Mental health screening in adolescents with CFS/ME, Loades, Crawley et al, 2021

Andy

Andy

Retired committee member
Psychiatric co-morbidity in adolescents is common, with the majority of those who have depression also having at least one anxiety disorder, and many meeting the diagnostic criteria for more than one anxiety disorder [1]. In our recent paper published in this journal, we reported that approximately one in three adolescents with Chronic Fatigue Syndrome (CFS/ME) has either an anxiety disorder, or major depressive disorder, or both [2].

In clinical practice, screening questionnaires which ask about depression and anxiety symptoms, such as the Revised Children’s Anxiety and Depression Scale, RCADS [3], and the Hospital Anxiety and Depression Scale, HADS [4], are often used as part of the assessment process. However, in our paper, we reported our findings of variable discriminative validity of these questionnaires for detecting anxiety and depression separately [2]. Whilst we found sufficiently accurate threshold scores for classifying those with anxiety disorders on both the 47-item and 25-item parent and child versions of the RCADS, we could not identify a sufficiently accurate threshold score for classifying those with depression. We also could not identify sufficiently accurate threshold scores on the HADS for either anxiety or depression.

Clinicians treating children with health disorders need a simple screening mechanism to identify those with co-morbid mental health problems that will require further assessment. Using one threshold score is therefore arguably more useful than calculating two separate scores (for depression and anxiety). Given the high co-morbidity between depression and anxiety in this population, we sought to identify the threshold score for mental health problems on two commonly used screening questionnaires, the RCADS-total and the HADS-total.
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Open access, https://link.springer.com/article/10.1007/s00787-021-01734-5
 
Clinicians treating children with health disorders need a simple screening mechanism to identify those with co-morbid mental health problems that will require further assessment. Using one threshold score is therefore arguably more useful than calculating two separate scores (for depression and anxiety). Given the high co-morbidity between depression and anxiety in this population, we sought to identify the threshold score for mental health problems on two commonly used screening questionnaires, the RCADS-total and the HADS-total.
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Yes, that's right. Dumb it down even further so you can misinterpret the results of inappropriate questionnaires some more.

Let's make it simpler & easier for the clinical team, probably by adding another layer of abstraction between what they're meant to be assessing and they're interpretation.

Let's not investigate the accuracy and how appropriate those screening "mechanisms" are.

Let's focus on making life easier to slap labels on young people.
 
I have a question for anyone who might know, is there a specific way of defining depression within the health care service? It would be good to have that as a reference to all of this.

And yes, instead of continuing work on labelling children so much needs to be done that comes before that (understanding the biology of depression etc). This has all been way oversimplified.

And how does one account for normal differences in functioning (one's innate characteristics when interacting with the world)?

There are many more of this kind of observation to make but none of these are specific to only this study. Can any meaning at all be derived from studies that are so imprecise? And what does that mean for attempts at treatment?

Also, in their own words:

Participants were recruited from specialist services, so findings may not generalise to other settings, nor to those who were too severely affected to participate. The diagnostic interview was also assumed to be completely accurate, and whilst we made every attempt to ensure that it was robustly conducted, diagnostic judgements may mean that errors were made
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They would seem to be more cautious in their claims than in the past?

But I feel like I've said this all before (long ago). My POV is that this is all money down the drain.

I also continue to be surprised that EC can find new victims. But I guess the pandemic has offered new unsuspecting subjects.
 
The exact same process behind the 1/5 with Covid experiencing "mental health" symptoms:
  1. Patients present with many symptoms
  2. No tests exist for symptoms
  3. Symptoms are dismissed and instead marked as either of: fatigue, anxiety or depression
  4. Trawl through medical records and find many mental health "diagnoses"
  5. Use questionnaires that deliberately conflate illness with depression
They literally misdiagnose people then use their own misdiagnosis as evidence that the misdiagnosis was right. As is tradition. This is beyond dysfunctional. And this is at least the 50th or so study doing the same thing. Copy-paste research.

These people whine about the danger of medical labels yet apply dozens of psychological labels with complete disregard for validity because the labels are so vague and ambiguous they apply in almost any case you want to. The more labels the better. What garbage.
 
rvallee said:
They literally misdiagnose people then use their own misdiagnosis as evidence that the misdiagnosis was right.
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No denying they are experts at something. Pity it is bootstrapping and gaslighting.

rvallee said:
These people whine about the danger of medical labels yet apply dozens of psychological labels with complete disregard for validity because the labels are so vague and ambiguous they apply in almost any case you want to.
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I still find their shameless blatant hypocrisy breathtaking.
 
