Fatigue and psychiatric disorder: Different or the same? 1999 Chalder, Wessely

Abstract
Background. Fatigue and psychiatric symptoms are common in the community, but their association and outcome are sparsely studied.

Method. A total of 1177 patients were recruited from UK primary care on attending their general practitioner. Fatigue and psychiatric disorder was measured at three time points with the 12-item General Health Questionnaire and the 11-item Fatigue Questionnaire.

Results. Total scores for fatigue and psychiatric disorder did not differ between the three time points and were closely correlated (r around 0·6). The association between non-co-morbid (‘pure’) fatigue and developing psychiatric disorder 6 months later was the same as that for being well and subsequent psychiatric disorder. Similarly, having non-co-morbid psychiatric disorder did not predict having fatigue any more than being well 6 months previously. Between 13 and 15% suffered from non-co-morbid fatigue at each time point and 2·5% suffered from fatigue at two time points 6 months apart. Less than 1% of patients suffered from non-co-morbid fatigue at all three time points.

Conclusions. The data are consistent with the existence of ‘pure’ independent fatigue state. However, this state is unstable and the majority (about three-quarters) of patients become well or a case of psychiatric disorder over 6 months. A persistent, independent fatigue state lasting for 6 months can be identified in the primary-care setting, but it is uncommon – of the order of 2·5%. Non-co-morbid (pure) fatigue did not predict subsequent psychiatric disorder.

journal link
https://www.cambridge.org/core/jour...-or-the-same/C193A17C3AACEE4798AB1EE298F99AA4

public full text available here
https://www.researchgate.net/public...nd_psychiatric_disorder_Different_or_the_same

 

Bizarre that Wessely should put his name to something quite as meaningless as this.

 

Are we supposed to assume that fatigue leads to psychiatric symptoms or that psychiatric symptoms lead to fatigue?

From the point of view of the doctor or nurse does it matter which way round it is? Because they can just choose the direction of association that makes their lives easier.

 

We don't have a reliable way to measure fatigue, and we don't have a reliable way to measure psychiatric disorders, so you an find whatever meaningless correlation makes you happy.

 

Seems pretty on brand for him. I'm not sure I noticed his name attached to something meaningful.

 

Some of his efforts have quite clear meanings, I think. which is why people disagree with him!
It is the level of meaninglessness that struck me here. Sort of distilled meaninglessness - single malt.

 

I clicked on the first author for this article in order to see who Van Der Linden was (I assume it was Chalder and was curious when she was qualifying in academia and if these were her 'early days' papers, but she is second on the list):

Search (cambridge.org)

all the papers listed are from an 'A' not a 'G' and are on the topic of beef production or other unrelated. So I've looked up the same paper via google and got the link showing something more feasible:

van der Linden G - Search Results - PubMed (nih.gov)
Affiliation for the 1999 article:
Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa

Ahh me being dumb, if you click on 'author details' to the right then you get the following:
G. VAN DER LINDEN
Affiliation:
From the Department of Psychiatry, University of Stellenbosch, Tygerberg, South Africa; Department of Psychological Medicine, Institute of Psychiatry and King's College School of Medicine, London; and School of Psychiatry, St George Hospital and Community Health Service, Academic Department of Psychiatry, University of New South Wales, Kogarah, NSW, Australia

Although now I'm confused because it is the same paragraph list for all of the authors.

So I don't know whether it is an error, whether they all worked at all of these places, or that list is 'in order of listed author'. Or no particular order at all - just that the 6 authors were at these 3 places.

The other 3 are:

I. HICKIE,
A. KOSCHERA,
P. SHAM

 

I think something to note is actually getting into the journal 'Psychological Medicine' - I would be interested if there is anyone on the forum who has a sense of how 'stringent' that was back then vs eg getting in with whatever conclusions vs method to a more psychosomatic (or other) publication these days?

 

this is a sidenote but I've looked up Chalder to see where she was at this point in time 1999 career-wise (she'd had her name on a few publications many years before), and was surprised by this on MEpedia (Trudie Chalder - MEpedia (me-pedia.org) ) :

From 2012 to 2014 Chalder was president of the British Association for Behavioural and Cognitive Psychotherapies.[5]

That's pretty significant to me.

Of course I don't know what 'power' is bestowed , or the process of getting there (is it a vote? from who?) which always says something. But that she did describes the organisation's 'focus' , at least at that period of time. SO is relevant.


Does she have a page here?

 

I've come across 'the international Chronic Fatigue Syndrome Study Group' which I'd never heard of before but came up for at least I. Hickie, curious if others know much about it as don't want to assume more from a quick google than it actually is,

could that be a possible link, or reason behind these working together/the paper - not that it is cited, but there isn't much I can see about it here due to paywall?

 

Wessely has never written anything but drivel, whether with 'meaning' or not! He likes trying to make himself sound clever and authoritative, but it all boils down to being a load of lovingly steamed & seasoned TRIPE.

 

Thanks for confirming, I was interested partly because back in 1999 the internet had obviously been up and running for a bit but things certainly were nowhere near as workable for people from 3 different continents to work together as we might now assume.

I know that perhaps there might have been conferences or whatnot these might have met at, but was then curious whether this 'study group' had significant power for a generation of time and that was anything that might have united these individuals.

I don't know, but looking at some of the things coming up on google there might have been something somewhere that back then had identified there were certain 'boxes' that needed to be ticked in a strategy regarding cfs.

I've just whilst looking for the link to the study group (it is referenced most commonly in the paper defining CFS): (PDF) The international chronic fatigue syndrome study group identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution (researchgate.net)

Also found the following paper: Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution - PMC (nih.gov)

As it mentions the following there is a sense that around this point in time 'a lot' was getting nailed down or something quite organised towards certain things.

There was then a whole section titled: Definition and Evaluation of Fatigue

which went through various different scales claiming to measure it etc.

I mention this because I'm guessing this wasn't a last-minute conference and CDC hosting sounds like it could have been as something 'big', so the 1999 date of this work is interesting and I wonder whether there are other accompanying 'fatigue-related' articles from these authors that this was part of?

I'm also of course curious too how international collaborative it really was (different people taking on different bits) or whether it was a bun fight of people competing for 'ownership' of things to get a piece of the pie or anything? Do you or anyone else have experience or knowledge from that time period?

 

I've searched my collection of thousands of ME papers for references to the "International Chronic Fatigue Syndrome Study Group". The earliest reference I have is to the Fukuda et al 1994 paper "The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study", where the group is listed among the authors. There is a listing of the members in the appendix.

 

Thank you. The link I've got doesn't have an obvious list of section links, so I'm 'going fishing' for the appendix.

Of course that means that in the process I've come across the following section:

OK on the membership, Ian HIckie appears to be the only one of these authors who is a member on this paper, so in 1994. The list is almost entirely from North America apart from one individual from Osaka University, Japan; Hickey from Australia; but also Anthony Cleare from IoP King's COllege London.

I haven't looked up Anthony Cleare but obviously at some point Wessely and Chalder then joined IoP King's I've no idea whether there would be a relationship like boss or just colleague or it could of course have become sharing connections etc if the dept were trying to build a specialism across a few people etc.

Then of course there are the actual authors of the 1994 article, who aren't on the list who are similarly North America 'heavy' in their institutions but also Netherlands, Sweden and there is PD White from St Barts , Nancy Klimas is another author, Leonard Jason, Elizabeth Under among others.

But so far this group as I have knowledge of (and there's the caveat) wouldn't account for all authors or even institutions on here