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


      • 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.



      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.


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


      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).


      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.


      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.



      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)
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