        • D'Alisa S.
        • Miscio G.
        • Baudo S.
        • Simone A.
        • Tesio L.
        • Mauro A.
        Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study.
        Disabil Rehabil. 2006; 28: 307-314
        • Garg H.
        • Bush S.
        • Gappmaier E.
        Associations between fatigue and Disability, functional Mobility, Depression, and quality of life in people with multiple sclerosis.
        Int. J. MS Care. 2016; 18: 71-77
        • Hautzinger M.
        • Bailer M.
        Allgemeine Depressions Skala. Manual.
        Beltz Test GmbH, Göttingen1993
        • Hemmett L.
        • Holmes J.
        • Barnes M.
        • Russell N.
        What drives quality of life in multiple sclerosis?.
        QJM. 2004; 97: 671-676
        • Jelinek G.A.
        • De Livera A.M.
        • Marck C.H.
        • Brown C.R.
        • Neate S.L.
        • Taylor K.L.
        • et al.
        Lifestyle, medication and socio-demographic determinants of mental and physical health-related quality of life in people with multiple sclerosis.
        BMC Neurol. 2016; 16: 235
        • Jones E.
        • Pike J.
        • Marshall T.
        • Ye X.
        Quantifying the relationship between increased disability and health care resource utilization, quality of life, work productivity, health care costs in patients with multiple sclerosis in the US.
        BMC Health Serv. Res. 2016; 16: 294
        • Kobelt G.
        • Eriksson J.
        • Phillips G.
        • Berg J
        The burden of multiple sclerosis 2015: methods of data collection, assessment and analysis of costs, quality of life and symptoms.
        Multiple Sclerosis. 2017; 23: 4-16
        • Krupp L.B.
        • Alvarez L.A.
        • LaRocca N.G.
        • Scheinberg L.C.
        Fatigue in multiple sclerosis.
        Arch. Neurol. 1988; 45: 435-437
        • Latimer-Cheung A.E.
        • Martin Ginis K.A.
        • Hicks A.L.
        • Motl R.W.
        • Pilutti L.A.
        • Duggan M.
        • et al.
        Development of evidence-informed physical activity guidelines for adults with multiple sclerosis.
        Arch. Phys. Med. Rehabil. 2013; 94 (e7): 1829-1836
        • Livingston T.
        • Fay M.
        • Iyer R.
        • Wells W.
        • Pill M.W.
        Quantifying differences in health care consumption for the management of multiple sclerosis within privately and publicly insured health care programs.
        J. Manag. Care Spec. Pharm. 2016; 22: 1385-1391
        • Marrie R.A.
        • Horwitz R.
        • Cutter G.
        • Tyry T.
        • Campagnolo D.
        • Vollmer T.
        The burden of mental comorbidity in multiple sclerosis: frequent, underdiagnosed, and undertreated.
        Multiple Sclerosis. 2009; 15: 385-392
        • Miller A.
        • Dishon S.
        Health-related quality of life in multiple sclerosis: the impact of disability, gender and employment status.
        Qual. Life Res. 2006; 15: 259-271
        • Milo R.
        • Kahana E.
        Multiple sclerosis: geoepidemiology, genetics and the environment.
        Autoimmun. Rev. 2010; 9: A387-A394
        • Mirsky M.M.
        • Marrie R.A.
        • Rae-Grant A.
        Antidepressant drug treatment in association with multiple sclerosis disease-modifying therapy: using explorys in the MS population.
        Int. J. MS Care. 2016; 18: 305-310
        • Mohr D.C.
        • Goodkin D.E.
        • Likosky W.
        • Gatto N.
        • Baumann K.A.
        • Rudick R.A.
        Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis.
        Arch. Neurol. 1997; 54: 531-533
        • Mostert S.
        • Kesselring J.
        Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception and activity level of subjects with multiple sclerosis.
        Multiple Sclerosis. 2002; 8: 161-168
        • Nortvedt M.W.
        • Riise T.
        The use of quality of life measures in multiple sclerosis research.
        Multiple Sclerosis. 2003; 9: 63-72
        • Oken B.S.
        • Kishiyama S.
        • Zajdel D.
        • Bourdette D.
        • Carlsen J.
        • Haas M.
        et al. Randomized controlled trial of yoga and exercise in multiple sclerosis.
