The association of major life events with chronic fatigue, 2019, Schmaling & Patterson

[Dolphin]

Note that "chronic Fatigue syndrome" is not mentioned anywhere in the abstract

https://www.sciencedirect.com/science/article/abs/pii/S0022399919305574

Journal of Psychosomatic Research
Available online 13 August 2019, 109810
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The association of major life events with chronic fatigue
Author links open overlay panelKaren B.Schmalinga
Thomas L.Pattersonb
a
Washington State University, United States of America
b
University of California San Diego, United States of America
Received 18 May 2019, Revised 11 August 2019, Accepted 12 August 2019, Available online 13 August 2019.

https://doi.org/10.1016/j.jpsychores.2019.109810Get rights and content

Highlights


•
Patients with chronic fatigue had about 3 major life events every 6 months.

•
Chronic fatigue-related major life events predicted worse clinical status.

•
Life events unrelated to fatigue were unrelated to clinical status.

•
The results suggest that stress management may be clinically useful.



Abstract
Objective
Major life events have been associated with the onset of unexplained chronic fatigue (CF) and with variability in illness course. The purpose of this study was to characterize the associations of major life events with illness status over time.

Method
Sentinel measures of clinical status were collected four times over 18 months in a cohort of 99 persons with CF; participants also were interviewed regarding major life events, which were independently rated by observers.

Results
Over time, more major life events attributed to CF predicted a worse clinical course, suggesting that illness-related major life events rather than stressful life events in general are associated with worse clinical status for persons with CF.

Conclusion
This study adds to the literature regarding specific types of life events' relationship to illness course, which has implications for the management of CF.

Keywords
Chronic fatigue
Life events
Outcome
Stress

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[rvallee]

We have to fight for every single dollar of research funding and meanwhile stuff like that keeps getting funded, the same stuff over and over again. It's like a jobs program for people who can't science good and wanna do other stuff good too.

Cool. Cool cool cool.

 

[Dolphin]

We have to fight for every single dollar of research funding and meanwhile stuff like that keeps getting funded, the same stuff over and over again. It's like a jobs program for people who can't science good and wanna do other stuff good too.

Cool. Cool cool cool.

I agree there is annoying stuff funded sometimes. But I imagine this might not have required much if any external funding.

Cheap research like this will always probably be done; the thing we need to ensure is there is public and private funding for biomedical studies so this type of research doesn’t make up a big percentage of the research output.

 

[rvallee]

I agree there is annoying stuff funded sometimes. But I imagine this might not have required much if any external funding.

Cheap research like this will always probably be done; the thing we need to ensure is there is public and private funding for biomedical studies so this type of research doesn’t make up a big percentage of the research output.

Unfortunately with the EBM paradigm where quantity trumps quality, thanks to cherry-picked systematic reviews, this is why pseudoscience has managed total domination. Science is not supposed to be drowning in garbage, the validation process is simply broken because cheap trials that validate prejudices have more weight than decades of pre-breakthrough research. This cripples progress entirely.

Not all research is worth funding. This idea is taken too far. I have no issues with a few. But this here has been done countless times exactly as is. It's replication that doesn't know it's replication. Like Chalder's type of research, basically doing the same 2 trials over and over again with tiny variations. The specific purpose of which is to create a false consensus by way of quantity + time. That's mostly why the MUS movement is happening, there are now thousands of papers published over decades that have "stood the test of time" despite being of absolutely no value. Their mere existence is the only substance in evidence, a tautological aberration.

It seems there are expectations that medical professionals would know better than be fooled by this. They clearly do not, especially with controversial issues where prejudice dominates and still have no quantifiable measures. There simply are too many personal opinions being turned into published papers because peer review doesn't work well with qualitative work. It's the exact same problem as fake news. Disinformation drowning out legitimate sources because it's so much cheaper to produce junk than going through a rigorous investigative process.

Anyway, as is typical humans have to do every single mistake to the maximum extent before acknowledging that they are, in fact, mistakes. So this is the normal process, it's just incredibly silly that this is still happening today, with so much evidence that it is morally and intellectually bankrupt. That nonsense should have been closed decades ago and instead it's undergoing a weird renewal almost indistinguishable from a cult.

 

[Dolphin]

I agree there is annoying stuff funded sometimes. But I imagine this might not have required much if any external funding.

Cheap research like this will always probably be done; the thing we need to ensure is there is public and private funding for biomedical studies so this type of research doesn’t make up a big percentage of the research output.

Just to clarify what I was saying:
There will always be people looking to do PhDs in psychology. Some PhD students will work on projects with external funding, but some may not. Similarly, academic psychologists often need to be seen to publish to hold their positions and/or to get tenure and the like. But they may not always have access to funding. So cheap studies can be run internally.

 

[Snow Leopard]

illness-related major life events rather than stressful life events in general

I wonder what this means? I don't have access to the article yet...