This from the team which failed to acknowledge dysautonomia for years ( which is commonly misconstrued as anxiety) , and whose comprehension of PEM is primary school level. ( that's being generous)

A common theme on parents forums from interaction with the Bath team is them not listening to the kids ( seems to be a preferred tick box of symptoms). Anecdotally a fair number of kids feel they have failed when going through the Bath protocol. I'm sure that does wonders for mental health

Oops , is there a correlation there ?
 
Snowdrop said:
I have a question for anyone who might know, is there a specific way of defining depression within the health care service? It would be good to have that as a reference to all of this.

And yes, instead of continuing work on labelling children so much needs to be done that comes before that (understanding the biology of depression etc). This has all been way oversimplified.

And how does one account for normal differences in functioning (one's innate characteristics when interacting with the world)?

There are many more of this kind of observation to make but none of these are specific to only this study. Can any meaning at all be derived from studies that are so imprecise? And what does that mean for attempts at treatment?

Also, in their own words:



They would seem to be more cautious in their claims than in the past?

But I feel like I've said this all before (long ago). My POV is that this is all money down the drain.

I also continue to be surprised that EC can find new victims. But I guess the pandemic has offered new unsuspecting subjects.
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I am definitely no expert on this but I did receive a “score” for depression and anxiety as part of my formal diagnosis at the CFS clinic here in the U.K.

just dug out my report and it refers to a “hospital anxiety/depression scale” which has the following range “normal range 0-7, action range 13-21”

I scored anxiety 6, depression 8 and also a 6 on an Epworth score (whatever that is) so this was the proof they used that this wasn’t the cause of my symptoms/CDC score.

I can’t recall the type of questions asked ...sorry it’s a bit blurry looking back. I’ve dug out what I could find on “HADS” via google here:

https://www.svri.org/sites/default/files/attachments/2016-01-13/HADS.pdf

Basically you get a score of up to 3 points for each question and there are 7 questions for depression and 7 for anxiety ..the higher the score, the more you are likely to have the condition. Looks like NICE still use it but it has been criticised I believe.

Looks like the Epworth score is about diagnosing sleep disorders (narcolepsy, sleep apnoea etc).
 
I would like to make a research proposal.

Assuming they were able I'd like to go through the questionnaires with the young people as they answered them.

Let them

A) answer it as they would,
then
B) discuss what they think each question means and why they answered in the way the did and record that.

Then let Crawley et al make their usual interpretation, diagnosis and comments based on A and have someone independent & with no axe to grind make comments and diagnosis based on B.

It would be interesting to see just how off far off the mark Crawley et al are. We could the draw up a measurement scale for that. Now what to call it?
 
Interesting looks like some serious problems for the HADS.

The sensitivity/specificity criteria were not that high (0.8 and 0.7) and they simply looked at depression or/and anxiety so the questionnaire didn't have to differentiate between the two. Nonetheless, the HADS failed to obtain the required sensitivity and specificity.

In other words, it does a poor job at screening ME/CFS patients who might have depression and/or anxiety.

Here's an online version of the scale: https://www.svri.org/sites/default/files/attachments/2016-01-13/HADS.pdf

It asks questions that only relate indirectly with depression or anxiety such as "I feel as if I am slowed down" or "I can enjoy a good book or radio or TV program"

I wonder how well the question "Do you have anxiety and/or depression?" would do on a screening test like this. That should be like a control condition that other questionnaires have to beat in order to be taken seriously.
 
Abstract
Psychiatric co-morbidity in adolescents is common, with the majority of those who have depression also having at least one anxiety disorder, and many meeting the diagnostic criteria for more than one anxiety disorder [1]. In our recent paper published in this journal, we reported that approximately one in three adolescents with Chronic Fatigue Syndrome (CFS/ME) has either an anxiety disorder, or major depressive disorder, or both [2].
Original language English
Pages (from-to) 1003-1005
Number of pages 3
Journal European Child & Adolescent Psychiatry
Volume 31
Issue number 6
Early online date 8 Feb 2021
Publication status Published - 30 Jun 2022

https://researchportal.bath.ac.uk/en/publications/mental-health-screening-in-adolescents-with-cfsme
 
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