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

Karlyn A. Edwards, Ivan R. Molton, Amanda E. Smith, Dawn M. Ehde, Charles H. Bombardier, Samuel Battalio, Mark P. Jensen



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.


Observational, longitudinal survey study.


A community-based population sample.


Adults with multiple sclerosis (MS) (N=489).


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.


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.


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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About the Editors

  • Prof Timothy Vartanian

    Timothy Vartanian, Professor at the Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, Cornell...
  • Dr Claire S. Riley

    Claire S. Riley, MD is an assistant attending neurologist and assistant professor of neurology in the Neurological Institute, Columbia University,...
  • Dr Rebecca Farber

    Rebecca Farber, MD is an attending neurologist and assistant professor of neurology at the Neurological Institute, Columbia University, in New...

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Note that EMD Serono, Inc., has no editorial control or influence over the content of this Resource Centre. The Resource Centre and all content therein are subject to an independent editorial review.

The Grant for Multiple Sclerosis Innovation
supports promising translational research projects by academic researchers to improve understanding of multiple sclerosis (MS) for the ultimate benefit of patients.  For full information and application details, please click here

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Multiple Sclerosis and Related Disorders, September 2015, Vol 4 Issue 5