Depression is the most significant independent predictor of fatigue in patients with primary Sjögren’s syndrome 2023 Ayar et al

Objectives
The study aimed to evaluate the level of fatigue and the relationship between mood, pain, fibromyalgia, insomnia, disease activity, and dryness with fatigue in primary Sjögren’s syndrome (PSS) patients.

Patients and methods
In this case-control study, the participants were recruited between January 2021 and July 2021. Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F), pain DETECT questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Insomnia Severity Index (ISI) were administered to 50 PSS patients (48 females, 2 males; mean age: 48.9±10.8 years; median age: 47 years; range, 29 to 71 years) and 60 healthy controls (HCs; 57 females, 3 males; mean age: 49.8±8.4 years, median age: 52 years; range, 32 to 72 years). In addition, EULAR Sjögren’s syndrome disease activity index (ESSPRI), EULAR Sjögren’s Syndrome Patient Reported Index (ESSDAI), pain thresholds, Schirmer tests, and whole unstimulated salivary flow rate measurements were determined in PSS patients. Independent predictors of fatigue (fatigue subscale scores <30.5) were investigated by logistic regression analysis.

Results
The frequency of fatigue in PSS patients and HCs was 54.0% and 8.3%, respectively. The rates of mood disturbance (BDI ≥11) in PSS patients with and without fatigue were 70.4% and 13.1%, respectively. BDI (Rho=-0.804), BAI (Rho=-0.586), ISI (Rho=-0.483), and ESSDAI (Rho=-0.345) were negatively correlated with the fatigue subscale score. Depression [Odds ratio (OR): 1.214, confidence interval (CI): 1.007-1.463], fibromyalgia (OR: 21.674, CI: 1.470-319.469), disease activity (OR: 1.440; CI: 1.005-2.065), and insomnia (OR: 1.223, CI: 1.003-1.4922) were identified as independent predictors of fatigue in PSS patients. It was determined that BD alone could predict fatigue by 84% in PSS patients.

Conclusion
Depression can be a prominent predictor of fatigue in PSS patients. There is a need for studies evaluating the effect of antidepressant treatment approaches on fatigue accompanied by mood disturbance in PSS patients.

Open access, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689022/

 

So questionnaires that ask, in part, about fatigue, are found to be good indicators of.... being fatigued.

 

Why not also "Fatigue is the most significant predictor of depression". Am I missing something?

 

The authors biases?

 

It could potentially require a different analysis and might not be true since "A predicting B" is a different statement than "B predicting A". I doubt it's worth reading through the study to be able to tell whether the argument they made is symmetric, since the most probable outcome is anyways the outcome @Andy has mentioned. They aren't interested in a rigorous analysis and just want their own biases to be displayed.

 

"Independent" "predictor". They seem to explicitly use predict as equivalent to correlates, using questionnaires with huge, deliberate, question overlap. This is like finding that homelessness is an independent predictor of poverty and finding nothing wrong with attributing it as a cause. It's so obviously incorrect that it defies reason that anyone would seriously argue it, with multiple people involved in a chain of evaluation also finding nothing wrong with it. And yet here we are.

The Beck Depression Inventory is so generic and conflates perfectly rational mood in the context of being ill with being mentally ill, again showing how utterly confused medicine is about illness and how it impacts people. It's truly baffling how such blatantly invalid assessment methods have been turned into standards in health care.

 

Could also be answer C: "problem we were too lazy to competently research also causes fatigue and depression."

 

And the old depression questionnaires not having versions that are adapted for those with comorbid conditions.

not very helpful/impressive that they can’t really tell whether someone with terrible fatigue from Sjogrend has depression or is just fatigued, in fact should be embarrassing to them.

particularly given if someone needs a change of medicine for something biomedical it’s pretty important

I’d imagine based on this poorly run area diagnosis or ‘notes made’ of depression is also a predictor or all sorts of other conditions people end up having and they never conclude it flags an issue if misdiagnosis and sorting their diagnostics and pathways - why does no one ask this continually?

 

It is so bad it needs to be forced to become a two-stage process of questionnaire IF ‘fatigue’ really is a ‘required symptom’ for depression.

But there are questions to be had there that have huge implications regarding genuine mental health issues when you look at the other questions

The whole sector seems to be happy to use this muddied concept as it suits the agenda I assume of those higher up but is ‘depression’ REALLY a symptom of many illnesses that cite it OR do they mean ‘fatigue’ , and of a specific type, to the point they could just be writing TGAT on the symptom list

it’s that stubbornness to be non forensic and non specific that potentially holds back all sorts of better diagnostics and research surely.