Associations of Fatigue with Depression, Pain, and EDSS Score in a Large Community Sample of Patients with Multiple Sclerosis.

TitleAssociations of Fatigue with Depression, Pain, and EDSS Score in a Large Community Sample of Patients with Multiple Sclerosis.
Publication TypeJournal Article
AuthorsChwastiak LA, Ehde DM, Gibbons LE, Kraft GH
JournalInternational Journal of MS Care

Background: Fatigue is a common and disabling symptoms in Multiple Sclerosis (MS). Seventy five to ninety five percent (75-95 %) of patients complain of fatigue; it is a major reason for unemployment. Depression is strongly associated with fatigue, but previous work attempting to correlate fatigue and severity of MS illness has produced conflicting results. Pain may complicate the subjective experience of fatigue. This study examines a large community sample of patients with MS and the relationships among depression, severity of MS illness, pain, and fatigue. We examine the impact of fatigue on three areas of functioning: physical, cognitive and psychosocial. Methods: A mail survey was sent to 1,389 members of the King County (WA) MS Association; 739 subjects returned the survey, for a response rate of 53%. Data was collected about demographics and employment and history of MS. Depression was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D). Severity of illness was determined by a self-report version of the Kurtzke Expanded Disability Status Scale (EDSS). Fatigue was evaluated by questions from the Modified Fatigue Impact Scale (MFIS). Questions about pain intensity and degree of interference in daily activities were from the MS Quality of Life Inventory. Results: Depression was strongly associated with fatigue, after controlling for the effects of age, gender, marital status, social support, and severity and duration of illness. It was the strongest predictor in cognitive and psychosocial aspects of fatigue. EDSS score was the strongest predictor of physical limitations due to fatigue, and was strongly associated with the other aspects. Conclusions: Depression and EDSS score are important factors in fatigue in this large community sample of patients with MS. A multidimensional approach to fatigue that addresses physical, cognitive, and psychosocial effects may be useful for clinicians. This may identify processes that contribute to the subjective experience of fatigue and direct treatment interventions.

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