        Neurology. 2004; 62: 2058-2064
        • Patti F.
        • Cacopardo M.
        • Palermo F.
        • Ciancio M.R.
        • Lopes R.
        • Restivo D.
        et al. Health-related quality of life and depression in an Italian sample of multiple sclerosis patients.
        J. Neurol. Sci. 2003; 211: 55-62
        • Penner I.K.
        • Raselli C.
        • Stöcklin M.
        • Opwis K.
        • Kappos L.
        • Calabrese P.
        The Fatigue Scale for Motor and Cognitive Functions (FSMC): validation of a new instrument to assess multiple sclerosis-related fatigue.
        Multiple Sclerosis. 2009; 15: 1509-1517
        • Petajan J.H.
        • Gappmaier E.
        • White A.T.
        • Spencer M.K.
        • Mino L.
        • Hicks R.W.
        Impact of aerobic training on fitness and quality of life in multiple sclerosis.
        Ann. Neurol. 1996; 39: 432-441
        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Ann. Neurol. 2011; 69: 292-302
        • Raissi A.
        • Bulloch A.G.
        • Fiest K.M.
        • McDonald K.
        • Jetté N.
        • Patten S.B.
        Exploration of undertreatment and patterns of treatment of depression in multiple sclerosis.
        Int. J. MS Care. 2015; 17: 292-300
        • Rasova K.
        • Havrdova E.
        • Brandejsky P.
        • Zálisová M.
        • Foubikova B.
        • Martinkova P.
        Comparison of the influence of different rehabilitation programmes on clinical, spirometric and spiroergometric parameters in patients with multiple sclerosis.
        Multiple Sclerosis. 2006; 12: 227-234
        • Schmidt S.
        • Wonneberger M.
        Long-term endurance exercise improves aerobic capacity in patients with relapsing-remitting multiple sclerosis: impact of baseline fatigue.
        J. Neurol. Sci. 2014; 336: 29-35
        • Simeoni M.
        • Auquier P.
        • Fernandez O.
        • Flachenecker P.
        • Stecchi S.
        • Constantinescu C.
        et al. Validation of the multiple sclerosis international quality of life questionnaire.
        Multiple Sclerosis. 2008; 14: 219-230
        • Simmons R.D.
        • Tribe K.L.
        • McDonald E.A.
        Living with multiple sclerosis: longitudinal changes in employment and the importance of symptom management.
        J. Neurol. 2010; 257: 926-936
        • Sollom A.C.
        • Kneebone I.I.
        Treatment of depression in people who have multiple sclerosis.
        Multiple Sclerosis. 2007; 13: 632-635
        • Sutherland G.
        • Andersen M.B
        Exercise and multiple sclerosis: physiological, psychological, and quality of life issues.
        J. Sports Med. Phys. Fitness. 2001; 41: 421-432
        • The IFNB Multiple Sclerosis Study Group
        Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial.
        Neurology. 1993; 43: 655-661
        • Twork S.
        • Wiesmeth S.
        • Spindler M.
        • Wirtz M.
        • Schipper S.
        • Pöhlau D.
        • et al.
        Disability status and quality of life in multiple sclerosis: non-linearity of the Expanded Disability Status Scale (EDSS).
        Health Qual Life Outcomes. 2010; 8: 55
        • Vickrey B.G.
        • Hays R.D.
        • Harooni R.
        • Myers L.W.
        • Ellison G.W.
        A health-related quality of life measure for multiple sclerosis.
        Quality of Life Research. 1995; 4: 187-206
        • White L.J.
        • Dressendorfer R.H
        Exercise and multiple sclerosis.
        Sports Med. 2004; 34: 1077-1100
        • Wonneberger M.
        • Schmidt S.
        Changes of gait parameters following long-term aerobic endurance exercise in mildly disabled multiple sclerosis patients: an exploratory study.
        Eur. J. Phys. Rehabil. Med. 2015; 51: 755-762
        • Zorzon M.
        • de Masi R.
        • Nasuelli D.
        • Ukmar M.
        • Mucelli R.P.
        • Cazzato G.
        • et al.
        Depression and anxiety in multiple sclerosis. A clinical and MRI study in 95 subjects.
        J. Neurol. 2001; 248: 416-421