Fatigue and social impairment in multiple sclerosis: the role of patients' cognitive and behavioral responses to their symptoms

Objectives: the aim of this study was to test whether the way in which multiple sclerosis (MS) patients interpret and respond to their symptoms may help to explain their experience of fatigue and social impairment. Method: in a cross-sectional study, 149 patients with a definite diagnosis of MS completed validated questionnaires that measured their symptom interpretation and behavioral response, fatigue, mood, and social adjustment. A neurologist assessed their level of neurological impairment. Results: regression analyses revealed that patients' cognitive interpretations of their symptoms, such as a tendency to attribute a wide range of symptoms to their MS and feelings of embarrassment about symptoms, were significantly associated with fatigue and social adjustment over and above neurological impairment, remission status, and mood. The behavioral variables including an all-or-nothing response to symptoms and rest/avoidance behaviours were also strongly associated with fatigue and social impairment. The degree of neurological deficit was not associated with either physical or mental fatigue, although it was associated with social impairment. Depression, anxiety, and remission status were also related to fatigue, and depression to social impairment. Conclusion: these findings suggest that treatment approaches that challenge unhelpful cognitive interpretations and behavioural responses to symptoms, and address anxiety and depression, may be important in improving the overall management of fatigue in MS