1. Guest, the 'News in Brief' for the week beginning 12th July 2021 is here.
    Dismiss Notice
  2. Welcome! To read the Core Purpose and Values of our forum, click here.
    Dismiss Notice
  3. Contribute to feedback on the CDC Evidence Review, for more details click here
    Dismiss Notice

Factors associated with work status in chronic fatigue syndrome (2019) S A M Stevelink, N T Fear, M Hotopf, T Chalder

Discussion in 'PsychoSocial ME/CFS Research' started by Esther12, Aug 4, 2019.

  1. Esther12

    Esther12 Senior Member (Voting Rights)

    Messages:
    4,089
    Likes Received:
    33,151
    I was sure I'd seen this posted here, but now cannot see it.

    They say "The early involvement of occupational health practitioners is recommended to maximize the chances of maintaining employment." - Not seen any good evidence for any intervention intended to improve employment outcomes for CFS though.

    This is published in journal from the Society of Occupational Medicine - I wonder if it's a precursor to more spin from Ira Madan, who has a long history of promoting CBT/GET on the basis of very weak evidence?

    Edit:
    Paywall, https://academic.oup.com/occmed/advance-article-abstract/doi/10.1093/occmed/kqz108/5543260
    Sci hub, https://sci-hub.se/10.1093/occmed/kqz108
     
    Last edited by a moderator: Mar 23, 2021
    Hutan, Joel, Snow Leopard and 12 others like this.
  2. Sean

    Sean Senior Member (Voting Rights)

    Messages:
    3,441
    Likes Received:
    28,757
    And still hasn't been. :rolleyes:
     
  3. James Morris-Lent

    James Morris-Lent Senior Member (Voting Rights)

    Messages:
    898
    Likes Received:
    6,653
    Location:
    United States
    The data, in the abstract at least, does not speak to this either way.
     
  4. NelliePledge

    NelliePledge Moderator Staff Member

    Messages:
    8,133
    Likes Received:
    48,149
    Location:
    UK West Midlands
    Finished in 2014 - so 5 years on is it even relevant
     
    Joh, Annamaria, MEMarge and 3 others like this.
  5. NelliePledge

    NelliePledge Moderator Staff Member

    Messages:
    8,133
    Likes Received:
    48,149
    Location:
    UK West Midlands
    The early involvement of occupational health is simply to get you back to work more or less as soon as they are in contact with you albeit on phased return. May well be the right approach to encourage people with depression to get back to work.

    From my experience phased return was like pushing a boulder up a hill. I had a very kind manager who kept HR out of it as much as possible but eventually when it was clear I wasn’t going to be able to do more than 15 hours a week I had no option but to permanently reduce my hours and take the cut in salary. Plus I’d racked up loads of hours of sick for all the time I wasn’t able to meet my full contract. Which meant I had a much shorter time at the end - when I couldn’t manage 15 hours reliably - til I ended up on statutory sick pay only and then a period of months on no pay while I applied for ill health retirement.

    Who knows if things might have been better if I had given it several months before trying to get back instead of several weeks. I was supposed to be able to take quite a lengthy period of sick absence if needed and still have employment to go back to but everything in practice goes against that.

    As for depressive symptoms I had depression diagnosis I have mentioned this a few times. But many of the problems I was having that were attributed to depression with insomnia unrefreshing sleep flu like symptoms laryngitis physical exhaustion were undiagnosed gradual onset ME.

    The reason older people with ME are less likely to be pushing to continue in employment is financial - some of us being in the relatively privileged position of having the extra possible outcome of retiring early if there’s an occupational pension, and if older and have a mortgage it may be not too far off being paid off.

    ETA I realise that what I’m really saying is that an extended phased return is a double whammy because you’re still racking up sick absences for the hours you can’t work and you’re actually doing as much work as you can manage and because you’ve said you’ll do x hours that’s what you ll push yourself to do. it’s just like graded exercise therapy.
     
