title: Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: A bicenter study from north of Iran.
abstract: BACKGROUND
  Although studies have demonstrated significant negative relationships between quality of life (QOL), fatigue, and the most common psychological symptoms (depression, anxiety, stress), the main ambiguity of previous studies on QOL is in the relative importance of these predictors. Also, there is lack of adequate knowledge about the actual contribution of each of them in the prediction of QOL dimensions. Thus, the main objective of this study is to assess the role of fatigue, depression, anxiety, and stress in relation to QOL of multiple sclerosis (MS) patients.
  
  
  METHODS
  One hundred and sixty-two MS patients completed the questionnaire on demographic variables, and then they were evaluated by the Persian versions of Short-Form Health Survey Questionnaire (SF-36), Fatigue Survey Scale (FSS), and Depression, Anxiety, Stress Scale-21 (DASS-21). Data were analyzed by Pearson correlation coefficient and hierarchical regression.
  
  
  RESULTS
  Correlation analysis showed a significant relationship between QOL elements in SF-36 (physical component summary and mental component summary) and depression, fatigue, stress, and anxiety (P < 0.01). Hierarchical regression analysis indicated that among the predictor variables in the final step, fatigue, depression, and anxiety were identified as the physical component summary predictor variables. Anxiety was found to be the most powerful predictor variable amongst all (β = -0.46, P < 0.001). Furthermore, results have shown depression as the only significant mental component summary predictor variable (β = -0.39, P < 0.001).
  
  
  CONCLUSIONS
  This study has highlighted the role of anxiety, fatigue, and depression in physical dimensions and the role of depression in psychological dimensions of the lives of MS patients. In addition, the findings of this study indirectly suggest that psychological interventions for reducing fatigue, depression, and anxiety can lead to improved QOL of MS patients.
authors.affiliation: Department of Psychology, University of Guilan, Rasht, Iran.
authors.forename: Ghasem
authors.initials: G
authors.lastname: Salehpoor
authors.affiliation: Department of Psychology, University of Isfahan, Isfahan, Iran.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Rezaei
authors.affiliation: Department of Neurology, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Mozaffar
authors.initials: M
authors.lastname: Hosseininezhad
keywords: Anxiety; depression; fatigue; multiple sclerosis; quality of life; stress