The presence of co-morbid mental health problems in a cohort of adolescents with CFS (2017) Chalder et al.

Clin Child Psychol Psychiatry. 2017 Oct 1:1359104517736357. doi: 10.1177/1359104517736357. [Epub ahead of print]

The presence of co-morbid mental health problems in a cohort of adolescents with chronic fatigue syndrome.

Loades ME, Rimes KA, Ali S, Lievesley K, Chalder T.

Abstract

OBJECTIVE:
To report on the prevalence of mental health disorders in adolescents with chronic fatigue syndrome (CFS) and to compare the diagnoses identified by a brief clinician-administered psychiatric interview with self-report screening questionnaires.

DESIGN:
Cross-sectional study.

SETTING:
Consecutive attenders to specialist CFS clinics in the United Kingdom.

PATIENTS:
N = 52 adolescents, age 12-18 years with CFS.

MEASURES:
Self-report questionnaires and a brief structured psychiatric diagnostic interview, administered by a researcher.

RESULTS:
On the psychiatric interview, 34.6% met a diagnosis of major depressive disorder and 28.8% had an anxiety disorder. Of these, 15% had co-morbid anxiety and depression. Those with a depression diagnosis reported significantly greater interference on the school and social adjustment scale. They also scored significantly higher on trait anxiety, but not on state anxiety. There were no differences between those who had an anxiety disorder and those who did not on fatigue, disability or depressive symptoms. Children's Depression Inventory (CDI) score was associated with a depression diagnosis on the psychiatric interview. However, neither the state nor the trait subscale of the State-Trait Anxiety Inventory (STAI) was associated with an anxiety diagnosis.

CONCLUSION:
Clinicians should assess for the presence of anxiety and depressive disorders in adolescents with CFS using a validated psychiatric interview. Treatment should be flexible enough to accommodate fatigue, depression and anxiety. Transdiagnostic approaches may suit this purpose. Goals should include pleasurable activities particularly for those who are depressed.


KEYWORDS:
CFS/ME; Chronic fatigue syndrome; MINI-KID; adolescents; anxiety; depression

https://www.ncbi.nlm.nih.gov/pubmed/29096528
http://journals.sagepub.com/doi/10.1177/1359104517736357

 

They're teenagers. The very definition of anxiety and volatile mood.

 

There is also a question as to the accuracy of diagnosis of mental health problems in adolescents (and adults) with regard to gender bias. Different genders as a group have different ways of showing problems with thinking, feeling, and behaving.

Is there a mention of the adolescents in this study having other health problems? Can't see it.

If you think about the proportion of us with IBS and the the link between IBS and Anxiety, that would make a difference. (I mean this in the way that IBS naturally causes anxiety)

Three Crawley studies in the References, and at least 1 FITNET too.

 

I couldn't find the CDI questions but it does seem to be tested on a small group

Wiki says: https://en.wikipedia.org/wiki/Children's_Depression_Inventory

The comment on diabetic children suggests that as a scale it is not robust to co-morbid conditions.

Given the issues with questionnaires etc I find it hard to take these papers too seriously.

 

Very important.

I recently read a comment piece about how, in adolescent boys, the scales are more accurate for these kind of questionnaires if a parent filled in the form, than if the adolescent did. (Can't find the comment or paper!)

This would make a big difference in the studies that Crawley likes to publish for example. Without a gender breakdown, the figures could massively influence the success rates of using CBT and GET.

There's also a suspicious difference between diagnosed rates and completed suicide rates in my layman's view. (At least for adults, not sure about younger)

 

It's not clear from the CFS study but these sorts of assessments are usually done soon after attending a service when people could be distressed about what is happening. Or somebody might get referred when most distressed so over time there could be a sort of regression to the mean effect. Also good chance they went to the service soon after diagnosed when quite likely to be distressed.

Like with those with diabetes, results might be quite different at another time point.

 

Biased sample?


There were two centres used

South London and Maudsley NHS Trust service is run by psychologists and psychiatrists. I think it is in the mental section of the hospital. If a child/teenager, their parents or their doctor didn't think a psychiatric issue is involved they might be less likely to be referred there.


Don't know much about GOSH service except recall it being criticised by the TYMES Trust

 

They didn't use the gold standard psychiatric interview:

 

Here are the questions that make up the Work and Social Adjustment Scale

 

Judging by the numbers, I think there is an error here and they were rated 0-3

 

At least one person had a SF-36 physical functioning score of 100 which would cause me to question the diagnosis (but who knows how they read the questions)

 

One of the big findings for me is how poor the match between the anxiety scales and structured diagnostic interview was:

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They are suggesting depression causes school absence and social functioning problems. But the direction of causality could be in the other direction i.e. missing school and time with friends causes depression. Or both could correlate with severity.

 

Were these comparisons controlled for severity of impairment?

 

CBT was not mentioned by name nor CBT/GET theories so I found it less annoying than some papers from those of the CBT school of thought.

 

There is also a question as to the accuracy of diagnosis of mental health problems in adolescents (and adults) with regard to gender bias.

FTFY.

 

I was trying to be very generous

Thank you for the expanded posts you do about papers.

I find they tend to make me a little feisty, so don't know how you can go through them.