Pre-existing mental illness as a risk factor for ME/CFS

forestglip · Oct 23, 2024

Posts split from a regional thread

Hutan said: ↑

Gosh, that was a roller coaster. Good, bad, ugly, confused...
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we know clear risk factors - women with previous mental illnesses, for example, are more likely to develop ME/CFS.
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Isn't this true?

Edit: I must have misremembered seeing more about mental illness being a risk factor. I'm not seeing much now though. Closest I found so far is:

A logistic regression analysis of risk factors in ME/CFS pathogenesis, 2019, Lacerda et al

We found an association between reports of family history of anxiety and ME/CFS, but not with personal history of anxiety.
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Trish · Oct 22, 2024

I don't think we have seen any evidence of preexisting psychiatric illness being a risk factor for developing ME/CFS. The studies of people developing ME/CFS following EBV by Leonard Jason found none. The only ones I recall that claim cause are wrongly imputing a causative direction from an association that is better explained as being ill and having one's life turned upside down leading to depression or anxiety.

SNT Gatchaman · Oct 22, 2024

Trish said: ↑

I don't think we have seen any evidence of preexisting psychiatric illness being a risk factor for developing ME/CFS.
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And the intramural study did say (with its small numbers) —

Even though PI-ME/CFS participants endorsed more depressive and anxiety symptoms than HVs, they did not meet psychiatric diagnostic criteria. There was also no difference in psychiatric history or reporting of traumatic events between the two groups. Thus, psychiatric disorders were not a major feature in this cohort and did not account for the severity of their symptoms.
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Hutan · Oct 22, 2024

SNT Gatchaman said: ↑

And the intramural study did say (with its small numbers) —
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From Supplementary Data 1 - the exclusion criteria made it less likely for the ME/CFS participants to have a psychiatric history:

1. Current or past psychotic disorder including depression with psychosis, bipolar disorder, and schizophrenia
2. Current DSM-5-defined major depression disorder, generalized anxiety disorder, post-traumatic stress disorder, panic disorder, or obsessive-compulsive disorder unless managed for more than six months with a stable treatment regimen
3. Current or substance use disorder within last 5 years as diagnosed on the Structured Clinical Interview for DSM-5 (SCID-5).
4. Current suicidal ideation
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So, I wouldn't use the Walitt et al study as evidence of psychiatric illness not being a risk factor for ME/CFS. But there certainly are others, including the Dubbo study, that did not find an increased prevalence of pre-existing mental illness in people who developed ME/CFS or PVFS.

forestglip · Oct 22, 2024

Trish said: ↑

The only ones I recall that claim cause are wrongly imputing a causative direction from an association that is better explained as being ill and having one's life turned upside down leading to depression or anxiety.
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I'm curious to see which one(s) did find an association, if you can remember.

ME/CFS Skeptic · Oct 22, 2024

forestglip said: ↑

I'm curious to see which one(s) did find an association, if you can remember.
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British birth cohorts suggested that psychopathology is a risk factor but there is uncertainty about diagnosis (e.g. diagnoses such as depression might have been for ME/CFS before it was recognized as such).
https://pmc.ncbi.nlm.nih.gov/articles/PMC3078325/
https://pubmed.ncbi.nlm.nih.gov/17976252/

forestglip · Oct 22, 2024

ME/CFS Skeptic said: ↑

British birth cohorts suggested that psychopathology is a risk factor but there is uncertainty about diagnosis (e.g. diagnoses such as depression might have been for ME/CFS before it was recognized as such).
https://pmc.ncbi.nlm.nih.gov/articles/PMC3078325/
https://pubmed.ncbi.nlm.nih.gov/17976252/
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It looks like the second study made some attempt to mitigate this risk.

To address the issue of early CFS being misdiagnosed as a psychiatric disorder, measures of participants’ fatigue and fitness levels were taken at ages 15, 31, 36 and 43 years. Reports of energy levels at age 15 were given by the participants’ teachers while at ages 31, 36 and 43 years they were self-reported.
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At age 15 years there were no significant differences in the levels of energy reported by participants’ teachers between those who later went on to report a diagnosis CFS/ME and those who did not. At age 31 years, those who were later to report CFS/ME tended to rate themselves as having higher levels of fitness (data not shown). Despite this, there was a non-significant trend towards decreased levels of energy at age 36 years. However, only three of the participants who later reported a diagnosis of CFS/ME scored highly (above the median) on the lack of energy PSE subscale, indicating that the vast majority of those who were later to report CFS/ME were not suffering significant fatigue at age 36 years. Therefore, measures of psychiatric disorder up to the age of 36 years should be representative of participant’s pre-fatigued state. By the age of 43 years, those who were later to be diagnosed with CFS/ME were beginning to report significantly more fatigue than the rest of the sample (data not shown), suggesting measures of psychiatric disorder taken at this age may not represent true preceding psychiatric disorder.

Combining the various measures of psychiatric disorder taken up to the age of 36 years produced an OR (adjusted for sex) for a later diagnoses of CFS/ME in those with any prior psychiatric disorder of 2.65 (95% CI 1.26–5.57, p=0.01).
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Edit: There's probably some degree of overdiagnosing ME/CFS though. And I don't see anything mentioning PEM being required.

These assumptions are supported by our prevalence estimate being lower than previous estimates of broadly defined chronic fatigue states (Steele et al. 1998), while being higher than that reported in studies using stricter diagnostic criteria (Jason et al. 1999; Reyes et al. 2003).
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0.69% of males and 1.59% of females later had ME/CFS.

Edit 2: It's unclear how much the prevalence of ME/CFS decreased, but the association was stronger when only including physician diagnosed ME/CFS:

The use of self-reported diagnosis is also supported by post-hoc analysis showing that the association between prior psychiatric disorder and CFS/ME remained, and was in fact slightly stronger, when patients who had not received their diagnosis of CFS/ME from a doctor were excluded. The OR (adjusted for sex) of individuals with physician-diagnosed CFS/ME having prior psychiatric disorder was 3.78 (95% CI 1.38–10.28, p=0.009).
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Trish · Oct 22, 2024

forestglip said: ↑

I'm curious to see which one(s) did find an association, if you can remember.
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If you pick a few at random from the subforum labelled:
Psychosomatic research - ME/CFS and Long Covid
You'll come across plenty that claim an association and at least imply cause.

forestglip · Oct 22, 2024

Trish said: ↑

You'll come across plenty that claim an association and at least imply cause.
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I don't think risk factor implies causation though. I'm just curious if the professor's specific statement there is accurate. I'm sure there are many possible common causes for both depression/anxiety and ME/CFS: genetic, immune, etc.

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