Fatigue, depression, and health-related quality of life in patients with multiple sclerosis in Isfahan, Iran M. Kargarfard a , M. Eetemadifar b , M. Mehrabi a , A. H. Maghzi c and M. R. Hayatbakhsh d a Faculty of Physical Education and Sport Sciences, University of Isfahan, Isfahan, Iran; b Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran; c Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran; and d School of Population Health, University of Queensland, Herston, Qld, Australia Keywords: depression, fatigue, multi- ple sclerosis, quality of life Received 20 June 2011 Accepted 16 August 2011 Background and purpose: Quality of life (QoL) of patients with multiple sclerosis (MS) is worse than that of other chronic diseases. There is a need to examine the impact of fatigue and depression on the QoL independent of level of physical disability in MS. The aim of this study is to explore physical, psychological, and social aspects of health-related QoL (HRQoL) of MS patients in association with physical disability, fatigue, and depression. Methods: In a cross-sectional study, 281 (63.4% women, 36.6% men) patients with MS participated in the study. The HRQoL was assessed by the Persian version of the mul- tiple sclerosis quality of life (MSQoL-54) questionnaires. Other covariates included in the study were disease type, physical disability, fatigue, disease impact, and depression. Results: In univariate analysis disease type, physical disability, fatigue, disease impact, and depression were significantly associated with both physical and mental health composite summaries of MSQoL-54. In multivariate regression analysis, patientsÕ physical disability remained significantly associated with both components of MSQoL-54, whilst fatigue and depression were associated with physical and mental composite summaries, respectively. Conclusions: Our findings suggest that MS-related physical disability, fatigue, and depression affect the HRQoL of MS patients, independently of each other and other potential confounding factors. Effective interventions that target fatigue and depres- sion may help improve the QoL of patients, regardless of their disease type and level of disability. Introduction Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system that affects mostly young and middle-aged adults [1,2] and is characterized by impaired neurotransmission, fre- quently resulting in cumulative disability [3]. The vast majority of patients experience an initial relapsing– remitting (RR) phase, followed in more than 80% of sufferers by secondary progression (SP) of disability with or without superimposed relapses [4,5]. In Asia, the Middle East has the highest prevalence of MS [6] and Isfahan in Iran is known as an area with a medium to high risk of MS [7]. The quality of life (QoL) in MS patients has become a focus of research in the last two decades [8]. It is generally recognized that MS sub- stantially affects different aspects of QoL [9]. In Iran, however, there have been few reports about quality of life in individuals with MS [10,11]. This study describes the QoL and its associated factors in MS patients in Iran. Review of studies in recent years shows reduced mortality and increased life expectancy in MS patients, meaning that individuals affected by MS live longer than before [12]. Despite remarkable progress in the available therapies to MS, the current treatments are mainly offered to slow the progression of the disease, reduce relapses, or improve symptoms [13]. However, over the course of the disease, with or without inter- vention, disabling symptoms such as fatigue, urinary incontinence, vision loss, impairment of coordination, spasticity, muscle weakness, and cognitive impairment substantially affect the QoL of patients [14]. Further- more, comparative studies suggest that, compared with other chronic diseases, MS patients have the most Correspondence: M. R. Hayatbakhsh, MD, PhD, School of Popula- tion Health, University of Queensland, Herston Road, Herston, Qld 4006, Australia (tel.: +617 33464638; fax: +617 33655509; e-mail: m.hayatbakhsh@uq.edu.au). Ó 2011 The Author(s) European Journal of Neurology Ó 2011 EFNS 431 European Journal of Neurology 2012, 19: 431–437 doi:10.1111/j.1468-1331.2011.03535.x