The Association of Salivary Cortisol Levels With Depression, Anxiety, and Quality of Life in Male Relapsing-Remitting Multiple Sclerosis Patients: A Case-Control Study

Abstract

Background: Dysfunctions of the hypothalamic-pituitary-adrenal (HPA) axis can trigger multiple sclerosis (MS) symptoms. Mood disorders comorbid with MS are implicated in the HPA axis activation in most people with MS (pwMS). This study purposed to examine salivary cortisol (SC) levels and their association with mood disorders in pwMS. Methods: Forty-three men as pwMS and sixteen men as healthy controls (HC) were included in this study. pwMS and HC completed the Beck Depression Inventory (BDI), 36-Item Short Form Survey (SF-36), Fatigue Severity Scale (FSS), Depression Anxiety and Stress Scale, and Hospital Anxiety and Depression Scale questionnaires. SC levels were also measured in pwMS and HC. A linear regression model was used to analyze the relationship between the Expanded Disability Status Scale (EDSS) and mood disorders and SC levels. Pearson's or Spearman's tests examined the correlation between SC levels and mood disorders. Results: The SC level, anxiety, depression, fatigue, and stress were significantly higher in pwMS than in HC (p<0.05). pwMS also showed significant correlations between SC levels and role physical (r=0.3, p<0.05) and emotional (r=0.34, p<0.05) in SF-36. Among SF-36 domains, only general health (beta=-0.72, p<0.05) and physical functioning (beta=-1.61, p<0.05) were negatively associated with disease duration. No correlation was found between SC levels and anxiety, depression, and fatigue (p>0.05). Conclusions: The pwMS showed mild to moderate depression, anxiety, and fatigue. Only general health and physical functioning as aspects of quality of life were related to disease duration, while SC levels, mood disorders, and other quality-of-life domains were not associated with clinical characteristics. Also, this study failed to find a significant role for SC as a valuable marker in approaching mood disorders in pwMS.