Bridging the Gap: A Symptom Network Analysis of Depression, Anxiety, and Fatigue in Multiple Sclerosis

Background: Depressive, anxiety, and fatigue symptoms are highly prevalent in people with multiple sclerosis (pwMS) and have been found to co-occur. Together, these symptoms result in poorer outcomes for pwMS. However, the network topology of comorbid depression, anxiety, and fatigue in pwMS has been to be investigated. Methods: We estimated depressive, anxiety, and fatigue symptom networks using data from the same people with multiple sclerosis at two time points: at baseline (N = 272) and at 6-months follow-up (N = 141). Expected influence (EI) centrality analyses were performed to estimate the relative influence of each symptom within the two networks. Bridge EI and community analyses were performed to identify potential bridge symptoms and densely connected symptom groups. Results: ‘Worthlessness’ and ‘anhedonia’ emerged with the highest EI at baseline and follow-up, respectively. In terms of bridging symptoms, ‘worthlessness’, ‘afraid something awful would happen’, and ‘fatigue severity’ emerged as potential bridging symptoms that clustered depressive, anxiety, and fatigue symptoms in pwMS. This changed to ‘restlessness’, ‘uncontrollable worry’, and ‘suicidal ideation’ at follow-up. Conclusions: Our findings demonstrate that depressive, anxiety, and fatigue symptoms are highly interconnected in MS. Findings provide useful information for assessment and treatment of these symptom comorbidities in MS.