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Depression mediates the relationship between fatigue and mental health-related quality of life in multiple sclerosis


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Fidao, A, De Livera, A, Nag, N, Neate, S, Jelinek, GA and Simpson-Yap, S ORCID: 0000-0001-6521-3056 2021 , 'Depression mediates the relationship between fatigue and mental health-related quality of life in multiple sclerosis' , Multiple Sclerosis and Related Disorders, vol. 47 , pp. 1-9 , doi: 10.1016/j.msard.2020.102620.

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Background: Fatigue is among the most prevalent symptoms for people with multiple sclerosis (pwMS) and is significantly detrimental to mental health-related (mental) quality of life (QoL). We examined the role of depression and physical activity as mediators in the fatigue-QoL relationship in pwMS. Methods: Using baseline cross-sectional data from an international cohort of 2,104 pwMS, characteristics of fatigue and mental QoL, measured by Fatigue Severity Scale and MSQOL-54 respectively, were assessed using linear and log-binomial regression. Structural Equation Models (SEM) were used to explore the mediating roles of depression and physical activity between fatigue and mental QoL. Results: The median mental QoL score was 71.9/100. The mean fatigue score was 41.5/63, with 65.6% participants having clinically significant fatigue. In the SEM evaluating depression as a mediator of the fatigue-QoL relationship, mental QoL was 14.72 points lower (95% CI: -16.43 -13.01, pConclusion: Depression accounted for the majority of the fatigue-mental QoL relationship when modelled as a mediator, while physical activity had only a minor role. Our findings may inform the development of treatments for reducing the impacts of fatigue and improving mental QoL in pwMS.

Item Type: Article
Authors/Creators:Fidao, A and De Livera, A and Nag, N and Neate, S and Jelinek, GA and Simpson-Yap, S
Keywords: multiple sclerosis, fatigue, quality of life, depression, mediation
Journal or Publication Title: Multiple Sclerosis and Related Disorders
Publisher: Elsevier B. V.
ISSN: 2211-0348
DOI / ID Number: 10.1016/j.msard.2020.102620
Copyright Information:

© 2020 The Authors. Published by Elsevier B.V. This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license (

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