Health-related quality of life in patients with chronic fatigue syndrome An international study, 2001, Buchwald, Sharpe, Hardt et al

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Health-related quality of life in patients with chronic fatigue syndrome An international study

Abstract
Objective: Chronic fatigue syndrome (CFS) has been reported worldwide. Our objectives were to determine if patients from different countries have similar profiles of impairments.

Methods: Health-related quality of life (HRQoL) was assessed in 740 CFS patients in the US, 82 in the UK, and 65 in Germany using the eight subscales of the Short-Form General Health Survey (SF-36). To examine the internal structure, factor analyses were performed.

Results:Overall, there was a remarkable similarity in HRQoL among all CFS patients, regardless of location. Patients scored two to three standard deviations below normal on six subscales and one standard deviation below normal on the other two subscales. Factor analysis suggested a two-factor model where the same six subscales constitute the first factor and the two others the second factor.

Conclusion: HRQoL is poor in CFS patients from three countries. This study is a first step towards conducting further comparative cross-cultural and international studies.

https://www.sciencedirect.com/science/article/abs/pii/S0022399901002203
 
This paper was included in a Special Issue of the Journal of Psychosomatic Research in August 2001 on the topic of Sleep and fatigue. Journal of Psychosomatic Research | Special Issue-Sleep and Fatigue | ScienceDirect.com by Elsevier

Among several papers was this one:

2001 – Increased vital exhaustion among type-D patients with ischemic heart disease - ScienceDirect

Abstract
Objective: To investigate the prevalence of the “distressed personality” (type-D) in cardiac patients and to explore the relationships between type-D, gender, vital exhaustion and angina pectoris.


Methods: A questionnaire was completed by 171 patients scheduled for coronary angiography (CAG) at baseline and again at 6 weeks following implementation of treatment with invasive procedures or medication.


Results: Women were more vitally exhausted at baseline and more likely to be classified as type-D. Type-D patients scored higher on vital exhaustion independent of all other variables. Angina was related to vital exhaustion, but improvement in angina following intervention was not associated with improvement in vital exhaustion scores.


Conclusion: Although medical interventions reduced angina, a concomitant decrease in vital exhaustion scores was not found. It is suggested that type-D may explain gender differences on distress. Clinical implications are discussed, including the importance of including personality factors in future research, as they have been shown to have independent prognostic value. {my bold]
 
On the Science Direct website this is under a page in 2022 Type-D Personality - an overview | ScienceDirect Topics


Health Psychology
Keen Seong Liew, ... David S. Krantz, in Comprehensive Clinical Psychology (Second Edition), 2022

8.13.2.5.5 Type D Personality


“Type D personality (or “distressed” personality) is a personality construct related to negative affect or chronic distress. It was identified by Denollet (Kupper and Denollet, 2018), and specifically defined in terms of the presence of both social inhibition and negative affectivity. Type D personality has been linked with worsening patient outcomes and well-being in multiple studies (Kupper and Denollet, 2018). For example, meta-analyses of nine prospective studies in CHD patients indicate that Type D personality is associated with a greater than three-fold increased risk of adverse events. These effects of Type D personality seem to be distinct from depression and other aspects of psychological distress, because in some studies, Type D personality has independent associations with adverse cardiovascular outcomes (Smith, 2011).

Patients with identified Type D personality are less likely to engage in health behaviors such as eating a healthy diet and engaging in physical exercise, and were also more likely to have impaired treatment adherence. Furthermore, the increased psychological distress associated with Type D personality may be similar to that of a chronic stressor which may alter the functioning of the body's stress response leading to increased cortisol. Increased cortisol levels have been associated with many CHD risk factors and cardiovascular conditions (Kupper and Denollet, 2018).
 
Cohort recruitment

US CFS patients were physician and self-referred adults seen at the University of Washington and patients were diagnosed according the the 1994 CDC criteria.

UK CFS patients had been referred to the Regional Infectious Diseases Unit in Edinburgh (where Sharpe works) and were diagnosed according to the British case definition (by White, Sharpe, Wessely et al see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1293107/). A majority of the patients also met the 1994 CDC criteria.

German CFS patients had been referred to the University Hospital in Mainz and were diagnosed according to the 1988 CDC criteria, a subset (83%)of which also met the 1994 CFC criteria.

Apart from the German patients there is no mention of these patients undergoing an extensive physical and psychological examination.


SF-36 results

To account for then necessary normalisation the raw values of the SF-36 were transformed into z scores based on population means and standard deviations considering age and gender.

All z scores of the 8 SF-36 sub scales were below 0 (reference score is set to 0). The physical functioning score was particularly low (well under -2 for each country).

Compared with general population means, mean raw values of all SF-36 subscale scores were significantly lower among CFS patients. For all CFS groups, the lowest raw values were observed for the role limitations — physical and vitality (subscales 2 and 5). For Subscales 1 – 6, mean z values in CFS patients were generally between 2 and 3, which means that only 0.5 – 2.5% of the reference populations had values below this level. Subscales 7 and 8 were relatively less impaired in all countries with means about one standard deviation below the population means. On the whole, patients in US scored lowest, patients in UK scored relatively high, and patients in Germany were in between.
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Even in comparison to chronically ill medical populations, CFS patients appeared strikingly disabled, particularly in the domains of role functioning, social functioning, and vitality [14,15]. Other questionnaires (e.g., Sickness Impact Profile, Quality of Life Index) have also revealed a similar degree of impairment among patients with CFS [25,26].
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In this regard, it is interesting that the CFS patients scored lowest on domains relating to physical limitations. Conversely, role limitations — emotional (Subscale 7) and emotional well-being (Sub- scale 8) scores, which contain items for mental problems, were relatively high.
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In spite of the differences in a few subscales, it appears that CFS patients are substantially impaired.
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