PT  - JOURNAL ARTICLE
AU  - Lindsay I. Berrigan
AU  - John D. Fisk
AU  - Scott B. Patten
AU  - Helen Tremlett
AU  - Christina Wolfson
AU  - Sharon Warren
AU  - Kirsten M. Fiest
AU  - Kyla A. McKay
AU  - Ruth Ann Marrie
AU  - For the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis (ECoMS)
TI  - Health-related quality of life in multiple sclerosis
AID  - 10.1212/WNL.0000000000002564
DP  - 2016 Apr 12
TA  - Neurology
PG  - 1417--1424
VI  - 86
IP  - 15
4099  - http://n.neurology.org/content/86/15/1417.short
4100  - http://n.neurology.org/content/86/15/1417.full
SO  - Neurology2016 Apr 12; 86
AB  - Objective: To evaluate the direct and indirect influences of physical comorbidity, symptoms of depression and anxiety, fatigue, and disability on health-related quality of life (HRQoL) in persons with multiple sclerosis (MS).Methods: A large (n = 949) sample of adults with MS was recruited from 4 Canadian MS clinics. HRQoL was assessed using the patient-reported Health Utilities Index Mark 3. Expanded Disability Status Scale scores, physical comorbidity, depression, anxiety, and fatigue were evaluated as predictors of HRQoL in a cross-sectional path analysis.Results: All predictors were significantly associated with HRQoL and together accounted for a large proportion of variance (63%). Overall, disability status most strongly affected HRQoL (β = −0.52) but it was closely followed by depressive symptoms (β = −0.50). The direct associations of physical comorbidity and anxiety with HRQoL were small (β = −0.08 and −0.10, respectively), but these associations were stronger when indirect effects through other variables (depression, fatigue) were also considered (physical comorbidity: β = −0.20; anxiety: β = −0.34).Conclusions: Increased disability, depression and anxiety symptoms, fatigue, and physical comorbidity are associated with decreased HRQoL in MS. Disability most strongly diminishes HRQoL and, thus, interventions that reduce disability are expected to yield the most substantial improvement in HRQoL. Yet, interventions targeting other factors amenable to change, particularly depression but also anxiety, fatigue, and physical comorbidities, may all result in meaningful improvements in HRQoL, as well. Our findings point to the importance of further research confirming the efficacy of such interventions.CFI=Comparative Fit Index; CI=confidence interval; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, 4th edition; EDSS=Expanded Disability Status Scale; HADS=Hospital Anxiety and Depression Scale; HADS-A=Hospital Anxiety and Depression Scale anxiety subscale; HADS-D=Hospital Anxiety and Depression Scale depression subscale; HRQoL=health-related quality of life; HUI3=Health Utilities Index Mark 3; MS=multiple sclerosis; NARCOMS=North American Research Committee on Multiple Sclerosis; RMSEA=root mean square error of approximation