title: Anxiety, depression and fatigue at 5-year review following CNS demyelination.
abstract: BACKGROUND
  Anxiety and depression are common in multiple sclerosis (MS). We evaluated the prevalence and factors associated with anxiety, depression and fatigue at the 5-year review of a longitudinal cohort study following a first clinical diagnosis of CNS demyelination (FCD).
  
  
  METHODS
  Cases with a FCD were recruited soon after diagnosis and followed annually thereafter. A variety of environmental, behavioural and clinical covariates were measured at five-year review. Anxiety and depression were measured using the Hospital Anxiety & Depression Scale (HADS), and fatigue by the Fatigue Severity Scale (FSS).
  
  
  RESULTS
  Of the 236 cases, 40.2% had clinical anxiety (median HADS-A: 6.0), 16.0% had clinical depression (median HADS-D: 3.0), and 41.3% had clinical fatigue (median FSS: 4.56). The co-occurrence of all three symptoms was 3.76 times greater than expectation. Younger age, higher disability, concussion or other disease diagnosis were independently associated with a higher anxiety score; male sex, higher disability, being unemployed, less physical activity, and antidepressant and/or anxiolytic-sedative medication use were independently associated with a higher depression score. Higher disability, immunomodulatory medication use, other disease diagnosis and anxiolytic-sedative medication use were independently associated with having fatigue, while female sex, higher BMI, having had a concussion, being unemployed and higher disability were associated with a higher fatigue score.
  
  
  CONCLUSIONS
  These results support previous findings of the commonality of anxiety, depression and fatigue in established MS and extend this to post-FCD and early MS cases. The clustering of the three symptoms indicates that they may share common antecedents.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
authors.forename: S
authors.identifier: http://orcid.org/0000-0001-6521-3056
authors.initials: S
authors.lastname: Simpson
authors.affiliation: School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Tan
authors.affiliation: School of Medicine, University of Tasmania, Hobart, TAS, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Otahal
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Taylor
authors.affiliation: Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC, Australia.
authors.forename: A-L
authors.initials: AL
authors.lastname: Ponsonby
authors.affiliation: National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia.
authors.forename: R M
authors.initials: RM
authors.lastname: Lucas
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Blizzard
authors.affiliation: QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
authors.forename: P C
authors.initials: PC
authors.lastname: Valery
authors.affiliation: Dept. Neurology, John Hunter Hospital, New Lambton, NSW, Australia.|University of Newcastle, Callaghan, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Lechner-Scott
authors.affiliation: School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Shaw
authors.affiliation: Dept. Neurology, John Hunter Hospital, New Lambton, NSW, Australia.|University of Newcastle, Callaghan, NSW, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia. ingrid.vandermei@utas.edu.au.
authors.forename: I
authors.initials: I
authors.lastname: van der Mei
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D015992:Body Mass Index; D015331:Cohort Studies; D020278:Demyelinating Autoimmune Diseases, CNS / Q000150:complications* / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D004185:Disability Evaluation; D004651:Employment; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult
keywords: anxiety; depression; fatigue; first demyelinating event; multiple sclerosis; prevalence