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Chen EY, Burton JM, Johnston A, Morrow AK, Yonts AB, Malone LA. Considerations in Children and Adolescents Related to Coronavirus Disease 2019 (COVID-19). Phys Med Rehabil Clin N Am 2023; 34:643-655. [PMID: 37419537 PMCID: PMC10063573 DOI: 10.1016/j.pmr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Pediatric post-acute sequelae of SARS-CoV-2 (PASC) or "long COVID" are a complex multisystemic disease that affects children's physical, social, and mental health. PASC has a variable presentation, time course, and severity and can affect children even with mild or asymptomatic acute COVID-19 symptoms. Screening for PASC in children with a history of SARS-CoV-2 infection is important for early detection and intervention. A multifaceted treatment approach and utilization of multidisciplinary care, if available, are beneficial in managing the complexities of PASC. Lifestyle interventions, physical rehabilitation, and mental health management are important treatment approaches to improve pediatric PASC patients' quality of life.
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Affiliation(s)
- Erin Y Chen
- Johns Hopkins School Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Justin M Burton
- Division of Pediatric Rehabilitation Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Alicia Johnston
- Division of Infectious Disease, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Amanda K Morrow
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Alexandra B Yonts
- Division of Infectious Diseases, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Laura A Malone
- Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
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2
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Dehhaghi M, Panahi HKS, Kavyani B, Heng B, Tan V, Braidy N, Guillemin GJ. The Role of Kynurenine Pathway and NAD + Metabolism in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Aging Dis 2022; 13:698-711. [PMID: 35656104 PMCID: PMC9116917 DOI: 10.14336/ad.2021.0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious, complex, and highly debilitating long-term illness. People with ME/CFS are typically unable to carry out their routine activities. Key hallmarks of the disease are neurological and gastrointestinal impairments accompanied by pervasive malaise that is exacerbated after physical and/or mental activity. Currently, there is no validated cure of biomarker signature for this illness. Impaired tryptophan (TRYP) metabolism is thought to play significant role in the pathobiology of ME/CFS. TRYP is an important precursor for serotonin and the essential pyridine nucleotide nicotinamide adenine dinucleotide (NAD+). TRYP has been associated with the development of some parts of the brain responsible for behavioural functions. The main catabolic route for TRYP is the kynurenine pathway (KP). The KP produces NAD+ and several neuroactive metabolites with neuroprotective (i.e., kynurenic acid (KYNA)) and neurotoxic (i.e., quinolinic acid (QUIN)) activities. Hyperactivation of the KP, whether compensatory or a driving mechanism of degeneration can limit the availability of NAD+ and exacerbate the symptoms of ME/CFS. This review discusses the potential association of altered KP metabolism in ME/CFS. The review also evaluates the role of the patient’s gut microbiota on TRYP availability and KP activation. We propose that strategies aimed at raising the levels of NAD+ (e.g., using nicotinamide mononucleotide and nicotinamide riboside) may be a promising intervention to overcome symptoms of fatigue and to improve the quality of life in patients with ME/CFS. Future clinical trials should further assess the potential benefits of NAD+ supplements for reducing some of the clinical features of ME/CFS.
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Affiliation(s)
- Mona Dehhaghi
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia.
- PANDIS.org, Australia.
| | | | - Bahar Kavyani
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia.
| | - Benjamin Heng
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia.
- PANDIS.org, Australia.
| | - Vanessa Tan
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia.
- PANDIS.org, Australia.
| | - Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Gilles J. Guillemin
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia.
- PANDIS.org, Australia.
- Correspondence should be addressed to: Dr. Gilles J. Guillemin, Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia. .
