Fatigue and sleep disturbances predict depressive symptoms in people with Multiple Sclerosis

Introduction:Depressive symptoms is common in multiple sclerosis (MS), with about 50% risk of development. Depression exacerbates symptoms of multiple sclerosis (MS), where sleep disturbances, fatigue, and MS-related disabilities intensify depressive symptoms. This interaction is further complicated by social factors as well as impaired cognitive and motor functions.

Objective:To investigate potential predictors of anxiety and depression symptoms in people with MS.

Methods:Data from 241 persons diagnosed with MS, inserted in the BRANDO database from Sinapse Clinic were analyzed. Depressive symptoms were assessed using the Beck Depression and Anxiety Inventory (BDI and BAI) and the Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Predictive factors were: Expanded Disability Status Scale (EDSS) score, sleep disturbances, sphincter control, sexual dysfunction, manual dexterity (Nine Hole Peg Test – NHPT), short walking capacity (Timed 25-Foot Walk Test-T25FWT), processing speed (Symbol Digit Modality Test – SDMT) and fatigue (Modified Fatigue Impact Scale–MFIS). Both correlation and multiple regression – stepwise analyses were conducted.

Results:Significant yet weak correlations were found between depressive symptoms (across all scales) and sleep disturbances (R, 0.23 – 0.32, N=78), sphincter control (R, 0.25 – 0.33, N=78), NHPT (R, 0.17 – 0.21, N=228), and SDMT (R, -0.20 - -0.26, N=209). Moderate correlations were observed with EDSS (R, 0.33 – 0.42, N=231) and MFIS (R, 0.54 – 0.69, N=218). Multiple regression identified fatigue (MFIS) as the main predictor for BAI (R-Square = 0.51), and fatigue and sleep changes as main predictors for BDI (R-Square = 0.49), HADS-A (R-Square = 0.36), and HADS-D (R-Square = 0.58).

Conclusions:While depressive symptoms in MS are associated with a range of symptoms from motor to cognitive functions, the main predictors in this sample were fatigue and sleep disturbances. Future studies should assess how depressive symptoms may change in response to interventions targeting fatigue management, such as behavioral interventions and physical exercise.