Unique Psychological Burden of Fear of Progression Seen in MG

When fear of progression interferes with patients’ normal course of treatment, such as therapy adherence and daily functioning, their already significant psychological burden can be exacerbated and intervention may be necessary, according to the authors of a new study published in Scientific Reports focusing on this challenge for patients with myasthenia gravis.¹

“Currently, there [are] no established data on fear of progression among patients who have myasthenia gravis,” the study authors wrote. “Identifying these factors may assist us in identifying high-risk patients and developing effective intervention strategies to alleviate [their] fear of progression.”¹ This, despite previous research demonstrating patients who have myasthenia gravis may exhibit signs of mood and anxiety disorders or experience some form of psychological distress.^2-4

From January 2024 through November 2024, their cross-sectional study at First Affiliated Hospital of Nanchang University utilized patient data from medical records, Myasthenia Gravis Foundation of America (MGFA) classification, Myasthenia Gravis Activities of Daily Living (MG-ADL) score, and the Spielberger State-Trait Anxiety Inventory (STAI) for a comprehensive evaluation of patient disease severity and anxiety level. Fear of progression was evaluated using the Fear of Progression Short Form. There were 83 patients (49.4% female patients), most of whom were older than age 18 to 40 or younger (27.7%) and at least age 40 to younger than 65 years (44.6%), married (69.9%), freelancers (41.0%) or employed (31.3%), and had a top education level of junior high school (30.1%) or senior high school/associate degree (19.3% each).¹

Overall, the patients had MGFA class I disease (71.1%), the ocular subtype (71.1%), a disease course of more than 1 to less than 5 years (39.8%) or newly diagnosed (30.1%), were receiving corticosteroids (61.4%), and were receiving immunosuppressants (61.4%), but did not have a history of thymoma (90.4%), chronic comorbidities (51.8%), myasthenic crisis (96.4%), or disease progression (62.7%). The mean (SD) patient age was 45.18 (17.92) years.¹

Higher fear of disease progression scores was seen in females vs males, aged older than 18 to 40 years or younger vs 40 to younger than 65 years, and divorced vs single status. | Image Credit: © Maggie-sora.chatgpt.com

The patients’ mean total score for fear of progression was 31.36 (10.22), and drilling down to physical health and social/family aspects, the mean scores were 15.87 (5.27) and 15.49 (5.63), respectively—all indicating “comparable psychological stress both regarding physical health concerns and the impact of illness on social and family life,” according to the authors. Scores could range from 12 (minimum) to 60 (maximum) for social/family and from 6 to 30 for fear of progression and physiologic distress.¹

Patients were most afraid that medications would “damage their bodies,” with this question having the highest individual mean score of 3.14 (1.01), followed by being less productive at 2.96 (1.19) and inability to work at 2.89 (1.20). Also, according to the predetermined cut-off score for dysfunctional fear of progression, 38.6% of patients were classified as having this level of fear related to their myasthenia gravis. The authors also determined that neither age (P = .33), marital status (P = .53), disease course (P = .99), nor history of myasthenic crisis (P = .87) had an effect on this outcome; however, patients with a history of myasthenic crisis did have higher overall fear of progression scores vs those who did not have a history of myasthenic crisis (32.33 [2.08] vs 31.32 [10.40]).¹

Higher fear of progression scores were also seen in the following categories¹:

• Females vs males: 34.73 (9.48) vs 28.07 (9.94)
• Age older than 18 to 40 or younger vs age 40 to younger than 65 years: 33.52 (9.59) vs 29.05 (9.19)
• Divorced vs single: 39.00 (9.64) vs 31.81 (9.55)
• Retired vs unemployed: 37.20 (13.45) vs 27.46 (9.85)
• Bachelor’s degree or higher vs senior high school at most: 35.57 (7.89) vs 28.25 (8.93)
• Disease course of less than 1 year vs between 5 and 10 years: 31.72 (10.90) vs 30.56 (8.90)
• Disease progression vs no progression: 36.00 (7.75) vs 28.60 (10.58)
• Thymoma-associated vs ocular myasthenia gravis: 39.00 (2.83) vs 29.88 (vs 10.68)

There were no significant differences in MG-ADL or STAI scores among the patients, but gender (P = .002) and disease progression (P = .001) overall were the most significant influences on fear of progression.¹

The authors concluded that despite sharing psychological burdens with anxiety, fear of progression did not significantly correlate with anxiety scores, indicating that it may be a distinct clinical phenomenon. Their results highlight the need for routine assessment of fear of progression among patients who have myasthenia gravis, as it can have a significant impact on their quality of life. Tailored interventions that address individual risk factors and psychological needs are essential to improve patient outcomes.¹

References

1. Luo S, Xiong Y, Song Z, et al. A cross-sectional study on fear of progression in patients with myasthenia gravis. Sci Rep. 2025;15(1):26181. doi:10.1038/s41598-025-11806-0
2. Kulaksizoglu IB. Mood and anxiety disorders in patients with myasthenia gravis: aetiology, diagnosis and treatment. CNS Drugs. 2007;21(6):473-481. doi:10.2165/00023210-200721060-00004
3. Paul RH, Cohen RA, Goldstein JM, Gilchrist JM. Severity of mood, self-evaluative, and vegetative symptoms of depression in myasthenia gravis. J Neuropsychiatry Clin Neurosci. 2000;12(4):499-501. doi:10.1176/jnp.12.4.499
4. Qiu L, Feng HY, uang X, et al. [Study of incidence and correlation factors of depression, anxiety and insomnia in patients with myasthenia gravis]. Zhonghua Yi Xue Za Zhi. 2010;90(45):3176-3179.