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Postacute/Long COVID in Pediatrics: Development of a Multidisciplinary Rehabilitation Clinic and Preliminary Case Series. Am J Phys Med Rehabil 2021; 100:1140-1147. [PMID: 34793374 PMCID: PMC8594395 DOI: 10.1097/phm.0000000000001896] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT The long-term sequelae after SARS-CoV-2 infections in children is unknown. Guidance is needed on helpful models of care for an emerging subset of pediatric patients with postacute/long COVID who continue to experience persistent symptoms after initial COVID-19 diagnosis. Here, we describe a pediatric multidisciplinary post-COVID-19 rehabilitation clinic model as well as a case series of the initial cohort of patients who presented to this clinic. A consecutive sample of nine patients (pediatric patients <21 yrs of age) who presented to our clinic are included. The most common presenting symptoms were fatigue (8 of 9 patients), headaches (6 of 9), difficulty with schoolwork (6 of 8), "brain fog" (4 of 9), and dizziness/lightheadedness (4 of 9). Most patients had decreased scores on self-reported quality-of-life measures compared with healthy controls. In the patients who participated in neuropsychological testing, a subset demonstrated difficulties with sustained auditory attention and divided attention; however, most of these patients had preexisting attention and/or mood concerns. There were also some who self-reported elevated depression and anxiety symptoms. Pediatric patients with postacute/long COVID may present with a variety of physical, cognitive, and mood symptoms. We present a model of care to address these symptoms through a multidisciplinary rehabilitation approach.
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Loades ME, Read R, Smith L, Higson-Sweeney NT, Laffan A, Stallard P, Kessler D, Crawley E. How common are depression and anxiety in adolescents with chronic fatigue syndrome (CFS) and how should we screen for these mental health co-morbidities? A clinical cohort study. Eur Child Adolesc Psychiatry 2021; 30:1733-1743. [PMID: 32964335 PMCID: PMC8558286 DOI: 10.1007/s00787-020-01646-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 09/12/2020] [Indexed: 12/15/2022]
Abstract
Adolescents with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) appear to be more likely to experience anxiety and/or depression using Patient Reported Outcome Measures (PROMs). However, we do not know how accurate these are at detecting problems in this patient group given the primary symptom of fatigue. We aimed to accurately determine the prevalence of anxiety/depression using gold-standard diagnostic interviews and evaluate the accuracy of PROMs measuring mood disorders in this patient group. We conducted a cross-sectional epidemiological study in a specialist tertiary paediatric CFS/ME service, England. The participants were164 12-18-year olds with clinician confirmed CFS/ME and their parents. The measures were a semi-structured diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, K-SADS, and questionnaires (Revised Children's Anxiety and Depression Scale, RCADS; Spence Children's Anxiety Scale, SCAS; Hospital Anxiety and Depression Scale, HADS). Parents completed the RCADS-P. 35% met the criteria for at least one common mental health problem. 20% had major depressive disorder, and 27% an anxiety disorder, with social anxiety and generalised anxiety being the most common. There was high co-morbidity, with 61% of those who were depressed also having at least one anxiety disorder. The questionnaires were moderately accurate (AUC > 0.7) at detecting clinically significant anxiety/depression, although only the RCADS-anxiety reached the predefined 0.8 sensitivity, 0.7 specificity target. Mental health problems are particularly common amongst adolescents with CFS/ME. Most screening tools were not sufficiently accurate in detecting clinically significant anxiety and depression, so these should be used with care in combination with thorough psychological/psychiatric assessment.