    Last edited: Aug 4, 2019
    Sean, Mithriel, Snow Leopard and 11 others like this.
  6. NelliePledge

    NelliePledge Moderator Staff Member

    Messages:
    8,133
    Likes Received:
    48,149
    Location:
    UK West Midlands
    Perhaps they should change their names by deed poll so the paper is by Malingerer, Fear, Avoidance and Catastrophise
     
  7. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    2,347
    Likes Received:
    15,003
    This study appears to make light of "cfs" again. As if the only factor keeping people with this illness from working is co-morbid depression.

    Aside from "cfs", it would be interesting to see the percentage of the employed who have depression.
     
  8. Andy

    Andy Committee Member (& Outreach when energy allows)

    Messages:
    13,564
    Likes Received:
    98,111
    Location:
    Hampshire, UK
  9. Trish

    Trish Moderator Staff Member

    Messages:
    33,623
    Likes Received:
    160,251
    Location:
    UK
    What a pointless study. It's described as a service evaluation.

    Oxford criteria used which only requires 6 months fatigue, so may include a lot of people who do not have CFS or ME.

    Lots of data cherry picked for significant correlations.

    No surprises at all - sicker patients less able to work, and not surprisingly those who had to give up work were more depressed or anxious - I suggest the researchers try being ill and having to negotiate the benefits system, live on a lot less money, lose their sense of self worth etc and see how depressed and anxious they get.

    And the conclusion that occupational health and psychotherapy will improve this situation is pure speculation and shouldn't be included. It's not a research finding from this study.

    Bah humbug.
     
  10. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    4,561
    Likes Received:
    21,874
    This
     
    alktipping, DokaGirl, rvallee and 2 others like this.
  11. strategist

    strategist Senior Member (Voting Rights)

    Messages:
    3,726
    Likes Received:
    38,135
    This study is actually advertising.
     
    Last edited: Aug 4, 2019
    alktipping, Yessica, DokaGirl and 7 others like this.
  12. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    4,561
    Likes Received:
    21,874
    It's preparing for more privatised spin offs from NHS in lieu of direct provision.

    How many private companies currently provide CBT therapy, who has a financial stake in them, and where do they operate?

    The fact that you don't need robust evidence has done nothing to halt the IAPT roll out. The pie has infinite slices.
     
    alktipping, DokaGirl, rvallee and 6 others like this.
  13. Michiel Tack

    Michiel Tack Senior Member (Voting Rights)

    Messages:
    2,490
    Likes Received:
    24,104
    Location:
    Belgium
    55% were currently working but if I understand correctly, this includes patients who worked part-time, did casual work or are a student. Nonetheless the average of 30 hours a week seems quite high.

    There was no significant difference in anxiety between those who worked and those who did not, so I assume this isn't a major factor determining whether patients continue to work or not. There was also no difference in somatic attributions between the groups, while the difference in physical functioning (60 versus 30) was huge. So it seems that what determines whether CFS patients continue to work or not is not patients thinking they have a somatic illness or anxiety, but how ill they actually are.
     
  14. Trish

    Trish Moderator Staff Member

    Messages:
    33,623
    Likes Received:
    160,251
    Location:
    UK
    Amw66, DokaGirl, Annamaria and 3 others like this.
  15. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    Messages:
    6,249
    Likes Received:
    51,300
    Location:
    UK
    "We assessed cross-sectional data from patients attending a UK specialist CFS treatment service between 1 January 2007 and 31 December 2014."
    majority of ME patients (moderate to severe) would not be able to attend so it's hardly a representative sample.
     
  16. Michiel Tack

    Michiel Tack Senior Member (Voting Rights)

    Messages:
    2,490
    Likes Received:
    24,104
    Location:
    Belgium
    Don't think so. I usually respond if I think there's something really misleading in the results, that might confuse readers. Don't think this is the case with this short paper. On the other hand, it's rather frustrating that the authors do not discuss the hypotheses they have tested.

    Why did they ask patients whether they saw their symptoms as physical, psychological or combination of both? They probably thought this was an important factor determining outcomes. But now that the results indicate it's irrelevant to work status, they barely mention it in the discussion section. They also highlight the high numbers of anxiety in this patient sample, by which they seem to say that this is important. But there was no difference in anxiety between the working and not-working group.

