scholarly journals How common are depression and anxiety in adolescents with chronic fatigue syndrome (CFS) and how should we screen for these mental health co-morbidities? A clinical cohort study

2020 ◽  
Author(s):  
Maria E. Loades ◽  
Rebecca Read ◽  
Lucie Smith ◽  
Nina T. Higson-Sweeney ◽  
Amanda Laffan ◽  
...  
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Chronic Fatigue Syndrome ◽  
Depression Scale ◽  
Chronic Fatigue ◽  
Anxiety And Depression ◽  
Fatigue Syndrome ◽  
Children’S Anxiety ◽  
Clinically Significant ◽  
Anxiety Depression

Abstract Adolescents with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) appear to be more likely to experience anxiety and/or depression using Patient Reported Outcome Measures (PROMs). However, we do not know how accurate these are at detecting problems in this patient group given the primary symptom of fatigue. We aimed to accurately determine the prevalence of anxiety/depression using gold-standard diagnostic interviews and evaluate the accuracy of PROMs measuring mood disorders in this patient group. We conducted a cross-sectional epidemiological study in a specialist tertiary paediatric CFS/ME service, England. The participants were164 12–18-year olds with clinician confirmed CFS/ME and their parents. The measures were a semi-structured diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, K-SADS, and questionnaires (Revised Children’s Anxiety and Depression Scale, RCADS; Spence Children’s Anxiety Scale, SCAS; Hospital Anxiety and Depression Scale, HADS). Parents completed the RCADS-P. 35% met the criteria for at least one common mental health problem. 20% had major depressive disorder, and 27% an anxiety disorder, with social anxiety and generalised anxiety being the most common. There was high co-morbidity, with 61% of those who were depressed also having at least one anxiety disorder. The questionnaires were moderately accurate (AUC > 0.7) at detecting clinically significant anxiety/depression, although only the RCADS-anxiety reached the predefined 0.8 sensitivity, 0.7 specificity target. Mental health problems are particularly common amongst adolescents with CFS/ME. Most screening tools were not sufficiently accurate in detecting clinically significant anxiety and depression, so these should be used with care in combination with thorough psychological/psychiatric assessment.

scholarly journals Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database

QJM ◽  
2013 ◽  
Vol 106 (6) ◽  
pp. 555-565 ◽  
Author(s):  
E Crawley ◽  
S M Collin ◽  
P D White ◽  
K Rimes ◽  
J A C Sterne ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Physical Function ◽  
Clinical Assessment ◽  
Rating Scale ◽  
Depression Scale ◽  
Chronic Fatigue ◽  
Anxiety And Depression ◽  
Fatigue Syndrome ◽  
Graded Exercise Therapy

Abstract Background Chronic fatigue syndrome (CFS) is relatively common and disabling. Over 8000 patients attend adult services each year, yet little is known about the outcome of patients attending NHS services. Aim Investigate the outcome of patients with CFS and what factors predict outcome. Design Longitudinal patient cohort. Methods We used data from six CFS/ME (myalgic encephalomyelitis) specialist services to measure changes in fatigue (Chalder Fatigue Scale), physical function (SF-36), anxiety and depression (Hospital Anxiety and Depression Scale) and pain (visual analogue pain rating scale) between clinical assessment and 8–20 months of follow-up. We used multivariable linear regression to investigate baseline factors associated with outcomes at follow-up. Results Baseline data obtained at clinical assessment were available for 1643 patients, of whom 834 (51%) had complete follow-up data. There were improvements in fatigue [mean difference from assessment to outcome: −6.8; 95% confidence interval (CI) −7.4 to −6.2; P < 0.001]; physical function (4.4; 95% CI 3.0–5.8; P < 0.001), anxiety (−0.6; 95% CI −0.9 to −0.3; P < 0.001), depression (−1.6; 95% CI −1.9 to −1.4; P < 0.001) and pain (−5.3; 95% CI −7.0 to −3.6; P < 0.001). Worse fatigue, physical function and pain at clinical assessment predicted a worse outcome for fatigue at follow-up. Older age, increased pain and physical function at assessment were associated with poorer physical function at follow-up. Conclusions Patients who attend NHS specialist CFS/ME services can expect similar improvements in fatigue, anxiety and depression to participants receiving cognitive behavioural therapy and graded exercise therapy in a recent trial, but are likely to experience less improvement in physical function. Outcomes were predicted by fatigue, disability and pain at assessment.

