Frontiers in neurology · 2026
Symptom clusters mediate anxiety/depression effects on quality of life in neuromyelitis optica spectrum disorders: a cross-sectional mediation analysis.
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Yang Qing, Wei Lin, Wang Lixin, Liang Hao, Xu Haoyou, Zhang Xiaopei, Liu Zhuyun
Аннотация
AIMS AND OBJECTIVES: To investigate the mediating effects of symptom clusters on the relationship between anxiety/depression and quality of life (QOL) among Chinese patients with neuromyelitis optica spectrum disorder (NMOSD).
BACKGROUND: NMOSD is a rare and severe inflammatory demyelinating disease of the central nervous system, predominantly affecting the optic nerves and spinal cord. Patients with NMOSD often experience significant neurological disability and a high burden of psychiatric comorbidities, including anxiety and depression, which are associated with lower QOL. Although anxiety and depression are established correlates of QOL in NMOSD, the pathways linking them through symptom clusters remain unexplored.
DESIGN: A cross-sectional design.
METHODS: A total of 140 participants diagnosed with NMOSD were recruited through online convenience sampling. Data were collected using standardized tools, including the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for assessing anxiety and depression, the 36-item Short-Form Health Survey (SF-36) for evaluating QOL, and a self-administered NMOSD symptom scale for identifying symptom clusters. Mediation analyses were performed using the SPSS PROCESS macro with bias-corrected bootstrap methods.
RESULTS: Patients with NMOSD had a QOL score of 97.76 ± 8.24. Educational level and primary caregivers were identified as factors associated with QOL. This study revealed significant negative correlations between anxiety/ depression and QOL, with mediation observed through distinct symptom clusters. Anxiety exhibited complete mediation via somatosensory and motor symptom clusters, with partial mediation through bladder-rectal symptoms. Depression demonstrated complete mediation through somatosensory, motor, visual-memory, and bladder-rectal symptom clusters. Notably, sleep-related symptom clusters did not show significant mediating effects.
CONCLUSION: Symptom clusters may mediate the associations between anxiety/depression and QOL. The study underscores the importance of considering both psychological distress and physical symptoms in relation to QOL in NMOSD patients. Future research is needed to validate these findings in larger, diverse cohorts and to explore targeted interventions aimed at optimizing functional outcomes in this population.
BACKGROUND: NMOSD is a rare and severe inflammatory demyelinating disease of the central nervous system, predominantly affecting the optic nerves and spinal cord. Patients with NMOSD often experience significant neurological disability and a high burden of psychiatric comorbidities, including anxiety and depression, which are associated with lower QOL. Although anxiety and depression are established correlates of QOL in NMOSD, the pathways linking them through symptom clusters remain unexplored.
DESIGN: A cross-sectional design.
METHODS: A total of 140 participants diagnosed with NMOSD were recruited through online convenience sampling. Data were collected using standardized tools, including the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for assessing anxiety and depression, the 36-item Short-Form Health Survey (SF-36) for evaluating QOL, and a self-administered NMOSD symptom scale for identifying symptom clusters. Mediation analyses were performed using the SPSS PROCESS macro with bias-corrected bootstrap methods.
RESULTS: Patients with NMOSD had a QOL score of 97.76 ± 8.24. Educational level and primary caregivers were identified as factors associated with QOL. This study revealed significant negative correlations between anxiety/ depression and QOL, with mediation observed through distinct symptom clusters. Anxiety exhibited complete mediation via somatosensory and motor symptom clusters, with partial mediation through bladder-rectal symptoms. Depression demonstrated complete mediation through somatosensory, motor, visual-memory, and bladder-rectal symptom clusters. Notably, sleep-related symptom clusters did not show significant mediating effects.
CONCLUSION: Symptom clusters may mediate the associations between anxiety/depression and QOL. The study underscores the importance of considering both psychological distress and physical symptoms in relation to QOL in NMOSD patients. Future research is needed to validate these findings in larger, diverse cohorts and to explore targeted interventions aimed at optimizing functional outcomes in this population.