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Psychiatry Investig > Epub ahead of print
[Epub ahead of print]
DOI:    Published online January 7, 2019.
Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors
So Hee Lee1, Hyoung-Shik Shin2, Hye Yoon Park3, Jeong Lan Kim4, Jung Jae Lee5, Haewoo Lee6, Sung-Doo Won7, Woori Han1
1Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
2Center for Infectious Diseases, National Medical Center, Seoul, Republic of Korea
3Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
4Department of Psychiatry, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
5Department of Psychiatry, School of Medicine, Dankook University, Cheonan, Republic of Korea
6Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
7Department of Clinical Psychology, Keyo Hospital, Uiwang, Republic of Korea
Correspondence: Hyoung-Shik Shin ,Tel: +82-2-2260-7558, Fax: +82-2-2268-0803, Email:
Received: August 16, 2018   Revised: October 6, 2018   Accepted: October 22, 2018   Published online: January 7, 2019

The relationship among chronic fatigue, depressive symptoms, and post-traumatic stress symptoms (PTSSs) among Middle East respiratory syndrome (MERS) survivors is poorly understood.
Of 148 survivors who consented to be registered and underwent assessments at 12 months (T1) and 18 months (T2) after the MERS outbreak, 72 (48.65%) were evaluated for chronic fatigue, depressive symptoms, and PTSSs based on the Impact of Event ScaleRevised (IES-R), the Patient Health Questionnaire-9 (PHQ-9), and the Fatigue Severity Scale (FSS). Data from 52 subjects, who completed both assessments, were analyzed using a regression-based serial multiple mediation model (PROCESS Model 6).
Bootstrap analyses indicated no direct effects of T1 FSS on T2 IES-R but significant positive indirect effects of T1 FSS on T2 IESR through T1 PHQ-9 and T2 PHQ-9 (B=2.1601, SE=1.3268, 95% confidence interval=0.4250–6.1307). In other words, both T1 PHQ-9 and T2 PHQ-9 fully mediated the relationship between T1 FSS and T2 IES.
Chronic fatigue 12 months after MERS had indirect effects on prolonged PTSSs 18 months after MERS via persisting depression in MERS survivors. This finding supports the need to promote interventional programs for emerging infectious disease survivors with chronic fatigue to reduce depression and prevent prolonged PTSSs.
Key words   Chronic fatigue, Depression, Emerging infectious diseases, Middle East respiratory syndrome, Post-traumatic stress symptoms, Survivors
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