I think it’s important to see how the IOM criteria work in clinical populations. I would prefer to see studies done by actually applying the criteria when diagnosing patients, and comparing to other criteria, rather than this post-hoc retrofitting via other questionnaires. And I’d like much larger samples.
Asprusten et al explain:
“We used variables from the above-mentioned set of questionnaires to operationalise the criteria, and then used baseline data to decide whether a patient fulfilled the SEID criteria or not”
I think questionnaires are being over-valued in the field. But there is some potentially valuable data in the study that I’d like to have the energy to pore over.
It’s worth noting that the SEID-positive adolescents
did not reach the cut-off for depression on the Mood and Feelings Questionnaire. They had higher scores on the scale, but as a group, were not depressed. I would have liked this to be clarified by the authors. I find it quite odd that it is not.
Asprusten et al report:
“The SEID-positive group had statistically significantly higher score on symptoms suggesting a mood disorder from the MFQ inventory (total score 23.2 vs 13.4, P≤0.001). We performed a sensitivity analysis by removing seven items from the MFQ likely to be positively answered by any fatigued person, but the difference remained statistically significant (total score 14.8 vs 8.46, P≤0.001).”
But scoring instructions for the MFQ clarify the possible cut-off for depression
https://www.corc.uk.net/outcome-experience-measures/mood-and-feelings-questionnaire/:
“Scoring … a 27 or higher on the long version may indicate the presence of depression in the respondent.”
There’s more detail here about cut-off points:
http://devepi.duhs.duke.edu/.\instruments\MFQ user.pdf
The Mood & Feelings Questionnaire is here:
http://devepi.duhs.duke.edu/instruments/MFQ Child Self-Report - Long.pdf
There is both a short version and long version; given that Asprusten et al refer to a maximum score of 68, they must be using the long version. The link below refers to a maximum score of 66. There’s probably an explanation for this, maybe a slightly different version. I can’t access their reference 26 to check.
If the finding that adolescents meeting SEID criteria have higher depressive symptom scores than those who are simply chronically fatigued is reliable (and I’d want to see it replicated in a non-retrofitting study), well, that wouldn’t be surprising to me. Wouldn’t we expect patients who are more symptomatic to potentially have a greater emotional impact?
And so what if patients fulfilling SEID criteria have more subclinical depressive symptoms? If they do, and they need or want help with that, give it to them. Why would this invalidate the SEID criteria?
From Asprusten et al’s discussion:
“The SEID-positive group had significantly more depressive symptoms. Taken together, the findings question the validity of the SEID diagnostic criteria in adolescent CFS, and suggest that the criteria tend to select patients with depressive symptoms.
The SEID criteria have been criticised for not having predefined exclusion criteria, enabling patients with major depressive disorders to be diagnosed with CFS.
37 The present sample should not contain patients with clinical depression disorder, given the predefined exclusion criteria of NorCAPITAL; however, patients with varying degrees of depressive symptoms were eligible. Our finding of higher depressive symptom scores among SEID-positive patients might theoretically be explained from overlapping symptoms in depression and chronic fatigue states. However, in a sensitivity analysis removing possibly overlapping items, the differences between the groups remained, strengthening the finding that the SEID-positive group has a
greater depressive symptom burden.
And from their conclusion (also in abstract):
This study questions the discriminant and prognostic validity of the SEID diagnostic criteria in adolescent CFS, and suggests that the criteria tend to select patients with depressive symptoms.
Crucially, they didn’t find that SEID criteria are selecting patients with depression, just that in this fairly small retrofitting study, they’re selecting patients who have higher, but still subclinical, scores on a Mood and Feelings questionnaire.
I find it odd that they don’t even attempt to explain
why those who fulfil SEID criteria might have higher scores on the MFQ. As clinicians, wouldn’t this be what you want to understand? I can't find any mention of the
impact of illness on a person.
It reads more like an anti-SEID/IOM study rather than a trying-to-understand-so-we-can-help-make-patients-better piece.
If I were a paediatrician, this study wouldn’t change my views on the usefulness of the SEID criteria. I’d just want to see more studies with different methodologies. And I’d see how useful they were to me and to my patients in clinical practice.
