Depressive symptoms and fatigue are independently associated with myasthenia gravis-specific quality of life beyond neurological severity: a cross-sectional study

Neurological examination and myasthenia gravis (MG)-specific functional scales may not fully capture the psychological and fatigue-related burden of MG. This cross-sectional registry-based study included 75 adults with MG. Depressive and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) with validated Latvian- and Russian-language thresholds.

Fatigue, quality of life, functional impairment and clinical severity were assessed using the Fatigue Severity Scale (FSS), 15-item Myasthenia Gravis Quality of Life Questionnaire (MG-QOL15), Myasthenia Gravis Activities of Daily Living (MG-ADL) and MG Composite Score (MGCS). Analyses included group comparisons, Spearman correlations, and exploratory multivariable linear regression. Positive depression and anxiety screens were identified in 32/75 (42.7%) and 38/75 (50.7%) patients using language-specific thresholds, compared with 25/75 (33.3%) and 18/75 (24.0%) using conventional thresholds, despite low-to-moderate disease activity (median MGCS 3; MG-ADL 1).

Depressive symptoms were associated with poorer MG-QOL15, higher MGCS, greater functional impairment and higher anxiety scores, whereas anxiety correlated only weakly with MG-QOL15 (rho = 0.270). Neurological severity alone may underestimate patient-perceived disease burden. Depressive symptoms and fatigue contribute independently to MG-specific quality of life beyond conventional clinical severity assessment, supporting psychological and fatigue screening even in patients with apparent clinical stability.

Myasthenia gravis activities of daily living 15-item Myasthenia Gravis Quality of Life Questionnaire This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Viktorija Ķēniņa and Vladimirs Krutovs contributed equally to this work. Department of Neurology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia Viktorija Ķēniņa, Vladimirs Krutovs, Ieva Glāzere, Marija Roddate, Gundega Ķauķe & Violeta Žukova Centre for Rare Neurological Diseases, Pauls Stradiņš Clinical University Hospital, Riga, Latvia Department of Biology and Microbiology, Faculty of Medicine, Rīga Stradiņš University, Dzirciema iela 16, Riga, 1007, Latvia Viktorija Ķēniņa, Vladimirs Krutovs, Ieva Glāzere & Marija Roddate Centre of Neuroimmunology and Imunodeficiencies, Riga, Latvia Department of Psychiatry and Narcology, Rīga Stradiņš University, Riga, Latvia National Mental Health Centre, Riga, Latvia The study was approved by the Research Ethics Committee of Rīga Stradiņš University (approval number: 2-PĒK-4/941/2025) and conducted in accordance with the Declaration of Helsinki.

All participants provided written informed consent before enrolment. Registry data were pseudonymized using unique patient identifiers and analyzed only in aggregated form to ensure participant confidentiality. The authors declare no competing interests.

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