Patients With MS Report That Depression, Fatigue Have Strongest Effect on Quality of Life

Multiple sclerosis (MS) is known to be associated with lower health-related quality of life, and a new study adds evidence that depression and fatigue are the major drivers of this relationship.

Multiple sclerosis (MS) is known to be associated with lower health-related quality of life, and a new study adds evidence that depression and fatigue are the major drivers of this relationship.

The study, published in Brain and Behavior, reports findings in a cohort of 322 patients with relapsing-remitting MS. Investigators gathered the patients’ sociodemographic and clinical data, as well as their physical disability scores as measured by their neurologists, and administered several neuropsychiatric tests to the participants. Specifically, they were tested for cognitive impairment and completed questionnaires to assess their mood, fatigue, and health-related quality of life. These measures were selected based on prior literature showing that fatigue is among the most common MS symptoms and that cognitive impairment is linked with patients becoming unemployed.

According to the study authors, the impact of cognitive dysfunction and clinical disability on quality of life in MS has not been fully investigated. Their research aims were to determine the effects of patients’ sociodemographic and clinical characteristics, as well as psychological aspects of MS, on their health-related quality of life. They also wanted to identify the strongest contributors to quality of life and assess potential differences between men and women.

The cohort was composed of 68.4% women and had a mean (standard deviation [SD]) age of 43.0 (11.9) years. Patients had a mean (SD) disease duration of 12.5 (8.0) years and a mean (SD) physical impairment score of 1.95 (1.60). About half of the cohort had fatigue (52.2%) or cognitive impairment (50.9%), whereas the prevalence of depression was 27.0%.

Statistical analyses revealed that depression and fatigue were the only aspects to have a clinically meaningful negative influence on all 14 subscales of self-reported health-related quality of life. Age, disability score, and education had an effect on just 3, 2, and 1 subscales, respectively, and disease duration and cognitive impairment were not meaningful predictors of scores on any of the subscales.

Factors other than fatigue and depression reduced quality of life scores in 9 domains for men and 2 domains for women. For instance, cognitive impairment in men had a negative effect on overall quality of life, role limitation due to emotional issues, sexual function, and the subscale of satisfaction with sexual function. Men’s physical status and age, which the authors noted are interrelated aspects of physical decline, had a stronger negative effect on more subscales than they did for women.

These findings indicate that “the less evaluated, yet frequently prevalent psychological burdens of the disease (particularly depression and fatigue) are the main determinants of the self‐reported well‐being” of patients with MS, the authors wrote.

They suggested that depression, fatigue, cognitive ability, and other psychological aspects should be regularly assessed and tracked in patients with MS, similar to the need for regular physical examinations and imaging scans in this population.

The study “also proves the need for involvement of psychological and psychiatric specialists and teamwork for the proper management of patients burdened by MS, as many of these symptoms can be ameliorated and managed by not only a psychopharmacological, but by a psychotherapeutic approach as well,” they concluded.


Biernacki T, Sandi D, Kincses ZT, et al. Contributing factors to health-related quality of life in multiple sclerosis [published online November 11, 2019]. Brain Behav. doi: 10.1002/brb3.1466.