Improving the identification and treatment of co-morbid depression and/or anxiety in adolescents with CFS/ME, 2021, Loades (Ph.D. Thesis)

[Dolphin]

From: Dr. Marc-Alexander Fluks

Source: University of Bristol
Date: March 22, 2022
URL: https://research-information.bris.a...nal_Copy_2022_03_22_Loades_M_PhD_Redacted.pdf Ref: https://research-information.bris.a...fication-and-treatment-of-co-morbid-depressio

Improving the identification and treatment of co-morbid depression and/or anxiety in adolescents with Chronic Fatigue Syndrome (CFS/ME)
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Maria Elizabeth Loades - Bristol Medical School, University of Bristol, Bristol, UK. Department of Psychology, University of Bath, Bath, UK. Email: m.e.loades@bath.ac.uk

Abstract

Background Many common mental health problems, including depression and anxiety, first emerge in adolescence. Prior work has found evidence of elevated depression and anxiety in samples of adolescents with chronic fatigue syndrome (CFS/ME).

However, this has been based on gold standard diagnostic interviews in small, self-selecting samples which may be biased or on screening questionnaires in larger, more representative samples which may be affected by symptom conflation and have not been validated for use in this population. Furthermore, few studies have investigated the prevalence of both depression and anxiety concurrently in the same adolescents with CFS/ME. Some adolescents with CFS/ME may be more likely to have co-morbid depression and/or anxiety than others and their outcomes may be different.

Identifying the demographic and clinical characteristics of those who are more likely to have co-morbid depression and/or anxiety would enable selective, targeted screening and monitoring. Negative thinking patterns are a malleable perpetuating factor in depression and anxiety. Understanding how the general and fatigue-specific negative thinking patterns of those adolescents with CFS/ME and co-morbid depression and/or anxiety compare to those with CFS/ME only would inform treatment targets.

Comparing outcomes at 6-month follow-up for those with co-morbid depression and/or anxiety to those with CFS/ME only is an important part of determining whether treatments for both CFS/ME and mental health problems need to be adapted.

My programme of work aimed to improve the identification and treatment of co-morbid depression and/or anxiety in adolescents with CFS/ME. I conducted 3 empirical studies and used the findings to inform the development of an adapted treatment for this subgroup.

Methods

Study 1: Cross-sectional clinical study using gold standard semi-structured diagnostic psychiatric diagnostic interview and screening questionnaires, N=164 adolescents (age 12 to 18) with confirmed CFS/ME.

Study 2: Longitudinal study, 3 clinical cohorts, using questionnaire data (demographics, fatigue, functioning, depression, and anxiety symptoms) at baseline (initial clinical assessment) and 6-month follow-up, N=490 adolescents (age 12 to 18) with confirmed CFS/ME.

Study 3: Cross-sectional study nested within the baseline of a randomised control trial, using questionnaires (depression and anxiety symptoms, general negative thinking patterns, fatigue specific thinking patterns, behavioural responses to fatigue symptoms), N=205 adolescents (age 11 to 18) with confirmed CFS/ME.

Results

Study 1: One third of the participants met the diagnostic criteria for current depression and/or anxiety. Of these, approximately 20% met the criteria for a major depressive disorder, and 27% an anxiety disorder, with many meeting the criteria for more than one disorder concurrently. The questionnaires I tested were not sufficiently accurate for screening purposes, apart from the Revised Children's Anxiety and Depression Scale-anxiety subscale (self-report and parent versions).

Study 2: Co-morbid depression and/or anxiety symptoms were common (45.3%) and at baseline, the odds of having co-morbid depression and/or anxiety symptoms increased 1.18-fold (95% CI 1.10, 1.26, p<0.001) for every one-point increase in baseline fatigue severity. Those with higher depression and/or anxiety symptom scores at baseline had worse fatigue severity, physical functioning, and school attendance 6 months later.

Study 3: Participants who had co-morbid depression and/or anxiety symptoms more strongly endorsed all the general negative thinking patterns than those with CFS/ME only. They also more strongly endorsed most types of unhelpful cognitive responses to fatigue, specifically damage beliefs, embarrassment avoidance, catastrophising and symptom focusing. Fear avoidance beliefs were strongly endorsed by both groups, irrespective of their co-morbid mental health status. Participants with co-morbid depression and/or anxiety symptoms also endorsed more strongly both all-or-nothing behaviours and avoidance/resting behaviours.