 

[Sly Saint]

Note that "chronic Fatigue syndrome" is not mentioned anywhere in the abstract

As I posted elsewhere, I don't get why researchers are allowed to use abstract terms for illnesses that do not officially exist (ie on the WHO ICD-10/11).
This paper (as far as we are able to read it) uses CF (chronic fatigue), Crawley uses CDF.

so therefore this is not only misleading but actually factually incorrect and given all the various supposed guidelines for writing/publishing research papers IMO should be picked up at peer review and corrected.

eta: re ICF (Ideopathic Chronic Fatigue) there is no entry in the ICD10 or 11 for this which is a pity as it would be a useful definition to clarify the difference between CF and CFS.
(checked with DxRevisionwatch)

 

[Jonathan Edwards]

As I posted elsewhere, I don't get why researchers are allowed to use abstract terms for illnesses that do not officially exist (ie on the WHO ICD-10/11).

Having been in the business of clinical research I would say that it is essential for researchers to be able to categorise illness in whatever way they think may be helpful as part of a scientific study. The names in ICD are ones people have found useful in the past in various clinical and scientific contexts but there is no reason to think they are the only, or the best, options.

That is not to say that researchers may use unhelpful terminology. It is just that there is no good scientific reason for being restrictive.

 

[Sly Saint]

That is not to say that researchers may use unhelpful terminology. It is just that there is no good scientific reason for being restrictive.

But surely if a recognised name/term exists for a particular 'illness' then that is what they should use, along with specifying the diagnostic criteria they are using to identify patients.
What if instead of using RA they used chronic joint pain (CJP) and then applied the findings to RA sufferers? Mind you the way things are going ..........

 

[Jonathan Edwards]

What if instead of using RA they used chronic joint pain (CJP) and then applied the findings to RA sufferers?

The point is that this is absolutely fine if the scientific question is about chronic joint pain - which after all is a perfectly reasonable concept. Trials of analgesics or joint replacements could very reasonably use this.

RA actually includes two quite different groups of people. There are people with chronic joint or tendon sheath synovitis with autoantibodies and people whose symptoms and signs are indistinguishable but do not seem to have any autoantibodies. For a treatment directed at autoantibodies it makes no sense to include the second lot, especially if early studies suggest that they show no benefit when the treatment is given hoping that maybe the autoantibodies were just hard to measure.

There is term that nearly fits the first lot - seropositive RA. But that really only covers people with rheumatoid factor autoantibodies. Some RA patients have different autoantibodies.

The situation for osteoarthritis is much worse. The diagnosis of osteoarthritis on its own is pretty useless for any mechanism or treatment study. Osteoarthritis of the base of th thumb probably has nothing much in common with osteoarthritis of the hip except that it is painful. It is doubtful whether osteoarthritis is even a coherent concept because it is used both for worn joints and gnarled joints.

Names for illnesses are constantly being changed as we learn more. If we insisted on sticking to the same names we would not be able to move forward.

 

[Snowdrop]

Just to clarify what I was saying:
There will always be people looking to do PhDs in psychology. Some PhD students will work on projects with external funding, but some may not. Similarly, academic psychologists often need to be seen to publish to hold their positions and/or to get tenure and the like. But they may not always have access to funding. So cheap studies can be run internally.

I have a solution for that. It's called cut funding at the source so we have vastly fewer psych programs and therefore PhD students and profs who need to fill the universe with trivia.

I don't know but expect that the only reason there are so many out there now has to do with the university making lots of money from it. So unfortunately only a pipe dream for me.

 

[Dolphin]

I have a solution for that. It's called cut funding at the source so we have vastly fewer psych programs and therefore PhD students and profs who need to fill the universe with trivia.

I don't know but expect that the only reason there are so many out there now has to do with the university making lots of money from it. So unfortunately only a pipe dream for me.

Given that there are a lot of people employed as psychologists, counsellors, etc. I imagine there will always be a lot of psychology departments. Its different to, say, sociology.

 

[rvallee]

I have a solution for that. It's called cut funding at the source so we have vastly fewer psych programs and therefore PhD students and profs who need to fill the universe with trivia.

I don't know but expect that the only reason there are so many out there now has to do with the university making lots of money from it. So unfortunately only a pipe dream for me.

There are a huge number of interesting research topics in psychology that could benefit from some interest. Funding is already relatively low, it's just mostly wasted on safe but useless junk. There just has to be brakes on the 835th identical version of the same fishing expedition. But since there is so much interpretation and speculation I think most replications aren't even aware that the exact same thing has been done countless times before.

It's an academic field that has a highly inflated rate of "significant results" and reporting that nothing of value was found, basically the rote and main outcome of science, is viewed as a failure, rather than a normal part of the scientific process. So the same junk keeps being done over and over again because it's safe. Entire careers are built on producing safe useless junk. That's basically the gist of the entire psychosocial ideology.

It's sad because we have the opposite problem in biomedical research, where many studies deserve to be replicated but with funding being so low and execution so expensive it just doesn't happen, preferring instead to open up new paths. The idea of allowing research to be a free-for-all to open up unexpected outcomes makes sense, but there would be huge benefits to at least making half of it part of some overall strategy.

 

[Mithriel]

This may be an example of why we have so much trouble communicating out concerns to medical people. Everything seems so innocuous and reasonable and even a standard part of medicine.

