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

Andy

Andy

Retired committee member
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/
 
InitialConditions said:
Why not also "Fatigue is the most significant predictor of depression". Am I missing something?
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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.
 
Since this study was done at a single time point, any causal attribution of one symptom predicting another is clearly not possible.

I remember querying the use of the term predictor on a thread for another paper of similar ilk and being told in this context the word predictor simply means if you look at the data, ticking the box for one symptom has a high probabllity that you will have also ticked the box for another symptom. In other words it's saying lots of the people who report being fatigued also report being depressed.

Or as seems very likely from what we know about the shortcomings of questionnares, it probably simply means it's a measure of overlap in questions asked on fatigue and depression questionnaires.

That's why I think it's far better to simply say to people 'are you fatigued', and if so how badly on a scale from healthy tiredness to unable to get out of bed. Similarly for depression, 'are you depressed', and if so how badly on a scale from healthy person's intermittent low feelings due to life events, and suicidally depressed. Or perhaps the scale could be about how much that symptom contributes to your inablity to live a full and happy life.
 
"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.
 
Andy said:
The authors biases?
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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?
 
rvallee said:
"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.
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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.
 
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