Contribution of individual psychological and psychosocial factors, Dubbo Infection Outcomes Study, 2019, Cvejic, Hickie et al

Based on Hutan's initial post -

It seems to me that simply assessing someone's mental state when they are ill may alter the response simply by making someone think more their symptoms and the inconvenience and possible worry caused.

Another issue is that we don't have any data from these patients prior to onset of illness. So there is no comparison pre and post onset. So we do not know that psychological changes haven't been caused by becoming ill, rather than affecting illness severity.

Isn't it possible that someone might seem more neurotic when faced with a sudden and unexpected, albeit temporary, loss of control in areas that are very important to them? Especially if you are a lone parent or the only wage earner , for example, and have no firm idea how long temporary might last.

 

Why would you have to control for time since symptom onset in a longitudinal study? I don't understand what was done here and why.

 

Psychosocial factors certainly affect the reporting of symptoms on symptom questionnaires as stated in the conclusion, so without objective signs of symptoms or their impact (actigraphy etc), the results are inconclusive.

As @Hutan suggests, this is a post-hoc analysis and therefore is "suggestive" quality at most (the lowest quality evidence).

 

Sci hub, https://sci-hub.tw/10.1016/j.bbi.2019.07.034

 

The responses to this article could reinforce the belief of the investigators that patients are neurotic. Maybe someday they'll consider how it feels for highly stigmatized and neglected patients to have a group of researchers regularly searching for flaws in patients thinking and behaviour, with often questionable methods and publishing the results in various media. Stigmatization of ME/CFS is no joke. It kills and destroys lives. It is serious threat to the well being of patients.

I question that I had while thinking about this study is whether this kind of personality research has ever produced anything useful for patients with any illness, or if it's just a way for researchers to keep themselves busy and publish something?

 

So the eminent Sir Simon is saying that not only is it a possibility for at least some viruses to enter the brain, this may pose increase risks of ongoing ill health.

It seems reasonable to assume depending on the areas of the brain affected and the specific virus involved, different ongoing health problems might ensue.

This suggests to me that this type of study is pretty much useless unless and until there is more knowledge about which viruses can affect the brain, what areas of the brain are affected and what symptoms and health problems are caused.

 

The end. Poor questionnaires that ask leading questions make for bad research.

The questionnaires are vague, non-specific and their very choice represent incorrigible bias, amplified by outcome-seeking analysis. Enough of this weak pseudoscience.

 

The abstract doesn´t describe the relationship between the infection and the disease. The reader already needs "to know" it.

Logically speaking, a contribution is not only not necessary, but even unlikely, b/c if it would be a real contribution it would have caused the disease before the infection.

Therefore also the psychosocial factors are unlikely to substantially contribute.

They might be a predisposition though, but this is a completely different thing. E.g. you will not cure an existing cancer if you destroy any genetic predisposition. When the cancer has occured you need to cure the cancer itself.
This is an important possibility, whatever it can mean in all concrete details in different diseases.

So, already in terms of logic they failed, let alone any empirical terms.

Is it finally the confession that they havn´t found anything after so much time? Or is it even the confession that they havn´t looked at their main subject? (Let me guess, it´s the last one.)

 

I agree with your post above @spinoza577, but

this is dodgy ground, I think. Psychological and social aspects may make some difference -

for example - if you live in poorly maintained housing that might have dampness, mould or infestation and can't afford to move somewhere better you might already be weakened and so that affects the severity and course of your illness. A socio-economic factor.

If you were the lone carer for a vulnerable person, naturally you will feel the burden of that responsibility and so may well not take the same care of yourself while ill & thus affect the course of the illness. A psychological and socio-economic factor.

It may be that someone who is wealthier and has choices will, when their symptoms improve, allow themselves a break or holiday. A bit like the idea of convalescence. Having this option gives both a psychological and physical (or bio) benefit.

That's the sneaky thing with the BPSers. There is a grain of truth & some merit in looking at how biopsychosocial factors can affect illness. Like in the covid pandemic when it's worth investigating why some communities are more at risk than others. That's not what the BPSers do though - they simply patient blame and gaslight.

 

Considering that the government adopted guidelines based on claims by some that knew so much about the role of individual psychological and psychosocial (why even separate those two?!) factors that all other efforts could be stopped and their model, based on affirmation of this knowledge they now admit does not exist, should be official practice, coercively used to deny medical and social support.

Frankly this is basically an admission of fraud, of experts having made baseless assertions that lead to official policies impacting the lives of vulnerable sick people despite them having no such knowledge at any point and there being no actual evidence offered beyond those very weak claims.

If there was any accountability in medicine this would be a massive scandal. But the lies perpetrated on us have made it so that nothing done to us matters, even explicit and well-documented harm. Based on those people's assurances that they had superior knowledge of our internal thoughts and cognitions, claims that are as absurd as it was pathetic for anyone to actually greenlight such obvious junk pseudoscience.

This goes beyond incompetence and malpractice, it's malicious criminal neglect. I have little hopes for justice any time soon but it's so grating that everything that happened since was predicted and desperately warned against, only to be met with comments from the likes of the RACGP (or whatever is their acronym) that if it were up to them it would be 100% psychological and effectively left out of medicine entirely.

 

Thanks for looking more closely at this @Hutan.

Maybe I can say it. Believing that you can control the situation has almost zero relationship to the actual outcome.

This is in extreme contrast to the general belief of society that we patients are able to achieve a recovery if only we did this or that or tried harder.

 

"Emotional lability" (mood swings) is one of the symptoms that Ramsey noted, so the illness could actually be causing symptoms that look like neuroticism. Add to that the fact that the symptoms actually cause a loss of function and control and I question whether rational patient concern over those consequences might not be wrongly attributed to neuroticism. As @Invisible Woman said, there's also no reason to invoke neuroticism to explain the natural anxiety brought on by the tangible economic and social jeopardy that the disease can put you in.

The only thing I can think of as to why you would want to "control for time since onset" would be that they (hopefully) realize that prolonged illness could lead to a level of despair which could easily be confused for neuroticism. They should want to assess your psychological state as soon as possible after onset (since that's the earliest they'd see you), but, even then, it may be too late to distinguish some sort of psychological predisposition from the effects of the disease itself.

The only sure way to study this would be to do a prospective psychological categorization of a huge cohort of physically well people and then see if those few who come down with a severe infection fare differently if they'd shown prior signs of neuroticism.

Of course, the problem with going that route is that it would be... um... hard.

 

Neuroticism and the sense of loss of control is generally seen as a bad thing in terms of recovery. I can see some reasons why but isn't there also a flip side for some?

For those feeling a loss of control complying strictly with a treatment regime, assuming it isn't making you worse like GET for ME patients, could give some a sense of control with the added motivation of regaining control of other aspects of your life.

Those who are neurotic might also tend to pay much greater attention to the fine details of their treatment & less likely to make mistakes such as taking their meds at the wrong time.

So if neuroticism & feeling a loss of control might cause issues in recovery for some, they also might increase the chance of recovery for others.

So I can see why neuroticism & control might not make much difference overall to recovery as described by @Hutan's finding.

 

Wow. I get the feeling that if we were to look in their desks, for at least a few of those people we will find a skull, calipers and books by Malthus and Charles Murray.

The ugly personal politics are oozing, believers in the just-world fallacy. This has nothing to do with science, just people who feel so damn superior and want to "find" justifications for their natural superiorities among different populations.

This is just about the worst perversion of what a competent BPS model should be, it's exactly and perfectly backwards. These people are nuts.