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Affiliation(s)
- Maria E Loades
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - Rebecca Read
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Lucie Smith
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | | | | | | | - David Kessler
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospital, Bath, UK
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Brigden A, Shaw A, Barnes R, Anderson E, Crawley E. "The child's got a complete circle around him". The care of younger children (5-11 years) with CFS/ME. A qualitative study comparing families', teachers' and clinicians' perspectives'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2179-2189. [PMID: 32519359 DOI: 10.1111/hsc.13029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
Society needs to improve the care of children with complex needs. Guidelines recommend integrating care across health and educational settings, however, there is little research on whether this is achieved or how this can be done in practice. Our aim was to address this gap by examining how the care of children (aged 5-11 years) with Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) is shared across home, education and health settings, in order to generate recommendations for integrating care. We undertook semi-structured interviews with families (22 participants), teachers (11 participants) and healthcare providers (9 participants), analysing the data thematically and comparatively. Our analysis of the data was informed by a socio-ecological perspective as we sought to understand the complexity of the relationships and systems around the child. The first theme focuses on the child ("individual level"); child-centred care is seen as essential whilst acknowledging that the child has limited capacity to manage their own care. The second theme presents the distinct roles of parents, teachers and clinicians ("interpersonal and organisational levels"). The third describes how these three levels interact in the management of the child's care, in the context of the health and education systems and policies ("policy levels"). The fourth explores optimal ways to integrate care across home, school and clinical settings. In conclusion, there is opportunity to support a child with complex health needs by targeting the systems around the child; parents, teachers and clinicians, as well as education and health policy that can enable shared-care. Involving schools in assessment, communicating diagnosis across settings and using a stepped-care approach to integrated care may be beneficial. Further work is needed to explore these recommendations, with attention to the policy factors that may act as barriers and enablers.
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Affiliation(s)
- Amberly Brigden
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Shaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Barnes
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Anderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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6
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Byrne EA. Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:371-379. [PMID: 32170570 PMCID: PMC7426317 DOI: 10.1007/s11019-020-09945-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Miranda Fricker's influential concept of epistemic injustice (Oxford University Press, Oxford, 2007) has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one's predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.
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Parslow RM, Shaw A, Haywood KL, Crawley E. Developing and pretesting a new patient reported outcome measure for paediatric Chronic Fatigue Syndrome/ Myalgic Encephalopathy (CFS/ME): cognitive interviews with children. J Patient Rep Outcomes 2019; 3:67. [PMID: 31707635 PMCID: PMC6842364 DOI: 10.1186/s41687-019-0156-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/18/2019] [Indexed: 01/12/2023] Open
Abstract
Background There is a lack of patient derived, child specific outcome measures to capture what health outcomes are important to children with Chronic Fatigue Syndrome/ Myalgic Encephalopathy (CFS/ME). We developed a new Patient Reported Outcome Measure (PROM) for paediatric CFS/ME through qualitative research with children. This study aimed to pre-test the new measure through cognitive interviews with children with CFS/ME. Methods Cognitive interviews were undertaken in children’s homes or over Skype. The Three-Step Test-Interview (TSTI) method was used to assess the quality of the draft PROM with children with CFS/ME to identify problems with initial content and design and test modifications over subsequent interview rounds. Children were purposively sampled from a single specialist paediatric CFS/ME service in England. Results Twenty-four children and their parents took part. They felt the new measure captured issues relevant to their condition and preferred it to the generic measures they completed in clinical assessment. Changes were made to item content and phrasing, timeframe and response options and tested through three rounds of interviews. Conclusions Cognitive interviews identified problems with the draft PROM, enabling us to make changes and then confirm acceptability in children aged 11–18. Further cognitive interviews are required with children 8–10 years old to examine the acceptability and content validity and provide evidence for age related cut offs of the new PROM to meet FDA standards. This study demonstrates the content validity of the new measure as relevant and acceptable for children with CFS/ME. The next stage is to undertake a psychometric evaluation to support the reduction of items, confirm the structure of the PROM and provide evidence of the data quality, reliability and validity.
