Fatigue in Multiple Sclerosis Is Associated With Childhood Adversities: Pust et al Aug 2020

Sly Saint · Aug 29, 2020

Fatigue is a common and disabling symptom in patients with Multiple Sclerosis (PwMS). Its pathogenesis, however, is still not fully understood. Potential psychological roots, in particular, have received little attention to date. The present study examined the association of childhood adversities, specific trait characteristics, and MS disease characteristics with fatigue symptoms utilizing path analysis. Five hundred and seventy-one PwMS participated in an online survey. Standardized psychometric tools were applied. The Childhood Trauma Questionnaire (CTQ) served to assess childhood adversities.

Trait variables were alexithymia (Toronto Alexithymia Scale; TAS-26) and early maladaptive schemas (Young Schema Questionnaire; YSQ). Current pathology comprised depression (Beck’s Depression Inventory FastScreen; BDI-FS) and anxiety symptoms (State-Trait Anxiety Inventory; STAI-state), as well as physical disability (Patient determined Disease Steps; PDDS).

The Fatigue Scale for Motor and Cognitive Functions (FSMC) was the primary outcome variable measuring fatigue. PwMS displayed high levels of fatigue and depression (mean FSMC score: 72; mean BDI-II score: 18).

The final path model revealed that CTQ emotional neglect and emotional abuse remained as the only significant childhood adversity variables associated with fatigue. There were differential associations for the trait variables and current pathology: TAS-26, the YSQ domain impaired autonomy and performance, as well as all current pathology measures had direct effects on fatigue symptoms, accounting for 28.2% of the FSMC variance.

Bayesian estimation also revealed indirect effects from the two CTQ subscales on FSMC. The final model fitted the data well, also after a cross-validation check and after replacing the FSMC with the Chalder Fatigue Questionnaire (CFQ). This study suggests an association psychological factors on fatigue in Multiple Sclerosis. Childhood adversities, as well as specific trait characteristics, seem to be associated with current pathology and fatigue symptoms. The article discusses potential implications and limitations.
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https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00811/full

The major limitation of the present study is that all data were obtained cross-sectionally and are correlational and the path model’s hierarchical structure does not necessarily imply a cause-effect relationship between the three levels. Moreover, responses in the CTQ specifically may be prone to recall bias or effort-after-meaning effects.
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The present study was web-based and all MS diagnoses and clinical data rely on participants’ self-reports A selection bias for the PwMS sample can also not be excluded. The advertisement of the study as a survey on fatigue in MS may explain the high average levels of fatigue in our sample. In a related matter, depression scores were quite high, and the percentage of patients who had depressive symptoms above the clinical cut-off was higher than what is common in MS (55). Structured clinical interviews would have been helpful to validate anxiety and depression symptoms. Bed-ridden patients or patients who do not have access to the internet might also not have participated. Biased sample characteristics could limit the generalizability of the present findings.

Moreover, MS has a genetic component and can cluster in families (56). Although the majority of MS patients do not have first-degree relatives with the disease, it is conceivable that genetic or environmental factors linked to family history of MS can affect childhood experiences. In our study, we did not assess and thus could not explore the effect of parental MS on any of the measures obtained.
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NelliePledge · Aug 29, 2020

So the behavioural treatment CBT helps (allegedly) so the problem must be behavioural.

all those health charities welcoming CBT as psychological support for their diseases be careful what you wish for - psychosomatic Trojan horse.

Sean · Aug 29, 2020

Retrospective.

rvallee · Aug 29, 2020

The normal reaction to this would be to consider this obviously ridiculous and therefore that all those "associations" elsewhere in the literature have no credible value, that neither "fatigue" nor actual "adversity" were actually "measured" and therefore those tools are obviously flawed to the point of being useless. None of those questionnaires are any more relevant to real life than any Facebook or teen magazine questionnaire. Grow the F up.

Repeat with me folks: correlation does not equal causation. Once more for the particularly slow ones at the back of the class, with a William Shatner affect for good measure: Correlation. Does not. Equal. Causation. Keep doing that, maybe it will prevent you from reporting obvious nonsense.

The introduction of psychology to medicine was a huge mistake, psychology is not even close to be ready to be used this way. Like physics or chemistry trying to do their thing without a working thermometer and instead using subjective cold, cool, warm, hot scales. You need relevant tools, thought experiments are not good enough.

Snowdrop · Aug 29, 2020

Muddled thinking in cognitive behaviourists is associated with irrational beliefs.

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Fatigue in Multiple Sclerosis Is Associated With Childhood Adversities: Pust et al Aug 2020

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