Relationship satisfaction, communication self-efficacy, and chronic fatigue syndrome-related fatigue, 2019, Milrad et al

Andy

Andy

Retired committee member
Nancy Klimas is a named author on this.
Highlights

• Relationship satisfaction and depression can impact CFS-related fatigue.
• Patient symptom disclosure satisfaction (PSDS) is a hypothesized intermediate.
• Depression and PSDS were examined as intermediary variables of this relationship.
• Relationship satisfaction was related to fatigue severity via depression and PSDS.
• This underscores the importance of considering these factors in the context of CFS.

Abstract
Rationale
Relationship dissatisfaction has been linked with worse health outcomes in many patient populations, though the mechanism(s) underlying this effect are unclear. Among patients with chronic fatigue syndrome (CFS) and their partners, there is evidence for a bi-directional association between poorer relationship satisfaction and the severity of CFS-related fatigue.

Objective
Here, we hypothesized that relationship dissatisfaction negatively impacts fatigue severity through greater depression and less patient satisfaction about communication about symptoms to partners.

Method
Baseline data were drawn from diagnosed CFS patients (N = 150) participating in a trial testing the efficacy of a stress management intervention. Data derived from fatigue severity (Fatigue Symptom Index, FSI), depression (Center for Epidemiologic Survey-Depression, CES-D), relationship quality (Dyadic Adjustment Scale, DAS) and communication satisfaction (Patient Symptom Disclosure Satisfaction, PSDS) questionnaires were used for bootstrapped indirect effect analyses using parallel mediation structural equation modeling in Mplus (v8). Age and BMI were entered as covariates.

Results
Greater relationship satisfaction predicted greater communication satisfaction (p < 0.01) and lower CES-D scores (p < 0.01), which in turn were each significantly related to greater fatigue severity (p < 0.05). Tests of the indirect paths indicated that relationship satisfaction had a significant effect on fatigue severity through both constructs, but primarily via depression. There was no direct association between relationship satisfaction and fatigue severity after the intermediate variables (depression, communication satisfaction) were included in the model.

Conclusion
Results highlight the importance of considering depression and communication-related factors when examining the effects of relationship satisfaction on CFS symptoms such as fatigue. Further mechanism-based, longitudinal research might identify relationship-related mediating variables that can be targeted therapeutically.
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Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0277953619303776
Sci hub, https://sci-hub.se/10.1016/j.socscimed.2019.112392
 
Don't want to defend this. But she's next-to-last author, which I understand is the least important placement. My guess would be her involvement was limited to providing some kind of info on patients. Perhaps contact info? The question would be whether she knew fully what the intention of the PI was. If so, why would she agree to something like this, though it wouldn't be the first time; if not, why not? What surprises me just a bit more is seeing Fletcher's name as well.
 
AYFKM with this?

Not mixing cause and effect is science 101. No matter how many times you try to figure out how the smoke started the fire it still did not start the damn fire.

Also: WTF is a relationship? This damned disease destroyed all of mine.
 
Relationship satisfaction and depression can impact CFS-related fatigue.
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I disagree with this sentence. We have no idea if relationship satisfaction or depression are impacting CFS-related fatigue. The impact could be quite plausibly be zero. It is just difficult to tell because fatigue is a nonspecific symptom of various problems and we cannot tell how much each of these is contributing to a patient's fatigue score.

I interpret "CFS-related" to mean caused by the disease process that produces the syndrome.

Worded differently: they seem to be proposing a mathematical relationship where relationship satisfaction and depression multiply fatigue caused by CFS, rater than adding to fatigue separately.

I'm nitpicking but it's interesting to pick apart what appears to be underlying assumptions.
 
Jonathan Edwards said:
Exactly how do you target therapeutically relationship-related mediating variables.

Is it dial-a-friend, or friends-on-wheels, or prescription only friends?

Rub-on friends? Friend patches? IV friends?
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The problem is that there is a common bias, namely questionnaire answering behaviour.

Tests of the indirect paths indicated that relationship satisfaction had a significant effect on fatigue severity through both constructs, but primarily via depression. There was no direct association between relationship satisfaction and fatigue severity after the intermediate variables (depression, communication satisfaction) were included in the model.
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This method does not separate the effect of (a negative bias on) questionnaire answering behaviour from depression itself.

The only way to resolve this is to use objective measures of fatigue on functioning.
 
Three Chord Monty said:
Don't want to defend this. But she's next-to-last author, which I understand is the least important placement. My guess would be her involvement was limited to providing some kind of info on patients. Perhaps contact info? The question would be whether she knew fully what the intention of the PI was. If so, why would she agree to something like this, though it wouldn't be the first time; if not, why not? What surprises me just a bit more is seeing Fletcher's name as well.
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Given the car crash of the genetics study that also bore her name earlier this year she may be too busy to attend to detail?
Concerning given it's not the first paper to suffer from GIGO
 
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