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

2017 ◽  
Vol 23 (3) ◽  
pp. 398-408 ◽  
Author(s):  
Maria Elizabeth Loades ◽  
Katharine A Rimes ◽  
Sheila Ali ◽  
Kate Lievesley ◽  
Trudie Chalder
Keyword(s):  
Mental Health ◽  
Anxiety Disorder ◽  
Chronic Fatigue Syndrome ◽  
Trait Anxiety ◽  
Chronic Fatigue ◽  
The State ◽  
Self Report ◽  
Psychiatric Interview ◽  
Depression Diagnosis ◽  
Fatigue Syndrome

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.

scholarly journals Screening instruments for psychiatric morbidity in chronic fatigue syndrome

1998 ◽  
Vol 91 (7) ◽  
pp. 365-368 ◽  
Author(s):  
Richard K Morriss ◽  
Alison J Wearden
Keyword(s):  
Mental Health ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Screening Instrument ◽  
Anxiety And Depression ◽  
Operating Characteristics ◽  
Psychiatric Interview ◽  
Mental Health Scale ◽  
Fatigue Syndrome ◽  
Gold Standards

Physicians require a screening instrument to detect psychiatric disorders in patients with chronic fatigue syndrome (CFS). Different threshold scores on the Hospital Anxiety and Depression scale (HAD) and the mental health scale of the Medical Outcome Survey (MOS) were compared with two gold standards for the presence or absence of psychiatric disorder, standard diagnostic criteria (DSM-III-R) and a threshold score for the number of psychiatric symptoms at a standardized psychiatric interview (Revised Clinical Interview Schedule total cut-off score of 11/12). They were compared by use of validating coefficients and receiver operating characteristics in 136 consecutive CFS medical outpatients. The HAD scale at cut-off of 9/10 was a valid and efficient screening instrument for anxiety and depression by comparison with both gold standards. The MOS mental health scale at its recommended cut-off score of 67/68 yielded too many false-positives to be recommended as a psychiatric screening instrument in CFS patients.

scholarly journals Cognitive and behavioral coping in people with Chronic fatigue syndrome: An exploratory study searching for intervention targets for depressive symptoms

2017 ◽  
Vol 24 (13) ◽  
pp. 1878-1883
Author(s):  
Vivian Kraaij ◽  
Janneke Bik ◽  
Nadia Garnefski
Keyword(s):  
Depressive Symptoms ◽  
Chronic Fatigue Syndrome ◽  
Coping Strategies ◽  
Depression Scale ◽  
Chronic Fatigue ◽  
Anxiety And Depression ◽  
Cognitive Coping ◽  
Hospital Anxiety ◽  
Cognitive Emotion Regulation ◽  
Fatigue Syndrome

The aim of the study was to find relevant coping factors for the development of psychological interventions for people with chronic fatigue syndrome who suffer from depressive symptoms. A total of 30 adults with chronic fatigue syndrome filled in the Cognitive Emotion Regulation Questionnaire, the COPE and the Hospital Anxiety and Depression Scale. The findings suggested that cognitive coping strategies have a stronger influence than behavioral coping strategies on depressive symptoms. Especially, the cognitive coping strategies refocusing positive, positive reappraisal and catastrophizing were of importance. These findings suggest that these coping strategies should be part of psychological programs for people with chronic fatigue syndrome.

Anxiety Depression and Burden among the Caregivers of Persons with Neurological Illness

2018 ◽  
Vol 9 (2) ◽  
pp. 63
Author(s):  
Anil Kumar Roy ◽  
Nilesh Maruti Gujar ◽  
Arif Ali ◽  
Utpal Borah
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Depression Scale ◽  
Sampling Technique ◽  
Anxiety And Depression ◽  
Hospital Anxiety ◽  
Care Burden ◽  
Neurological Illness ◽  
Rehabilitation Sciences ◽  
Anxiety Depression

Background: Studies have shown that caregivers of the persons with the neurological illness have high levels of psychological distress, depression and caregiver’s burden. The aim of the study was to find out anxiety, depression and caregiver’s burden among the caregivers of persons with neurological illness (PWNI). Method: Thirty caregivers of PWNI attending the Centre of Rehabilitation Sciences, LGB Regional Institute of Mental Health, Tezpur, Assam were selected using purposive sampling technique for the present study. Socio-demographic and clinical data sheet, Zarit Burden Interview Scale and The Hospital Anxiety and Depression Scale were used. Results: The results shown that in Hospital Anxiety and Depression Scale, 26.6% of the caregivers' scores were in the abnormal range in the domain of depression. While in the domain of anxiety, 16.6% scored in the abnormal range. In Zarit Burden of Scale, 13.3% of the caregivers were having little or no burden, 26.6% of the caregivers were having mild to moderate level of burden, 20% were having moderate to severe burden and 30% were having a severe burden of care. Care burden has significant positive correlation with depression (r= .124, p≤ 0.01 and anxiety (r= .124, p≤ 0.05). Conclusion: Caregivers of PWNI have been found to be at higher risk of mental health problems and care burden. The importance of addressing the burden of caregivers involved in the care of PWNI need to be taken into consideration while providing treatment and rehabilitation of PWNI.     Keywords: Anxiety, depression, burden, neurological illness

