Nature of fatigue moderates depressive symptoms and anxiety in sarcoidosis

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 18months patients completed the FAS again. Results Concomitant fatigue (FAS>21) and high-trait anxiety (STAI>40) was frequently reported (3536%). The combination of fatigue and high levels of depressive symptoms (CES-D>16) was reported in 4346%. 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.