Depressive symptoms in adolescents with CFS: Are rates higher than in controls and do depressive symptoms affect outcome?, 2019, Chalder et al

Andy

Andy

Retired committee member
Abstract
INTRODUCTION::
Previous research has indicated that co-morbid depression is common in adolescents with chronic fatigue syndrome (CFS).

OBJECTIVES::
We sought to compare the characteristics of depressive symptoms in adolescents with CFS to those of healthy controls (HCs) and illness controls (adolescents with asthma).

DESIGN::
Case-control study nested within a prospective clinical cohort.

METHODS::
A total of 121 adolescents with CFS who attended an initial assessment at two specialist CFS units completed the Children's Depression Inventory (CDI). Their responses were compared to 80 HCs and 27 adolescents with asthma (illness controls). The clinical cohort of adolescents with CFS completed questionnaires at assessment, and those who were seen subsequently for treatment at the CFS unit (68%) completed the measures again at their first treatment session.

RESULTS::
CFS participants scored significantly higher on all the depression subscales than participants with asthma and HCs. Depression score explained 11% of the variance in subsequent fatigue, but only 1.9% of the variance in physical functioning. Depression score also explained most (68%) of the variance in subsequent depression.

CONCLUSION::
Depressive symptoms are more prominent in adolescents with CFS than in HCs or illness controls. These symptoms also appear to remain over time during a naturalistic follow-up where no treatment was provided. This highlights the need for further research into depression in CFS, including stratifying treatment outcomes by depression status to determine what is effective at addressing these symptoms.
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Paywalled at https://journals.sagepub.com/doi/abs/10.1177/1359104519838584?journalCode=ccpa
Sci Hub, https://sci-hub.se/10.1177/1359104519838584
 
This highlights the need for questionnaires that can distinguish between depression and symptoms we have traditionally considered as evidence of it. It should also be seen as conclusive evidence that we haven't a clue what we are talking about
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Fixed that for them.

ETA - Suggested questionnaire for the Depression Evaluation Form 1 (DEF1);

Q1. Are you depressed? (yes/no)

That's it.
 
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Depression score explained 11% of the variance in subsequent fatigue, but only 1.9% of the variance in physical functioning.
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Combining this with the recent prospective studies showing, for glandular fever/mono for example, that initial illness severity is the best predictor for later physical functioning... perhaps that might indicate that initial psychological factors aren't particularly relevant?

The depression/fatigue correlation is less important given that, y'know, depression often induces feelings of fatigue even when there is no indication of ME/CFS.
 
What does the scale measure - is this something potentially ineffectual and conflatable like HADS ?
 
Looks like the connection between the Chalder and Crawley teams is someone called M. Loades who is an author on 2 more papers with Chalder recently published using this same cohort, plus one with Bath Clinic people using a different cohort. There seems to be a determined effort to push for more psychological interpretation and treatment of adolescent ME/CFS. All based on questionnaires of course, and misinterpretation of association as causation.

Here are the news items I wrote for 3 papers we've seen in the last 2 months. Don't think I'll bother with a news item on this one. It's too much!

Clinical Child Psychology and Psychiatry
"Cognitive and behavioural responses to symptoms in adolescents with CFS: A case-control study nested within a cohort" by Loades et al (including Chalder).
Used questionnaires to compare cognitive and behavioural responses of adolescents and their parents with CFS (N =121) and asthma. (N=27). Claims to find such responses particularly prominent in CFS adolescents and that they could be contributing to "fatigue maintenance and disability". Confuses correlation and causation. Not a recommendation.
Paper here Thread here

Psychology and Health
''Perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome and their parents: a preliminary investigation in a case control study nested within a cohort'' by Loades, Chalder et al.
What can I say? On the plus side: ''Adolescents with CFS did not consistently report higher levels of perfectionism and unhelpful beliefs about emotions than adolescents with asthma or healthy adolescents.'' On the minus side, it's back to blaming parents and making speculations not supported by the data. NOT a recommendation.
Article here Thread here

Clinical Child Psychology and Psychiatry
''Illness perceptions in adolescents with CFS'' by Cara Haines, M Loades et al. (Bath/Bristol).
Compared illness perceptions in adolescents with CFS with patients with other physical health conditions (diabetes and arthritis). The authors say differences found in patients' perceptions and lack of personal control should be treated by therapy. Not a recommendation.
Article here Thread here
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Sly Saint said:
"
Postgraduate research supervised by
https://research-information.bristo...es(b0046095-2534-4bab-a537-10e3921bc8a6).html

eta:
"for more information about the research I do please see:
http://www.bristol.ac.uk/ccah/research/childdevelopmentdisability/chronic-fatigue/ "
Chronic Fatigue Syndrome (CFS/ME) in Children
Lead: Esther Crawley, with Basim Almutairi, Emma Anderson, Lucy Beasant, Simon Collin, Maria Loades, Amberly Brigden and Roxanne Parslow.
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legacy projects
 
In the current study, the CDI was used as a proxy for a confirmed clinical diagnosis of depres-sion. However, the CDI has not been psychometrically examined in fatigued samples, nor specifi-cally validated for use in adolescents with CFS. Therefore, the assumption that it is a valid and reliable measure of depression may be questionable, given the overlap between symptoms of CFS and depression (e.g. fatigue, lack of energy, sleep problems).
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The persistence of these symptoms could then indicate either persistence of depression or persistence of CFS.
 
