Janssens A C J W, van Doorn P A, de Boer J B, Kalkers N F, van der Meche F G A, Passchier J, Hintzen R Q
Department of Neurology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Mult Scler. 2003 Aug;9(4):397-403. doi: 10.1191/1352458503ms930oa.
Disability status, depression and anxiety are important determinants of quality of life (QoL) in patients with multiple sclerosis (MS). We investigated whether anxiety and depression influence the relation between disability status and QoL in our cohort of recently diagnosed patients. Disability status [Expanded Disability Status Scale (EDSS)], anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], and QoL (SF-36) were prospectively obtained in 101 MS patients. The relation between EDSS and SF-36 scales was examined using regression analyses, without and with adjustment for anxiety and depression. Interaction effects were investigated by comparing the relation between EDSS and QoL in patients with high and low anxiety and depression. In the unadjusted analyses, EDSS was significantly related to all SF-36 physical and mental health scales. After adjustment for anxiety and depression, EDSS was significantly related only to the SF-36 physical functioning, role-physical functioning and bodily pain scales. The relation between EDSS and these SF-36 scales was consistently higher in patients with more symptoms of anxiety or depression, suggesting that anxiety and depression strengthened the association of EDSS in these SF-36 physical health scales. After adjustment for anxiety and depression, EDSS was not significantly related to the SF-36 mental health scales and the general health scale. This finding is compatible with the hypothesis that anxiety and depression are intermediate factors in the association of EDSS with these SF-36 scales. Screening for symptoms of anxiety and depression is recommended in studies that use QoL as an outcome measure of treatment or intervention efficacy.
残疾状况、抑郁和焦虑是多发性硬化症（MS）患者生活质量（QoL）的重要决定因素。我们调查了焦虑和抑郁是否会影响我们最近诊断的患者队列中残疾状况与生活质量之间的关系。前瞻性地获取了101例MS患者的残疾状况[扩展残疾状况量表（EDSS）]、焦虑和抑郁[医院焦虑抑郁量表（HADS）]以及生活质量（SF - 36）。使用回归分析检查EDSS与SF - 36量表之间的关系，分别在不考虑和考虑焦虑与抑郁因素进行调整的情况下。通过比较焦虑和抑郁程度高与低的患者中EDSS与生活质量之间的关系来研究交互作用。在未调整的分析中，EDSS与所有SF - 36身体和心理健康量表显著相关。在对焦虑和抑郁进行调整后，EDSS仅与SF - 36身体功能、角色 - 身体功能和身体疼痛量表显著相关。焦虑或抑郁症状较多的患者中，EDSS与这些SF - 36量表之间的关系始终更强，这表明焦虑和抑郁增强了EDSS与这些SF - 36身体健康量表之间的关联。在对焦虑和抑郁进行调整后，EDSS与SF - 36心理健康量表和总体健康量表无显著相关性。这一发现与焦虑和抑郁是EDSS与这些SF - 36量表之间关联的中间因素这一假设相符。在将生活质量作为治疗或干预疗效的结果指标的研究中，建议筛查焦虑和抑郁症状。