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Affiliation(s)
- Roxanne M Parslow
- Centre for Academic Child Health (CACH), Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Alison Shaw
- Centre for Primary Care Research, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - Kirstie L Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Esther Crawley
- Centre for Academic Child Health (CACH), Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
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8
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Collin SM, Norris T, Joinson C, Loades ME, Lewis G, Stansfeld SA, Crawley E. Depressive symptoms at age 9-13 and chronic disabling fatigue at age 16: A longitudinal study. J Adolesc 2019; 75:123-129. [PMID: 31382113 PMCID: PMC6706778 DOI: 10.1016/j.adolescence.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/29/2022]
Abstract
Introduction We investigated whether depressive symptoms at ages 9–13 years were associated with chronic disabling fatigue (CDF) at age 16 among children in the Avon Longitudinal Study of Parents & Children (ALSPAC) birth cohort. Methods Depressive symptoms at ages 9, 10, 11, 12, and 13 years were defined as a child- or parent-completed Short Mood and Feelings Questionnaire (SMFQ) score ≥11 (range 0–26). SMFQ score was also analysed as a continuous exposure. Chronic disabling fatigue at 16 was defined as fatigue of ≥6 months' but <5 years’ duration which prevented school attendance or activities, for which other causes were not identified, and with a Chalder Fatigue Questionnaire score ≥19. Logistic regression was used with multiple imputation to correct for missing data bias. We performed sensitivity analyses in which children who had CDF and depressive symptoms at age 16 were reclassified as not having CDF. Results In fully adjusted models using imputed data (N = 13,978), depressive symptoms at ages 9, 11, and 13 years were associated with 2- to 3-fold higher odds of CDF at age 16. Each one-point increase in SMFQ score at ages 9, 10, 11, 12, and 13 years was associated with 6–11% higher odds of CDF at age 16. Depressive symptoms and continuous SMFQ scores at each age were not associated with CDF if the outcome was reclassified to exclude children with comorbid depressive symptoms at age 16. Conclusions Depressive symptoms at ages 9–13 were associated with chronic disabling fatigue at age 16, but causality is not certain.
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Affiliation(s)
- Simon M Collin
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Tom Norris
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Carol Joinson
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Maria E Loades
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK; Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, W1T 7NF, UK
| | - Stephen A Stansfeld
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London, EC1M 6BQ, UK
| | - Esther Crawley
- Centre for Academic Child Health, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
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Loades M, Rimes K, Lievesley K, Ali S, Chalder T. Perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome and their parents: a preliminary investigation in a case control study nested within a cohort. Psychol Health 2019; 34:850-866. [PMID: 30821511 PMCID: PMC6754752 DOI: 10.1080/08870446.2019.1579331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
Objectives: To investigate perfectionism and beliefs about emotions in adolescents with chronic fatigue syndrome (CFS) and their parents. Design: Case-control comparing adolescents (age 11-18) with CFS (N = 121), asthma (N = 27) and healthy controls (N = 78) with a 3-month follow up for CFS participants. Main outcome measures: Adolescents: Chalder Fatigue Questionnaire, physical functioning, Beliefs about Emotions scale (BES), Child and Adolescent Perfectionism Scale, Frost Multidimensional Perfectionism Scale (FMPS). Parents: BES, FMPS, Self-sacrificing scale, Affective styles questionnaire. Results: Adolescents with CFS did not consistently report higher levels of perfectionism and unhelpful beliefs about emotions than adolescents with asthma or healthy adolescents. Mothers' and adolescents' beliefs about emotions and unhelpful perfectionism were significantly associated (p = .007). Linear regression found that neither adolescent perfectionism nor beliefs about emotions accounted for variance in subsequent fatigue or physical functioning. Conclusion: Parental perfectionism and emotion regulation style may contribute to perfectionism in adolescents with CFS. Parental representations could contribute to fatigue maintenance.