I see the point about how looking at joint pain in general rather than specific named diseases could be very worthwhile but, as with most things, when the BPS people use it for us they give it a twist which makes it harmful.

Like the EU banana it is difficult to describe but easy to recognize. Trying to think of a way to describe it, take a study looking at coughing. Working out the mechanism behind something you call chronic cough syndromes could be useful across many of diseases. The problem comes when you use the result that the main cause is living beside a busy road to stop medication for TB.

That does not happen because TB has tests and defenders in the medical community but ME does not have that luxury. Even if their studies were beautifully done to a very high standard, they are then taking those answers based on a single trivialised symptom of ME which is shared by a multitude of conditions and using them to deny treatment and research to very sick people.

If someone did research to show that chronic joint pain was caused by not exercising enough and then saying that RA patients should only be treated by being told to join a gym there would be an outcry.

 

[Sly Saint]

unhelpful terminology

“acronyms of ignorance”
https://www.s4me.info/threads/gover...lishing-the-bps-model.2319/page-3#post-123982

 

[Dolphin]

The full text is now available for free here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745257/

 

[Ravn]

illness-related major life events rather than stressful life events in general

I wonder what this means? I don't have access to the article yet...

It means this:

For example, participants might rate being fired from a job secondary to absenteeism due to illness as an event related to CF, but not the death of a loved one.

Unless I'm missing some critical point here somewhere this is next level

99 patients, a mix of 93% Fukuda and 7% idiopathic CF

Major life events (MLE) include being ill and the consequences of being ill.

Number and type of life events.
Table 1 shows the average number of life events reported by patients at each research appointment, which ranged from 1–11 events per patient. At the index visit, patients reported a variety of events, endorsing 90 of the 133 possible categories one or more times. The most frequently-reported events were those related to health (“suffered from a physical illness or disability lasting a month or more, not requiring hospitalization,” 12.1%; “ongoing medical or psychiatric treatment,” 11.9%; “chronic poor health,” 6.0%; “sustained a minor injury,” 3.2%), finances (“chronic financial stress,” 4.8%; “financial situation worsened,” 3.7%; “insurance company problems,” 3.4%), self (“revision of personal habits, including sleeping eating, exercising,” 3.9%), and others (“close family member became or was pregnant,” 2.7%; ‘attended funerals,” 2.4%). These ten most-frequently endorsed categories changed little over time with few exceptions. At the six month appointment, “sexual difficulties” was endorsed by 2.4%; at the one-year appointment, “close family member was hospitalized for a life-threatening physical illness, disability, or major surgery” was endorsed by 2.4%, and “conditions at work got worse” by 1.9%; and at the 18 month appointment, “new person became resident in the household” by 2.7% and death of “someone else who was important to you” other than family or friends by 2.2%.

They found an association between MLEs related to being ill (say chronic poor health) and how ill people were.

They found no association between MLEs unrelated to being ill (say attended funerals) and how ill people were.

• Patients with chronic fatigue had about 3 major life events every 6 months.
• Chronic fatigue-related major life events predicted worse clinical status.
• Life events unrelated to fatigue were unrelated to clinical status.
• The results suggest that stress management may be clinically useful.

Somehow they twisted this into support for the sensitisation model.

When living with a chronic illness, particularly one with unclear prognosis and treatment options such as CF, attentiveness regarding events with the potential for negative illness consequences is understandable, and consistent with a sensitization model [18]. Although untested in the present study, at a physiological level, others have observed blunted cortisol responses to stress in CF [18, 32], which might contribute to sensitivity [18]. At a psychological level, attentiveness appears to be specific to CF-related events – akin to the selective cognitive processing priority sensitization model proposed by Brosschot [33]. Specifically, worse clinical status was related to negative MLEs related to CF more than to generalized negativity (i.e., neuroticism).

Significant dissonance between the above conclusions and the acknowledged limitations. Though it is not clear who the observers were and why their assessment of patient reports should be any less biased than the patient reports themselves (they used some standardised psychiatric interview technique but that's hardly a guarantee for anything)

A challenge for CF research is its reliance on patient report. The present study included a measure of negative affectivity and used standardized observer ratings of events in order to mitigate the effects of potential reporting biases. The use of objective measures and/or independent reports that complement patient reports will increase confidence in the results.
[...]
the study allowed us to model the association of life events and CF over time, but cannot determine if life events play a causal role in CF

Indeed. But you have shown as near as possible that MLEs do not play a causal role in CF.

 

[Sean]

At a psychological level, attentiveness appears to be specific to CF-related events​

Maybe patients need to pay more attention to their body and its operation because the 'chronic fatigue'* demands more active conscious input to manage?

As always, they simply assume that any difference in (self-reported) perception or behaviour is inherently pathological, that any deviation from the 'appropriate norms' cannot possibly be for good reasons.

(*i.e. physical symptoms)

The use of objective measures and/or independent reports that complement patient reports will increase confidence in the results.​

No. Just no. That is not adequate control of subjective interpretation in patient self-report. Both patient and clinician/researcher subjectivity must be controlled for, not just patients'.