Improvement in depressive symptoms is associated with sustained improvement in fatigue impact in adults with multiple sclerosis

• Published in: Multiple sclerosis and related disorders 2024-12, Vol.92, p.106158, Article 106158
• Main Authors: Knowles, Lindsey M., Mistretta, Erin G., Arewasikporn, Anne, Hugos, Cinda L., Cameron, Michelle H., Haselkorn, Jodie K., Turner, Aaron P.
• Format: Article
• Language: English
• Subjects: Adult; Depression; Depression - etiology; Depression - therapy; Fatigue; Fatigue - etiology; Fatigue - therapy; Female; Humans; Male; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Nonpharmacological intervention; Self-Management
• ISSN: 2211-0348; 2211-0356; 2211-0356
• DOI: 10.1016/j.msard.2024.106158

•Reduced depressive symptoms predicts improved cognitive fatigue in adults with MS.•Reduced depressive symptoms predicts improved physical fatigue in adults with MS.•Reduced depressive symptoms predicts improved psychosocial fatigue in adults with MS.•Future research should examine targeting depressive symptoms for MS fatigue management. Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). Behavioral interventions that target one or more behaviors such as sleep hygiene, exercise, energy management, cognitive processes, as well as mood have been shown to reduce fatigue in people with MS. Yet, little is known about mechanisms of intervention effects on MS fatigue. Research suggests that depressive symptoms may be an important intervention target for improving MS fatigue. This study examined the association between pre- to post-intervention improvement in depressive symptoms and improvement in MS fatigue impact from pre-intervention through six months post-intervention. This study is a secondary analysis of data from a randomized controlled trial comparing a fatigue self-management intervention to general MS education for improving fatigue in people with MS. Adults with MS (N = 218) were recruited for the parent trial from the Portland, Seattle, Baltimore, and North Florida/South Georgia VA Medical Centers, affiliated academic medical centers, and surrounding communities. Both study interventions showed similar efficacy, so participants were combined into one sample for this secondary analysis. Structural equation modeling was used to examine whether clinically significant change in depressive symptoms (a 17.5 % reduction in the total Beck Depression Inventory-II score) from pre- to post-intervention, was associated with improvement in fatigue impact on the physical, cognitive, and psychosocial subscales of the Modified Fatigue Impact Scale from pre-intervention through six-month follow-up. Participants were predominantly female (72 %), middle-aged (M = 53.7 ± 10.1), and White (76 %) with a disease duration of 12.5 ± 8.4 years. Over half of the sample (58 %) had relapsing-remitting MS. Clinically significant improvement in depressive symptoms was associated with reduction in physical fatigue impact (β = -0.17, p = .004, 95 % CI [-0.28, -0.05]), cognitive fatigue impact (β = -0.20, p = .000, 95 % CI [-0.31, -0.10]), and psychosocial fatigue impact (β = -0.13, p = .03, 95 % CI [-0.25, -0.01]) through the six-month follow-up contr