抑郁症状的改善与成人多发性硬化症患者疲劳影响的持续改善有关。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-11-05 DOI:10.1016/j.msard.2024.106158

Lindsey M. Knowles , Erin G. Mistretta , Anne Arewasikporn , Cinda L. Hugos , Michelle H. Cameron , Jodie K. Haselkorn , Aaron P. Turner

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引用次数: 0

摘要

背景：疲劳是多发性硬化症（MS）最常见的致残症状之一。针对睡眠卫生、运动、能量管理、认知过程以及情绪等一种或多种行为的行为干预已被证明可以减轻多发性硬化症患者的疲劳。然而，人们对干预对多发性硬化症疲劳的影响机制知之甚少。研究表明，抑郁症状可能是改善多发性硬化症疲劳的重要干预目标。本研究探讨了从干预前到干预后六个月期间，抑郁症状的改善与多发性硬化症疲劳影响的改善之间的关联：本研究是对一项随机对照试验数据的二次分析，该试验比较了疲劳自我管理干预与普通多发性硬化症教育对改善多发性硬化症患者疲劳的作用。母试验从波特兰、西雅图、巴尔的摩和北佛罗里达/南佐治亚退伍军人医疗中心、附属学术医疗中心及周边社区招募成年多发性硬化症患者（N = 218）。两项研究的干预效果相似，因此将参与者合并为一个样本进行二次分析。研究人员使用结构方程模型来检验抑郁症状从干预前到干预后的临床显著变化（贝克抑郁量表-II总分降低17.5%）是否与干预前至6个月随访期间改良疲劳影响量表的身体、认知和心理分量表中疲劳影响的改善相关：参与者主要为女性（72%）、中年（M = 53.7 ± 10.1）和白人（76%），病程为 12.5 ± 8.4 年。超过一半的样本（58%）患有复发缓解型多发性硬化症。抑郁症状的临床明显改善与躯体疲劳影响（β = -0.17，p = .004，95 % CI [-0.28，-0.05]）、认知疲劳影响（β = -0.20，p = .000，95 % CI [-0.31，-0.10]）和心理社会影响的减少有关。10]）和社会心理疲劳影响（β = -0.13，p = .03，95 % CI [-0.25，-0.01]），并控制基线抑郁症状和疲劳影响、多发性硬化症亚型（RRMS 或进行性多发性硬化症）和收入水平。该模型显示出足够的拟合度，χ2(6) = 12.747, p = .047, RMSEA = 0.072, CFI = 0.986, SRMR = 0.016，分别占身体、认知和心理疲劳影响变异的32%、39%和28%，与较大的效应大小相对应：这些研究结果以先前的研究为基础，支持减轻抑郁症状对改善多发性硬化症患者疲劳影响的重要性。未来的研究应探讨明确关注减轻抑郁症状或相关认知行为因素是否能减轻多发性硬化症患者的疲劳。

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Improvement in depressive symptoms is associated with sustained improvement in fatigue impact in adults with multiple sclerosis

Background

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). Behavioral interventions that target one or more behaviors such as sleep hygiene, exercise, energy management, cognitive processes, as well as mood have been shown to reduce fatigue in people with MS. Yet, little is known about mechanisms of intervention effects on MS fatigue. Research suggests that depressive symptoms may be an important intervention target for improving MS fatigue. This study examined the association between pre- to post-intervention improvement in depressive symptoms and improvement in MS fatigue impact from pre-intervention through six months post-intervention.

Methods

This study is a secondary analysis of data from a randomized controlled trial comparing a fatigue self-management intervention to general MS education for improving fatigue in people with MS. Adults with MS (N = 218) were recruited for the parent trial from the Portland, Seattle, Baltimore, and North Florida/South Georgia VA Medical Centers, affiliated academic medical centers, and surrounding communities. Both study interventions showed similar efficacy, so participants were combined into one sample for this secondary analysis. Structural equation modeling was used to examine whether clinically significant change in depressive symptoms (a 17.5 % reduction in the total Beck Depression Inventory-II score) from pre- to post-intervention, was associated with improvement in fatigue impact on the physical, cognitive, and psychosocial subscales of the Modified Fatigue Impact Scale from pre-intervention through six-month follow-up.

Results

Participants were predominantly female (72 %), middle-aged (M = 53.7 ± 10.1), and White (76 %) with a disease duration of 12.5 ± 8.4 years. Over half of the sample (58 %) had relapsing-remitting MS. Clinically significant improvement in depressive symptoms was associated with reduction in physical fatigue impact (β = -0.17, p = .004, 95 % CI [-0.28, -0.05]), cognitive fatigue impact (β = -0.20, p = .000, 95 % CI [-0.31, -0.10]), and psychosocial fatigue impact (β = -0.13, p = .03, 95 % CI [-0.25, -0.01]) through the six-month follow-up controlling for baseline depressive symptoms and fatigue impact, MS subtype (RRMS or Progressive MS), and income level. The model demonstrated adequate fit, χ2(6) = 12.747, p = .047, RMSEA = 0.072, CFI = 0.986, SRMR = 0.016, and accounted for 32 %, 39 %, and 28 % of the variance in physical, cognitive, and psychosocial fatigue impact respectively, which corresponded with large effect sizes.

Conclusion

These findings, building on previous research, support the importance of reducing depressive symptoms for improving fatigue impact in people with MS. Future research should examine whether explicit focus on reducing depressive symptoms or related cognitive behavioral factors reduces fatigue in people with MS.

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.