The effect of fatigue and clinical course on depression, anxiety, stress, quality of life and employment status in patients with multiple sclerosis

Fatigue is a common symptom in multiple sclerosis (MS) and most MS patients are of two types; relapsing-remitting (RRMS) and secondary progressive (SPMS). Fatigue with regard to feeling of weakness, lack of energy and clinical course due to the establishment of a variable prognosis can influence psychological symptoms, functional ability and employment status of patients. Thus, the aim of the present study was to evaluate the effect of fatigue and clinical course on psychological symptoms, physical and psychological dimensions, and employment status. In this retrospective cross-sectional study, 152 patients were sampled by consecutive method. All patients were evaluated using fatigue severity scale (FSS), depression, anxiety, and stress scale (DASS-21) and short form health survey questionnaire (SF-36). Data were analyzed using multivariate variance analysis (MANOVA) and Fisher exact test. Mean of psychological symptoms and physical and psychological dimensions scores in fatigued and SPMS patients was worse than non-fatigued and RRMS groups. Also, un-employment was reported with higher frequency in fatigued patients. In this regard, no significant finding was observed between RRMS and SPMS. In addition, the difference between both groups of fatigued and non-fatigued, RRMS and SPMS patients was significant regarding the variables depression, anxiety, stress, and physical and psychological dimensions (p<0.05). This study explained the impact of fatigue and clinical course on psychological symptoms, physical and psychological aspects of life and employment status of MS patients. However, it seems that the influence of some variables on each other in a bidirectional relationship is also explainable. Clinical implications have been discussed in this report.