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Affiliation(s)
- M.E. Loades
- Department of Psychology, University of Bath
| | | | | | - S. Ali
- South London & Maudsley NHS Trust
| | - T. Chalder
- King’s College London
- South London & Maudsley NHS Trust
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Loades ME, Rimes KA, Ali S, Chalder T. Depressive symptoms in adolescents with chronic fatigue syndrome (CFS): Are rates higher than in controls and do depressive symptoms affect outcome? Clin Child Psychol Psychiatry 2019; 24:580-592. [PMID: 30945566 PMCID: PMC7099942 DOI: 10.1177/1359104519838584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Previous research has indicated that co-morbid depression is common in adolescents with chronic fatigue syndrome (CFS). OBJECTIVES We sought to compare the characteristics of depressive symptoms in adolescents with CFS to those of healthy controls (HCs) and illness controls (adolescents with asthma). DESIGN Case-control study nested within a prospective clinical cohort. METHODS A total of 121 adolescents with CFS who attended an initial assessment at two specialist CFS units completed the Children's Depression Inventory (CDI). Their responses were compared to 80 HCs and 27 adolescents with asthma (illness controls). The clinical cohort of adolescents with CFS completed questionnaires at assessment, and those who were seen subsequently for treatment at the CFS unit (68%) completed the measures again at their first treatment session. RESULTS CFS participants scored significantly higher on all the depression subscales than participants with asthma and HCs. Depression score explained 11% of the variance in subsequent fatigue, but only 1.9% of the variance in physical functioning. Depression score also explained most (68%) of the variance in subsequent depression. CONCLUSION Depressive symptoms are more prominent in adolescents with CFS than in HCs or illness controls. These symptoms also appear to remain over time during a naturalistic follow-up where no treatment was provided. This highlights the need for further research into depression in CFS, including stratifying treatment outcomes by depression status to determine what is effective at addressing these symptoms.
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Affiliation(s)
- Maria Elizabeth Loades
- 1 Department of Psychology, University of Bath, UK.,2 Bristol Medical School, University of Bristol, UK
| | - Katharine A Rimes
- 3 King's College London, UK.,4 South London and Maudsley NHS Foundation Trust, UK
| | - Sheila Ali
- 4 South London and Maudsley NHS Foundation Trust, UK
| | - Trudie Chalder
- 3 King's College London, UK.,4 South London and Maudsley NHS Foundation Trust, UK
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Crawley E. Pediatric chronic fatigue syndrome: current perspectives. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2018; 9:27-33. [PMID: 29722371 PMCID: PMC5919160 DOI: 10.2147/phmt.s126253] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Pediatric chronic fatigue syndrome is an important illness as it is relatively common and also very disabling with a wide range of impacts on the child, the family, and health care systems. It is a complicated illness but the majority of children get better with specialist treatment. This literature review provides an update on the epidemiology of chronic fatigue syndrome / myalgic encephalomyelitis, including factors associated with it, and discusses the current evidence for treatment.
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Affiliation(s)
- Esther Crawley
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
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Baos S, Brigden A, Anderson E, Hollingworth W, Price S, Mills N, Beasant L, Gaunt D, Garfield K, Metcalfe C, Parslow R, Downing H, Kessler D, Macleod J, Stallard P, Knoop H, Van de Putte E, Nijhof S, Bleijenberg G, Crawley E. Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial. Trials 2018; 19:136. [PMID: 29471861 PMCID: PMC5824604 DOI: 10.1186/s13063-018-2500-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 12/07/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. METHODS Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. DISCUSSION If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. TRIAL REGISTRATION ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.
