CFS in Chinese middle-school students, 2018, Shi et al

Chronic fatigue syndrome in Chinese middle-school students

Abstract (my bolding):
The objective of the present study was to determine the prevalence of chronic fatigue syndrome (CFS) and its associated factors in middle-school students in Suzhou, China. From September 2010 to January 2011, across-sectional study was conducted in junior- and senior middle-school students aged 10 to 18 years using a battery of confidential questionnaires. Our results indicate that 18,139 completed the questionnaires effectively, of whom 163 (0.9%) met the definition of CFS, with senior high-school students and male students predominating. The prevalence of CFS in the middle-school students increased steadily with age. The main symptoms of CFS in these students included being afraid of going to school, despondency, and irritability in addition to those specified in the Centers for Disease Control and Prevention (CDC). Our study shows that CFS is prevalent among Chinese teenagers, and requiring proper intervention and treatment.

 

Is it me, or is the whole sentence odd?

It makes it seem almost as if being afraid to go to school, despondency and irritability are symptoms that carry more weight than the CDC definition.

What do they mean afraid to go to school? Because they physically or cognitively can't cope, are concerned about the way their physical condition affects their schoolwork?

Or is it written this way so that the reader will assume the kids are anxious about schoolwork and so have developed ME?

Or was something lost in translation?

ETA: most people would be irritable and despondent if they couldn't keep up with all their friends - especially at that age!

 

https://journals.lww.com/md-journal...gue_syndrome_in_Chinese_middle_school.37.aspx

 

This uses Fukuda and the "Chaldea [sic] fatigue scale" as well as the SF-36 for physical function.The reference for the depression scale is an article referenced from 1965 entitled "A self-eating depression scale". (Say what???)


Self-report by the students with the help of trained investigators. So no physical exam. No description of post-exertional malaise.

The study says Fukuda is the only accepted guideline for case definition at present. (????)

I can't go any further....

I think the investigators need some education.

 

Yep. That could possibly be because the questions are deliberately phrased to elicit a certain response.

Well...no, no comment. The guys have already put together a great critique on that. Just in case anyone missed it:

https://s4me.info/threads/s4me-subm...-with-the-chalder-fatigue-questionnaire.2065/


Basically they say:

Total pile of...

 

The symptoms displayed sound more like a reaction to the incredible cultural pressure that Chinese students, especially boys, are placed under within their education system:

http://www.bbc.com/capital/story/20150611-chinas-parent-army

 

As well as the questionnaire, they did use this.

 

It was odd to see a higher prevalence in males. I'm not sure I've ever seen that before in CFS studies.

 

It is odd to see that only 20.7% of those classified as having CFS reported having unrefreshing sleep. Unrefreshing sleep is usually one of the most most frequently reported symptoms in CFS cohorts.

14% of those not satisfying the CFS criteria also reported unrefreshing sleep.

 

It's this one apparently https://psychology-tools.com/zung-depression-scale/

This scale is interesting because there is no option to indicate that a symptom is not present. A symptom is always present "a little of the time" or more, never absent.

If I select "a little of the time" for all symptoms, then I get a score of 50 out of 80, indicating mild depression. Something seems fishy about this.

 

It's one of those tricksy scales where the "right" answer is sometimes no and sometimes yes. But the minimum score is still 20 apparently: "Scores in the 20 - 44 range indicate slight to no Depression." according to that site, but it's the "Normal range" according to Wikipedia.

 

These don't seem to have been used with regard to diagnosis or exclusions.

Also they don't seem to have published any data on them in the paper.

 

I don't believe they specify which threshold they used.

 

It would have been interesting if they'd also used and reported on a more strict threshold such as a score greater than or equal to 6, as was used as an entry criterion in PACE Trial.

 

99.4% of those classified as having CFS reported postexertional malaise.

However 53.9% of those who were not classified as having CFS also reported the symptom. This figure for controls seems very high and makes me question the validity of whatever question was used. They may have translated something into Chinese but perhaps the translation is problematic (or of course the original might be problematic).

 

Here are the 12 areas they asked about:

If they had asked about other symptoms, other things may have come up higher than the 3 they highlighted