title: Fatigue, depression, and physical impairment in multiple sclerosis.
abstract: BACKGROUND
  Fatigue, depression, and physical impairment are common among multiple sclerosis (MS) patients. The aim of this study was to determine the relationship between depression, physical impairment, and fatigue in an Iranian MS cohort.
  
  
  METHODS
  Fifty consecutive relapsing-remitting MS patients and 50 age- and sex-matched healthy controls (HCs) were recruited from Sina Rehabilitation Clinic, Tehran, Iran. The depression substance of Hospital Anxiety and Depression Scale (HADS), Expended Disability Status Scale, and Fatigue Severity Scale questionnaires were used to assess depression, physical impairment, and fatigue, respectively.
  
  
  RESULTS
  This study included 38 (76%) females and 12 (24%) males in both patients and HC groups. The depression substance of the HADS in MS and HCs showed a mean value of 1.92 ± 0.80 and 1.17 ± 0.38, respectively (P < 0.001). Pearson's correlation analyses showed that in the MS group depression was associated with fatigue (r = 0.54, P = 0.01), but not with physical impairment (r = 0.16, p = 0.01), while fatigue was associated with both depression (r = 0.54, P = 0.01) and physical impairment (r = 0.36, P = 0.01). Depression in HCs group was also associated with fatigue (r -0.64, P = 0.01).
  
  
  CONCLUSIONS
  Fatigue is associated with both depression and physical impairment, and an intervention in one of these conditions might improve others.
authors.affiliation: Department of Clinical Sciences, School of Medicine, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Azimian
authors.affiliation: Department of Clinical Sciences, School of Medicine, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Azam
authors.initials: A
authors.lastname: Shahvarughi-Farahani
authors.affiliation: Department of Clinical Sciences, School of Medicine, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Rahgozar
authors.affiliation: Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Etemadifar
authors.affiliation: Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Medical Sciences, School of Medicine, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Nasr
keywords: Depression; Fatigue; Iran; Multiple Sclerosis; Physical impairment