All ETDs from UAB

Advisory Committee Chair

Robert Motl

Advisory Committee Members

Dorothy Pekmezi

Donald H Lein Jr

David Morris

Brian M Sandroff

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Major depressive disorder (MDD) is highly prevalent among the 1 million per-sons living with multiple sclerosis (MS) in the United States. The prevalence of MDD is nearly 1.7 times higher in persons with MS than in the general population. MDD is associated with negative outcomes in MS, including worse neuropsychological functioning, lower quality of life (QOL), and worse disability. Higher levels of physical activity (PA) are associated with lower depressive symptoms in MS and participation in moderate to vigorous physical activity (MVPA) has been recommended for managing depression se-verity in the general population. However, the rates, patterns, and behavioral correlates of PA behavior among persons with MS and MDD are not known. Further, specific target outcomes and consequences of PA in this population have yet to be identified. This dissertation aimed to describe the current evidence regarding treatments for depression in MS and examine the rates, patterns, and theoretical correlates of PA among persons with MS who have MDD to inform the future design of behavior change interventions. Results are presented through four single study chapters. The existing evidence suggests that cur-rent individual treatments for MDD in persons with MS are only partially efficacious, and combinatory therapies are needed for managing MDD in MS. MVPA and steps/day rep-resent promising targets for behavior change interventions among persons with MS who have depressive symptoms, however, it the contribution of fatigue and disability on PA iv participation must be considered. Social cognitive theory (SCT) is an appropriate frame-work for promoting physical activity change among persons with MS who have MDD, and SCT constructs such as self-efficacy and goal setting should incorporated in future interventions targeted at increasing MVPA in this population. This dissertation provides preliminary evidence to inform future behavior change interventions among those with MS who have MDD. It is necessary to examine further correlates of physical activity behavior such as MS symptoms, self-regulatory behavior change constructs, and their aligning behavior change strategies, to further tailor comprehensive approaches for PA promotion in persons with MS who have MDD.



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