Why asthma? There's been a glut of those lately. How is asthma a proper "illness control" for ME (or even CFS, whatever that is)? Obviously rates of depression would be much lower with asthma patients. That seems very deliberate to seek an outcome, yet again.

There is a long history of asthma being dismissed by some as mostly or partly psychological and I noticed in the MUS they have something called "brittle asthma" so I'm wondering if that's the reason they find it a valuable comparison. But that's extremely weak and dishonest. Talk about comparing apples and oranges.

MS or similar severe diseases would be a much better control. Why in the hell is no one asking those basic questions and allowing such odd comparisons despite there being basically no relation or commonality between the two diseases?

By this weak protocol, it would be easy to find that the flu is a major cause of (temporary) depression, since the questionnaires do not distinguish between can't and won't. How does this garbage keep getting funded?
 
Is it just me? I get the feeling these people may be attempting to distance themselves from claims to fix ME itself these days, and retreat back to sticking with the psychological consequences of it. Maybe it is just dawning on them they should never have strayed from that in the first place.
 
Barry said:
Is it just me? I get the feeling these people may be attempting to distance themselves from claims to fix ME itself these days, and retreat back to sticking with the psychological consequences of it. Maybe it is just dawning on them they should never have strayed from that in the first place.
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But isn't the implication of this study that depression is a bigger factor in ME than in other disabling conditions, suggesting that it is some how more 'psychological'.

This however is meaningless unless you can measure the comparable illness burden between ME and Asthma. Also how do you compare the difference between a condition relatively well understood with established treatments, with a badly understood condition with no effective treatments, but that is likely to be mismanaged by the medical profession.
 
Peter Trewhitt said:
But isn't the implication of this study that depression is a bigger factor in ME than in other disabling conditions, suggesting that it is some how more 'psychological'.
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Still the same problem of mixing cause and effect and finding imaginary causation out of superfluous correlation. Very similar to Wessely's claims that the only predictor of illness severity is "strength of belief" (however that was measured...), which of course is exactly what is expected. It's like finding that poor people believe themselves as less rich and arguing that this belief is the cause of their poverty. Complete nonsense. Of course poor people believe they are not rich, that's what being poor means.

I don't see much difference between then and now. Chalder is fishing and cherry-picking for any loose correlation she can find and taking post hoc ergo propter hoc all the way to 11. That's how it started and so it goes.

This however is meaningless unless you can measure the comparable illness burden between ME and Asthma
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I'd say those are relatively well-known and they are not at all on the same level. Actually making it even more meaningless since besides being diseases they have nothing whatsoever in common. Maybe the only connection is response to exertion, but that would be the mother of all superficial similarities. Sadly, that probably makes it more likely that this is why they chose asthma.
 
Sadly, I think this cannot be sorted until there is better characterisation of what exactly depression is. There are ubiquitous links on the web to find how various organisations define it but it still seems very vague. The questionnaires I've read about actually seem to make it less clear rather than more.

Is it co-morbid or a result of chronic illness. I think an astute person who understands their own biases could probably assess with some accuracy on a case by case basis (without recourse to questionnaires) but the trend is toward mass diagnosis--this is a problem in itself.
 
rvallee said:
There is a long history of asthma being dismissed by some as mostly or partly psychological and I noticed in the MUS they have something called "brittle asthma" so I'm wondering if that's the reason they find it a valuable comparison.
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I remember commenting on this on another thread. Brittle asthma is a term used for a dangerous type of asthma that is poorly understood. Risk of dying is much higher due to rapid onset of severe/lifethreatening attacks and the difficulty of treating it. Usual drugs don't work well or at all. Quality of life can be poor. It's a different kettle of fish to asthma as generally thought of and like with any serious chronic condition people can develop depression and/or anxiety. Imo some aspects of living with it would be very familiar to many people living with ME but it's also very different in other ways and there are better conditions to use as a comparison so I don't know why they use it.

eta - they don't say they are comparing with patients with brittle asthma though. I dunno.
 
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Peter Trewhitt said:
But isn't the implication of this study that depression is a bigger factor in ME than in other disabling conditions, suggesting that it is some how more 'psychological'.
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I only skimmed the forum during my lunch break, so no doubt you are right.

Trouble is there is so much scope for conflation of CF versus ME/CFS. Severe depression can lead to CF, as I understand it. So if you have an illness that can provoke severe depression, then you may have comorbid CF. So if you have ME/CFS, and if that provokes severe depression (especially if 'treated' by clinicians who don't know there a*se from their elbow when it comes to ME), then you may have comorbid CF in addition to ME/CFS. The depression-related CF component may respond to depression-related treatments, but the ME will not benefit, and may well get worse. Is it any wonder what a cock-up it all is.
 
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