Depression, Fatigue Influence Health-related Quality of Life More Than Physical Impairment of MS, Study Reveals

Depression and fatigue have a more powerful influence on the overall health-related quality of life, compared to physical impairment, among patients with multiple sclerosis, a new study shows.

The study, “Contributing factors to health‐related quality of life in multiple sclerosis,” was published in the journal Brain and Behaviour.

Many people with MS experience impairments and restrictions to their everyday lifestyles. Consequently, several studies have established that  health-related quality of life  is significantly lower in MS patients compared to the general population.

Lower household income, higher disability (measured through the EDSS score), lower score on the 9‐hole‐peg test (a measure of upper extremity function), weaker coping capacity, and a more debilitating and progressive disease course are all known contributors to lower health-related quality of life (HRQoL) among MS patients.

Apart from physical symptoms, MS patients also can develop cognitive and psychological symptoms at any stage of the disease. Some studies have shown that the non-physical symptoms of the disease, particularly depression and cognitive impairment, often have a greater influence on HRQoL of MS patients, compared to their physical state or other characteristics.

In this study, a group of Hungarian researchers set out to further explore the effects of sociodemographic, clinical and psychological characteristics on the HRQoL of patients with MS.

Researchers recruited 322 patients with relapsing-remitting MS (RRMS), median age of 42.96 at enrollment, who filled out the Fatigue Impact Scale (FIS) to measure levels of fatigue, the Beck Depression Inventory (BDI) to evaluate presence of depression, and the Brief International Cognitive Assessment for MS (BICAMS) test to measure cognitive impairment.

HRQoL was assessed using the MS Quality of Life‐54 (MSQoL‐54) questionnaires, which is composed of 14 individual subscales to evaluate different contributors to quality of life, such as pain, physical health, cognitive function, energy, satisfaction with sexual function, and social function.

Results showed that approximately half of the patients in the study demonstrated cognitive impairment (50.9%), and fatigue (52.2%). Depression was present in 27% of patients.

Depression and fatigue had the most widespread and robust effect on the overall HRQoL score, as well as on all of the 14 subscales.

Fatigue, in general, had the strongest influence on all of the subscales.

Other factors, including age, education, and EDSS (disability level), had a slight effect on some of the subscales when the entire group was evaluated. In particular, EDSS was found to negatively affect physical aspects of HRQoL, while educational status was associated with an impact on the social domain: “Patients with more than 12 years of education evaluated their social life to be negatively affected by the disease,” researchers wrote.

Surprisingly, perhaps, impairment appeared to be only a minor contributor.

Researchers also explored the potential differences between genders, considering that there are known differences between men and women regarding prognosis and symptoms.

The team found that of all the aspects examined, depression and fatigue were the only variables to have a major impact on all 14 examined domains (categories) of HRQoL for both men and women. Differences were seen, however, between genders in ten HRQoL subscales.

For men, their physical status and age had a more profound and powerful impact on more subscales than it did for women. Additionally, cognitive impairment for men was a negative contributor for the overall quality of life, role limitation due to emotional problems, sexual function, and satisfaction with sexual function.

“Psychopathological symptoms have a more powerful influence on the HRQoL of MS patients than physical impairment, also these symptoms influence men’s and women’s HRQoL with different power,” researchers wrote.

“This invokes the need for complex and personalized care in the treatment of PwMS [people with MS]. Ours is the first study to show a difference between the sexes in this regard,” the team concluded.