Relative Importance of Baseline Pain, Fatigue, Sleep, and Physical Activity: Predicting Change in Depression in Adults With Multiple Sclerosis.

TitleRelative Importance of Baseline Pain, Fatigue, Sleep, and Physical Activity: Predicting Change in Depression in Adults With Multiple Sclerosis.
Publication TypeJournal Article
AuthorsEdwards KA, Molton IR, Smith AE, Ehde DM, Bombardier CH, Battalio SL, Jensen MP
JournalArch Phys Med Rehabil
Date Published2016 Mar 23

OBJECTIVE: To determine whether baseline levels of pain, fatigue, sleep disturbance, and physical activity measured at the initial assessment predicted the development of or improvement of depression 3.5 years later, while controlling for sex, age, and disease severity. DESIGN: Observational, longitudinal survey study. SETTING: A community-based population sample. PARTICIPANTS: Adults with multiple sclerosis (MS) (N=489). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Primary outcome was classification of depression group measured using a Patient Health Questionnaire-9 cutoff score ≥10, indicating probable major depression. RESULTS: Fatigue severity (odds ratio, 1.19; 95% confidence interval, 1.12-1.26; P<.0001) and sleep disturbance (odds ratio, 1.06; 95% confidence interval, 1.02-1.10; P=.001) predicted probable major depression 3.5 years later among those not depressed at the initial assessment. An effect of age (odds ratio, .96; 95% confidence interval, .92-.99; P=.008) was found among those who developed depression, indicating that younger adults were more likely to develop depression. Pain, fatigue, sleep, and physical activity at baseline were not significantly associated with recovery from depression among those depressed at the initial assessment. CONCLUSIONS: Fatigue and sleep may contribute to the development of depression. Clinical trial research targeting these variables to determine their influence on depression is warranted.

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What was this research about?

               Depression, or low mood, is a common problem for people with multiple sclerosis (MS). However, not everyone with MS experiences depression. We can help prevent depression in people with MS by finding out what treatable problems make people more likely to become depressed. In this research, we looked at four problems that could be linked to low mood: chronic pain, chronic fatigue (feeling tired), sleep problems, and not exercising. We also looked at whether people with MS who develop depression over time are younger or older than those who do not.

What did the researchers do?

               We sent two surveys to about 500 people with MS. On the first survey, we asked them questions about their mood, as well as questions about pain, fatigue, trouble sleeping, and exercise. Then, we sent another survey about 4 years later with the same mood questions, to find out which of the respondents developed a depressed mood during the four years between surveys.

What did the researchers find?

               About one in four respondents said they were feeling depressed on the first survey. Of those who were not feeling depressed, about 7% became depressed by the time they completed the second survey. Younger respondents were more likely to become depressed than older respondents. This may be because older people have had more time to develop their coping skills. In addition, respondents who said they felt tired more often and those who had more trouble sleeping were more likely to become depressed. Pain and exercise habits had no effect on mood changes.

How can you use this research?

               Fatigue and sleep problems are two common issues for people with MS. You can help keep your mood up by learning to manage your energy and sleep better. A few things to try include:

  • Pace yourself. Many people tell us that saving their energy for important things and taking rest breaks helps them continue doing things they enjoy.
  • Mindfulness meditation can help you stave off fatigue and regulate your sleep.
  • Many people find that taking short naps during the day helps save energy. However, napping for too long can make it harder to sleep well at night.
  • Practice good sleep habits by waking up and going to bed around the same times each day. Try to follow a regular bedtime routine, and avoid alcohol and caffeine before bedtime.
  • Sometimes, counseling approaches such as cognitive-behavioral therapy can help you learn how to manage fatigue and sleep issues as well as keeping your mood up.

Things you should know:

PubMed ID27016262