Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors

So Hee Lee, Hyoung-Shik Shin, Hye Yoon Park, Jeong Lan Kim, Jung Jae Lee, Haewoo Lee, Sung-Doo Won, Woori Han, So Hee Lee, Hyoung-Shik Shin, Hye Yoon Park, Jeong Lan Kim, Jung Jae Lee, Haewoo Lee, Sung-Doo Won, Woori Han

Abstract

Objective: The relationship among chronic fatigue, depressive symptoms, and post-traumatic stress symptoms (PTSSs) among Middle East respiratory syndrome (MERS) survivors is poorly understood.

Methods: Of 148 survivors who consented to be registered and underwent assessments at 12 months (T1) and 18 months (T2) after the MERS outbreak, 72 (48.65%) were evaluated for chronic fatigue, depressive symptoms, and PTSSs based on the Impact of Event ScaleRevised (IES-R), the Patient Health Questionnaire-9 (PHQ-9), and the Fatigue Severity Scale (FSS). Data from 52 subjects, who completed both assessments, were analyzed using a regression-based serial multiple mediation model (PROCESS Model 6).

Results: Bootstrap analyses indicated no direct effects of T1 FSS on T2 IES-R but significant positive indirect effects of T1 FSS on T2 IESR through T1 PHQ-9 and T2 PHQ-9 (B=2.1601, SE=1.3268, 95% confidence interval=0.4250-6.1307). In other words, both T1 PHQ-9 and T2 PHQ-9 fully mediated the relationship between T1 FSS and T2 IES.

Conclusion: Chronic fatigue 12 months after MERS had indirect effects on prolonged PTSSs 18 months after MERS via persisting depression in MERS survivors. This finding supports the need to promote interventional programs for emerging infectious disease survivors with chronic fatigue to reduce depression and prevent prolonged PTSSs.

Keywords: Chronic fatigue; Depression; Emerging infectious diseases; Middle East respiratory syndrome; Post-traumatic stress symptoms; Survivors.

Figures

Figure 1.
Figure 1.
Model depicting the effect of severe fatigue, depression on post-trauma of MERS. **p

References

    1. Cho SY, Kang JM, Ha YE, Park GE, Lee JY, Ko JH, et al. MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study. Lancet. 2016;388:994–1001.
    1. Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011;11:37.
    1. Tansey CM, Louie M, Loeb M, Gold WL, Muller MP, de Jager J, et al. One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Arch Intern Med. 2007;167:1312–1320.
    1. Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry. 2007;52:233–240.
    1. Wing YK, Leung CM. Mental health impact of severe acute respiratory syndrome: a prospective study. Hong Kong Med J. 2012;18:24–27.
    1. Mohammed A, Sheikh TL, Gidado S, Poggensee G, Nguku P, Olayinka A, et al. An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study-- 2014. BMC Public Health. 2015;15:1–8.
    1. Keita MM, Taverne B, Sy Savané S, March L, Doukoure M, Sow MS, et al. Depressive symptoms among survivors of Ebola virus disease in Conakry (Guinea): preliminary results of the PostEboGui cohort. BMC Psychiatry. 2017;17:127.
    1. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38:e2016048.
    1. Park JS, Lee EH, Park NR, Choi YH. Mental health of nurses working at a government-designated hospital during a MERS-CoV outbreak: a cross-sectional study. Arch Psychiatr Nurs. 2018;32:2–6.
    1. Sim M. Psychological trauma of Middle East Respiratory Syndrome victims and bereaved families. Epidemiol Health. 2016;38:e2016054.
    1. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46:1121–1123.
    1. Chung KI, Song CH. Clinical usefulness of fatigue severity scale for patients with fatigue, and anxiety or depression. Korean J Psychosom Med. 2001;9:164–173.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613.
    1. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:509–515.
    1. Eun HJ, Kwon TW, Lee SM, Kim TH, Choi MR, Cho SJ. A study on reliability and validity of the Korean version of impact of event scale-revised. J Korean Neuropsychiatr Assoc. 2005;44:303–310.
    1. Hayes AF. 2012; PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modeling (White paper) Available at: . Accessed January 16, 2018.
    1. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: a Regression-Based Approach. New York, NY: The Guilford Press; 2013.
    1. Brown RF, Valpiani EM, Tennant CC, Dunn SM, Sharrock M, Hodgkinson S, et al. Longitudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis. Psychol Psychother. 2009;82:41–56.
    1. Chang CM, Connor KM, Lai TJ, Lee LC, Davidson JR. Predictors of posttraumatic outcomes following the 1999 Taiwan earthquake. J Nerv Ment Dis. 2005;193:40–46.
    1. Lam MH, Wing YK, Yu MW, Leung CM, Ma RC, Kong AP, et al. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. Arch Intern Med. 2009;169:2142–2147.
    1. Mak IWC, Chu CM, Pan PC, Yiu MGC, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009;31:318–326.
    1. Velden PGV, Grievink L, Kleber RJ, Drogendijk AN, Roskam AJ, Marcelissen FG, et al. Post-disaster mental health problems and the utilization of mental health services: a four-year longitudinal comparative study. Adm Policy Ment Health. 2006;33:279–288.
    1. Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2008;38:467–480.
    1. Fuller-Thomson E, Nimigon J. Factors associated with depression among individuals with chronic fatigue syndrome: findings from a nationally representative survey. Fam Pract. 2008;25:414–422.
    1. Yancey JR, Thomas SM. Chronic fatigue syndrome: diagnosis and treatment. Am Fam Physician. 2012;86:741–746.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj