Exploring Psychosocial Factors Affecting Fatigue in Young Adults with MS

Fatigue in multiple sclerosis (MS) is often viewed as a byproduct of neurological damage, but a new study suggests that for younger patients, psychological and emotional processing may play a more prominent role than previously recognized.

In a cross-sectional analysis recently published in Healthcare, researchers from the University of Verona explored how resilience, mindfulness, and illness perception relate to fatigue in young adults with MS while accounting for anxiety and depression. Despite low physical disability, more than two-thirds of the 51 participants—most of them women with relapsing-remitting MS—reported moderate to severe fatigue.

Using the Brief Illness Perception Questionnaire (B-IPQ), the study found that negative illness perceptions—particularly around symptom identity and perceived consequences—were significantly associated with higher fatigue scores, even after adjusting for anxiety and depression. In other words, patients who viewed their disease as more disruptive or difficult to manage tended to experience more fatigue.

These associations were especially strong for motor fatigue, which correlated with both negative illness perceptions and depressive symptoms. By contrast, cognitive fatigue was more strongly linked to anxiety levels.

This dissociation between motor and cognitive fatigue aligns with previous findings suggesting distinct psychosocial pathways. The authors call for future studies to explore how these mechanisms differ and interact over time.

Mindfulness, especially traits such as non-judgment and non-reactivity, was inversely associated with total fatigue scores. These associations remained significant even when controlling for anxiety and depression, suggesting a possible protective effect. Interestingly, other mindfulness components—like present-moment awareness or descriptive ability—were not significantly linked to fatigue once emotional distress was accounted for.

The researchers point to this as a rationale for integrating mindfulness-based interventions into fatigue management. “Interventions that promote acceptance and a non-judgmental stance may help reduce fatigue symptoms,” they wrote, referencing prior studies showing positive outcomes for mindfulness-based stress reduction (MBSR) and Acceptance and Commitment Therapy (ACT) in MS.

While lower resilience was initially correlated with higher fatigue, this relationship weakened when adjusted for depression and anxiety. This suggests that resilience may influence fatigue indirectly, through its impact on emotional well-being rather than as a direct moderator.

Women in the study reported significantly higher levels of both motor and cognitive fatigue than men. This finding remained robust in the multivariate model, underscoring the need for gender-sensitive approaches in MS care.

Overall, the final regression model—including gender, illness perception, mindfulness, anxiety, and depression—accounted for over half the variance in fatigue scores, a substantial explanatory power for a relatively small sample.

With pharmacologic treatments showing limited efficacy for MS-related fatigue, these findings underscore the importance of non-pharmacological strategies. The study advocates for early psychological intervention—particularly those targeting maladaptive illness beliefs and promoting mindfulness—as a way to help young adults preserve quality of life and occupational function.