scholarly journals Who should we ask about mental health symptoms in adolescents with CFS/ME? Parent-child agreement on the revised children’s anxiety and depression scale

2021 ◽  
Vol 26 (2) ◽  
pp. 367-380
Author(s):  
Teona Serafimova ◽  
Maria Loades ◽  
Daisy Gaunt ◽  
Esther Crawley
Keyword(s):  
Mental Health ◽  
Depression Scale ◽  
Parent Report ◽  
Self Report ◽  
Anxiety And Depression ◽  
Mental Health Symptoms ◽  
Child Report ◽  
Health Symptoms ◽  
Children’S Anxiety ◽  
Parent Child

Background: One in three adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have mental health problems. Multi-informant perspectives are key to psychological assessment. Understanding parent-child agreement is crucial to accurate diagnosis, particularly where severe fatigue limits self-report. Methods: Agreement on the revised children’s anxiety and depression scale (RCADs) was assessed between parents and children with CFS/ME ( n = 93) using Bland-Altman plots, cross tabulations and regression analyses. Results: Diagnostic thresholds were met more frequently based on child-report. Parent- and child-report had similar sensitivity and specificity on RCADS compared to gold-standard diagnostic interviews. Regression analysis found similar accuracy between both reports. For anxiety diagnoses, odds ratio (OR) for child-report was 1.10 (CI = 1.06–1.14), and 1.10 (CI = 1.05–1.14) for parent-report. For depression, OR for child report was 1.26 (CI = 1.11–1.43), while for parent-report is was 1.25 (CI = 1.10–1.41). For total score, OR for child-report was 1.10 (CI = 1.05–1.13) while OR for parent-report was 1.09 (CI = 1.05–1.13). Conclusions: Reasonable agreement was observed between parent- and child-report of mental health symptoms in paediatric CFS/ME. While parent-report can facilitate psychological evaluation in CFS/ME, this is not a substitute for a child’s own report.

scholarly journals Exploring anhedonia in adolescents with Chronic Fatigue Syndrome (CFS): A mixed-methods study

2021 ◽  
pp. 135910452110055
Author(s):  
Lucie Smith ◽  
Esther Crawley ◽  
Madeleine Riley ◽  
Megan McManus ◽  
Maria Elizabeth Loades
Keyword(s):  
Mixed Methods ◽  
Chronic Fatigue Syndrome ◽  
Chronic Fatigue ◽  
Diagnostic Interview ◽  
Mixed Methods Study ◽  
Mixed Methods Approach ◽  
Fatigue Syndrome ◽  
Core Symptom ◽  
Clinically Significant ◽  
The Way

Background: Chronic Fatigue Syndrome (CFS/ME) may get in the way of enjoying activities. A substantial minority of adolescents with CFS/ME are depressed. Anhedonia is a core symptom of depression. Anhedonia in adolescents with CFS/ME has not been previously investigated. Method: One hundred and sixty-four adolescents, age 12 to 18, with CFS/ME completed a diagnostic interview (K-SADS) and questionnaires (HADS, RCADS). We used a mixed-methods approach to explore the experience of anhedonia and examine how common it is, comparing those with clinically significant anhedonia to those without. Results: Forty-two percent of adolescents with CFS/ME reported subclinical or clinical levels of anhedonia. Fifteen percent had clinically significant anhedonia. Thematic analysis generated two themes: (1) stopping activities that they previously enjoyed and (2) CFS/ME obstructs enjoyment. Most (72%) of those who reported clinically significant anhedonia met the depression diagnostic criteria. Those who were depressed used more negative language to describe their experience of activities than in those who were not depressed, although the themes were broadly similar. Conclusions: Experiencing pleasure from activities may be affected in CFS/ME, particularly in those who are depressed. Anhedonia may get in the way of behavioural strategies used within CFS/ME treatments.

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