Conclusions

A substantial minority of adolescents with CFS/ME are likely to have co-morbid depression and/or anxiety, particularly those who are more fatigued and more impaired. They also continue to be more impaired and fatigued at follow-up. In terms of potential treatment targets, those with comorbid depression and/or anxiety tend to endorse more negative general and fatigue-specific thinking patterns. Treatments need to be adapted for this subgroup. My programme of work culminated in using the existing evidence and public and patient involvement from healthcare professionals and young people with lived experience of CFS/ME to describe a potential adapted treatment approach based on co-produced logic models. This approach will need to be evaluated in future and my work has laid the foundations for a clinical trial, although more work is needed.

-------- (c) 2022 University of Bristol

 

[Trish]

These threads look like they are papers based on this PhD research:

Do adolescents with chronic fatigue syndrome (CFS/ME) and co-morbid anxiety and/or depressive symptoms think differently to those who do not have co-morbid psychopathology?, 2020, Loades, Crawley et al

Exploring anhedonia in adolescents with Chronic Fatigue Syndrome (CFS): A mixed-methods study, 2021, Smith, Crawley, Loades et al

Who should we ask about mental health symptoms in adolescents with CFS/ME? .., Serafimova, Loades, Crawley, 2021

Mental health screening in adolescents with CFS/ME, Loades, Crawley et al, 2021

CADENCE study: to assess whether raised CRP is associated with probable depression in children and young people with CFS/ME, Loades, Crawley - ongoing

A Novel Approach to Treating CFS and Co‐morbid Health Anxiety: A Case Study (2016) Daniels

Review: How has cognitive behaviour therapy been adapted for adolescents with comorbid depression and chronic illness? A scoping review, 2020, Loades

Chronic Fatigue in the Context of Pediatric Physical and Mental Illness, 2020, Loades and Chalder

 

[rvallee]

My programme of work culminated in using the existing evidence and public and patient involvement from healthcare professionals and young people with lived experience of CFS/ME to describe a potential adapted treatment approach based on co-produced logic models. This approach will need to be evaluated in future and my work has laid the foundations for a clinical trial, although more work is needed.

Circular work: work that exists only to produce more work in the future. Always developing new programmes, never actually delivering anything. Even as all the new funding they get is based on their past work, which they can themselves pretend did not happen, unless it's to get more funding.

As if the last several decades did not heavily feature using CBT and counseling in general for this. The most common belief in medicine is that ME is the physical symptoms of depression, and that's why CBT works, because CBT works on depression. Those have been the claims for years. Obviously Loades should know this.

It's always both brand new and also has years of success in clinical use. Always. There is simply no need to bother even acknowledging reality in psychology, facts can be entirely made-up, the last several decades can be cherry-picked for parts that both existed and did not exist.

The incompetence is staggering, but it includes everyone involved in the process of publishing this. It's not normal to have what is supposed to be an academic paper simply pretend like the last few years did not happen as they did.

 

[Jonathan Edwards]

The blind leading the blind maybe?

 

[Kitty]

Think I'll wait for the preliminary study on co-morbid batshit rage among young people who have to put up this sort of codswallop AND deal with ME. Will be much more entertaining, and might even come with diagrams.

 

[alktipping]

Think I'll wait for the preliminary study on on co-morbid batshit rage among young people who have to put up this sort of codswallop AND deal with ME. Will be much more entertaining, and might even come with diagrams.

Unfortunately any child who demonstrates an understanding of this as quackery will be re diagnosed with pervasive refusal syndrome = more quackery .

 

[Amw66]

Questionnaires....the eternal issue.
Validity of depression and anxiety scales for use in chronic illness ? Something that's dawning for LC and on which Dr Khan has been vocal.

The issue with children that a descriptive illness language is given to them , learned from medical practitioner s . A learned lexicon of symptoms , the relative merits of which will have been gauged by the response from the clinician.

How falsifiable is the hypothesis? Or is this not a thing anymore ..

I definitely picked the wrong profession if this is what it takes to be successful in psychology

Who will she be defending this to l wonder...

This is truly a parallel universe.

 

[Sean]

Negative thinking patterns are a malleable perpetuating factor in depression and anxiety.

Negative, as defined by...?

 

[bobbler]

Negative, as defined by...?

It is like the ambiguous use of 'optimism'. There is realistic optimism where you are actually really truly being optimistic despite your situation "my life's awful but hey ho at least I still have my hair" vs telling someone off for not lying about their life or situation "we don't want to hear about illness or sad things, haven't you done anything exciting this week?"