Nature of fatigue moderates depressive symptoms and anxiety in sarcoidosis.

ABSTRACT

OBJECTIVES: Fatigue, depressive symptoms, and anxiety are frequently reported in sarcoidosis. However, the relationship between these debilitating symptoms is unclear. Therefore, the purpose of this prospective follow-up study was to identify the prevalence of depressive symptoms and anxiety in sarcoidosis patients, stratified for the nature of fatigue. In addition, we examined whether depressive symptoms and anxiety predicted fatigue. DESIGN: This is a prospective follow-up study. METHODS: Sarcoidosis outpatients (n = 274) were included. Clinical data were obtained from medical records. At baseline, patients completed the Fatigue Assessment Scale (FAS), the Center for Epidemiological Studies-Depression Scale (CES-D), and the State and Trait Anxiety Inventory (STAI). After 6, 12, and 18 months patients completed the FAS again. RESULTS: Concomitant fatigue (FAS > 21) and high-trait anxiety (STAI > 40) was frequently reported (35-36%). The combination of fatigue and high levels of depressive symptoms (CES-D > 16) was reported in 43-46%. Combined high-trait anxiety and high levels of depressive symptoms were reported in 31% of the patients. These percentages were higher in patients with all day fatigue, compared with patients with intermittent, or mild fatigue. Both anxiety and depressive symptoms were significant predictors of high fatigue scores. CONCLUSIONS: Nature of fatigue moderates the relationships between fatigue and anxiety and fatigue and depressive symptoms in sarcoidosis. Hence, beside fatigue, depressive symptoms and anxiety should be an integral part of the multidisciplinary management of sarcoidosis patients. STATEMENT OF CONTRIBUTION What is already known on this subject? Fatigue is a frequently reported symptom in sarcoidosis. Symptoms such as depressive symptoms and anxiety are also prevalent in sarcoidosis. However, the relationships between these symptoms are still unclear and require more research. What does this study add? This paper shows that fatigue is often accompanied by depressive symptoms and anxiety, although these symptoms are not fully overlapping. In addition, depressive symptoms and anxiety predict fatigue after follow-up. Fatigue, depressive symptoms and anxiety are most strongly correlated in patients with All Day Fatigue, which indicate that these patients may benefit from psychological interventions in the management of fatigue.