    I suspect that if somatic attributions and anxiety, which both feature prominently in their cognitive behavioural model, had shown significant differences between the groups, that the authors would have highlighted this and how important it is to incorporate this in the treatment etc.
     
    lycaena, alktipping, DokaGirl and 9 others like this.
  17. NelliePledge

    NelliePledge Moderator Staff Member

    Messages:
    8,133
    Likes Received:
    48,149
    Location:
    UK West Midlands
    DWP/NHS (not sure which) have a contract with a company that helps with advice about return to work and can take this on so the GP doesn’t have to have any discussions with employer. Basically it’s just some people in a call centre.
    http://fitforwork.org/

    Which is a subsidiary of this group
    https://www.maximusuk.co.uk/
     
    Last edited: Aug 4, 2019
  18. strategist

    strategist Senior Member (Voting Rights)

    Messages:
    3,726
    Likes Received:
    38,135
    They could argue that the physical functioning scores reflect perception of physical functioning and that this perception causes poor health and poor work status.

    All their theories are based on causally interpreting such correlations through a psychogenic lens, so why not here too?
     
    Last edited: Aug 4, 2019
    ukxmrv, DokaGirl, rvallee and 4 others like this.
  19. SallyC

    SallyC Senior Member (Voting Rights)

    Messages:
    179
    Likes Received:
    1,575
    Maximus do the work capability assessment tests for ESA...
     
    Sean, DokaGirl, Annamaria and 2 others like this.
  20. It's M.E. Linda

    It's M.E. Linda Senior Member (Voting Rights)

    Messages:
    667
    Likes Received:
    5,202
    I will be included in this assessment. Attended a CFS/ME Clinic from Jan 2014- discharged early Jan 2015

    ‘Self reported current employment status’ - well my Clinician was involved in at least 3 letters to and fro with a local Occupational Health Consultant, who was acting on behalf of my employer.

    Due to strict HR rules within the civil service, I had mandatory reviews all through the Sickness Absence period, both with my manager(s) [supported by my Union rep] and with independent medical staff, first with a G.P. and then three meetings with the above Occ Health Consultant from the local hospital (employed by the Occ Health business employed by the civil service).

    The very first hurdle I would have had to overcome, was to actually get to work (50-60 min journey there by car in rush hour, 30-35 min journey home).

    Despite OH assistance, all the way through the procedure, they did not enable me to return to work, not even to phased return.


    Try someone who had been hospitalised by Sepsis, followed by an CFS/ME diagnosis (who had already had PVFS 12 years earlier).

    I admitted to being very anxious about my health, my job (which I loved and had received recent ‘outstanding’ reports), our financial situation, two teenagers and a greyhound, OH bearing the burden, our mortgage, moving to half pay, then no pay. As @Trish said, no wonder I was anxious - I was not depressed - but, even if I had been, it would not have been surprising.

    When first diagnosed (even having had PVFS), you still do not realise the strain you put your body through to get to clinic.

    Not until Tribunal put me into Support Group ESA July 2015 (Sepsis August 2013) did I even realise that the whole sickness procedure, attending clinic and coping with U.K. benefits system had been severely affecting my M.E. My slight improvements began in 2016.

    At one point, I contacted “Access to Work” as I understood that you could get funding to ease your journey if you were considered disabled or on a phased return to work. In 2014, they offered to pay for a taxi from home to the local railway station. I would then have had to commute by train (short 10 min journey), then walk to office (2mins). The stress of attempting to co-ordinating a taxi, train, walk option would have been worse than driving myself!


    The moral of this tale is I had OH ‘support’.
    Despite initial concerns, the doctors I saw were actually good, kind and helpful.
    I had no exercises/counselling or household aids provided (which may, or may not, have helped)
    The CFS/ME Clinic actually wrote decent explanatory letters (later used as evidence for benefits).
    I was dismissed from work.
    I still have M.E.
     

Share This Page