Depressive symptoms at age 9–13 and chronic disabling fatigue at age 16: A longitudinal study -Aug 2019 Collin,Loades, Crawley et al

Sly Saint · Aug 6, 2019

Journal of Adolescence
Volume 75, August 2019, Pages 123-129

Abstract
Introduction
We investigated whether depressive symptoms at ages 9–13 years were associated with chronic disabling fatigue (CDF) at age 16 among children in the Avon Longitudinal Study of Parents & Children (ALSPAC) birth cohort.

Methods
Depressive symptoms at ages 9, 10, 11, 12, and 13 years were defined as a child- or parent-completed Short Mood and Feelings Questionnaire (SMFQ) score ≥11 (range 0–26). SMFQ score was also analysed as a continuous exposure. Chronic disabling fatigue at 16 was defined as fatigue of ≥6 months' but <5 years’ duration which prevented school attendance or activities, for which other causes were not identified, and with a Chalder Fatigue Questionnaire score ≥19. Logistic regression was used with multiple imputation to correct for missing data bias. We performed sensitivity analyses in which children who had CDF and depressive symptoms at age 16 were reclassified as not having CDF.

Results
In fully adjusted models using imputed data (N = 13,978), depressive symptoms at ages 9, 11, and 13 years were associated with 2- to 3-fold higher odds of CDF at age 16. Each one-point increase in SMFQ score at ages 9, 10, 11, 12, and 13 years was associated with 6–11% higher odds of CDF at age 16. Depressive symptoms and continuous SMFQ scores at each age were not associated with CDF if the outcome was reclassified to exclude children with comorbid depressive symptoms at age 16.

Conclusions
Depressive symptoms at ages 9–13 were associated with chronic disabling fatigue at age 16, but causality is not certain.
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https://www.sciencedirect.com/science/article/pii/S0140197119301289

again using this proxy CDF (chronic disabling fatigue).
Is this now a formal diagnosis?
Or are they maybe, finally, realising that CDF does not equate to ME or CFS?

(they are already apparently beginning to question use of the Chalder Fatigue Scale. see thread:
https://www.s4me.info/threads/bristol-cfs-me-clinic-researching-patients-problems-with-chalder-fatigue-questionnaire.10683/ )

Barry · Aug 6, 2019

Sly Saint said: ↑

Or are they maybe, finally, realising that CDF does not equate to ME or CFS?
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Deep depression can have significant fatigue as a self-reported symptom (I know this from a close family member long time back), but that is a million miles away from depression being a causal factor in ME. Indeed, give what I recall of my relative, if you took a large cohort of people with severe depression as their primary condition, I'd be amazed if a significant percentage of them did not report significant fatigue. Maybe EC and Co. are now deciding to call it something else, CDF, given the game is up that it is not ME.

James Morris-Lent · Aug 6, 2019

Some clarification/elaboration from the body of the article:

Children could only be classified as having CDF if they scored ≥19 (range 0–33) on the Chalder Fatigue scale. This threshold has 82.4% sensitivity and 86.4% specificity for CFS/ME in adults (Cella & Chalder, 2010; Chalder et al., 1993). Children who met our CDF criteria but who were reported by parents to have had problems with alcohol or drugs (crack, solvents, heroin, or cocaine) or a diagnosis of anorexia nervosa were classified as not having CDF.
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We use the term CDF rather than CFS/ME because children in our study were not examined by a physician.
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5. Conclusions

We did not find evidence to support a causal association between depressive symptoms at ages 9–13 years and risk of chronic disabling fatigue later in adolescence. The extent to which associations between depressive symptoms and later chronic fatigue reflect ongoing mood disorders, or conversely, the extent to which comorbid depression is secondary to pediatric chronic fatigue requires further study. In the meantime, clinicians working with children with emotional disorders need to be aware of the risk of chronic fatigue during adolescence and should consider liaising with specialist clinical services which have experience of pediatric chronic fatigue.
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Snow Leopard · Aug 6, 2019

Conclusions
We did not find evidence to support a causal association between depressive symptoms at ages 9–13 years and risk of chronic disabling fatigue later in adolescence. The extent to which associations between depressive symptoms and later chronic fatigue reflect ongoing mood disorders, or conversely, the extent to which comorbid depression is secondary to pediatric chronic fatigue requires further study.
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Positive predictive values were poor,

mean years - sensitivity - PPV (manually calculated by me for all you Bayes lovers)
9.7 - 11.5% - 6.3%
10.6 - 13.3% - 3.5%
11.7 - 9.84% - 5.0%
12.8 - 18.6% - 4.1%
13.2 - 16.7% - 6.8%
13.8 - 35.2% - 4.4% (curious loss of specificity, with a gain of sensitivity, overall no change on PPV!)

Depressive symptoms and continuous SMFQ scores at each age were not associated with CDF if the outcome was reclassified to exclude children with comorbid depressive symptoms at age 16.
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So the sensitivity dropped from fairly low to something non significant.

rvallee · Aug 6, 2019

Who keeps funding the same studies being done over and over again? This is truly pathetic.

And Crawley should be barred from researching on children. She has showed serious lapses in judgment in regards to informed consent. Enough of this nonsense.

We use the term CDF rather than CFS/ME because children in our study were not examined by a physician.
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Aren't pediatricians physicians? Does that mean Crawley simply did not want to bother with that? Again with the churn of low-quality research. And they are doing that while being silenced and chased out of this field of research, almost impressive.

Snowdrop · Aug 6, 2019

This paper does seem to take at least a small step back from fatigue/low mood=ME/cfs.

I'd like to think that in private a journal editor or two has suggested they step up their game with regard to how they conduct their research.

If so, there is a long journey ahead.

Baby steps.

Just to add: it seems to me at least some of what they are studying is just normal teenage growth and development. This whole group seems intent on manipulating things so that everyone behaves all exactly alike.

large donner · Aug 6, 2019

We use the term CDF rather than CFS/ME because children in our study were not examined by a physician.
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How the hell does the study make any sense then if no one has anything ruled in our out? Who the hell is the cohort and what are you trying to prove or disprove.

NelliePledge · Aug 7, 2019

CDF because not examined by a physician- well on that basis a substantial number of adults who have been seen by CFS clinics must be classed as having CDF because a lot of (majority?) patients are seen without any physician input.

However to get referred you have to be seen by your GP who according to NICE guidelines can diagnose you.

So it’s just garbled clap trap.

Amw66 · Aug 7, 2019

large donner said: ↑

How the hell does the study make any sense then if no one has anything ruled in our out? Who the hell is the cohort and what are you trying to prove or disprove.
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A common issue with paediatric research.
Sadly here even with a physician diagnosis it would count for little .

Trish · Aug 7, 2019

It looks to me that the most important finding from this is that the Chalder Fatigue Scale is not a valid way of measuring ME/CFS, because it's confounded by depression.

They found an association between early depression and later fatigue measured with CFQ, but once they removed the cases who were still depressed at the later stage, the association disappeared.

That tells me that the CFQ is a measure of fatigue caused by depression, as well as fatigue caused by anything else (that was already obvious, but it's interesting to have it confirmed). That makes ME/CFS studies that use it as an outcome measure invalid unless they exclude people with depression. (I seem to remember a lot of the PACE participants also had depression).

Does that make sense?

Barry · Aug 7, 2019

Trish said: ↑

It looks to me that the most important finding from this is that the Chalder Fatigue Scale is not a valid way of measuring ME/CFS, because it's confounded by depression.
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I suspect 'fatigue' probably has many different incarnations, despite being referred to by a single word.

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