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Affiliation(s)
- Sarah Baos
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Amberly Brigden
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Emma Anderson
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - William Hollingworth
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Simon Price
- Computer Science, University of Bristol, Merchant Venturers Building, Woodland Road, Bristol, BS8 1UB UK
| | - Nicola Mills
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Lucy Beasant
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Daisy Gaunt
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Kirsty Garfield
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Roxanne Parslow
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Harriet Downing
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David Kessler
- Bristol Medical School: Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - John Macleod
- Bristol Medical School: Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Paul Stallard
- Department for Health, University of Bath, Bath, BA2 7AD UK
| | - Hans Knoop
- Department for Medical Psychology, Academic Medical Centre (AMC) University of Amsterdam, Postbox 22660, 1100 DD Amsterdam, The Netherlands
| | - Elise Van de Putte
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Sanne Nijhof
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
| | | | - Esther Crawley
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
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Collin SM, Norris T, Gringras P, Blair PS, Tilling K, Crawley E. Childhood sleep and adolescent chronic fatigue syndrome (CFS/ME): evidence of associations in a UK birth cohort. Sleep Med 2018; 46:26-36. [PMID: 29773208 PMCID: PMC5974860 DOI: 10.1016/j.sleep.2018.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE/BACKGROUND Sleep abnormalities are characteristic of chronic fatigue syndrome (CFS, also known as 'ME'), however it is unknown whether sleep might be a causal risk factor for CFS/ME. PATIENTS/METHODS We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. We describe sleep patterns of children aged 6 months to 11 years, who were subsequently classified as having (or not having) 'chronic disabling fatigue' (CDF, a proxy for CFS/ME) between the ages 13 and 18 years, and we investigated the associations of sleep duration at age nine years with CDF at age 13 years, as well as sleep duration at age 11 years with CDF at age 16 years. RESULTS Children who had CDF during adolescence had shorter night-time sleep duration from 6 months to 11 years of age, and there was strong evidence that difficulties in going to sleep were more common in children who subsequently developed CDF. The odds of CDF at age 13 years were 39% lower (odds ratio (OR) = 0.61, 95% CI = 0.43, 0.88) for each additional hour of night-time sleep at age nine years, and the odds of CDF at age 16 years were 51% lower (OR = 0.49, 95% CI = 0.34, 0.70) for each additional hour of night-time sleep at age 11 years. Mean night-time sleep duration at age nine years was 13.9 (95% CI = 3.75, 24.0) minutes shorter among children who developed CDF at age 13 years, and sleep duration at age 11 years was 18.7 (95% CI = 9.08, 28.4) minutes shorter among children who developed CDF at age 16 (compared with children who did not develop CDF at 13 and 16 years, respectively). CONCLUSIONS Children who develop chronic disabling fatigue in adolescence have shorter night-time sleep duration throughout early childhood, suggesting that sleep abnormalities may have a causal role in CFS/ME or that sleep abnormalities and CFS/ME are associated with a common pathophysiological cause.
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Affiliation(s)
- Simon M Collin
- Centre for Child and Adolescent Health, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK; Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Tom Norris
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - Paul Gringras
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Peter S Blair
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Kate Tilling
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK; Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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14
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Brigden A, Loades M, Abbott A, Bond-Kendall J, Crawley E. Practical management of chronic fatigue syndrome or myalgic encephalomyelitis in childhood. Arch Dis Child 2017; 102:981-986. [PMID: 28659269 PMCID: PMC5947766 DOI: 10.1136/archdischild-2016-310622] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/04/2022]
Abstract
Paediatric chronic fatigue syndrome or myalgic encephalomyelitis affects at least 1% of secondary school children in the UK and is very disabling. Treatment is effective but few children get a diagnosis or access treatment. This paper summarises what we currently know about diagnosing and treating this important illness in childhood.
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Affiliation(s)
- Amberly Brigden
- Centre for Child and Adolescent Heath, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Maria Loades
- Centre for Child and Adolescent Heath, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Psychology, University of Bath, Bath, UK
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
| | - Anna Abbott
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
| | - Joanne Bond-Kendall
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
| | - Esther Crawley
- Centre for Child and Adolescent Heath, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
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Stoll SVE, Crawley E, Richards V, Lal N, Brigden A, Loades ME. What treatments work for anxiety in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)? Systematic review. BMJ Open 2017; 7:e015481. [PMID: 28877941 PMCID: PMC5588976 DOI: 10.1136/bmjopen-2016-015481] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Anxiety is more prevalent in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) than in the general population. A systematic review was carried out to identify which treatment methods are most effective for children with CFS and anxiety. DESIGN Systematic review using search terms entered into the Cochrane library and Ovid to search the databases Medline, Embase and psychINFO. PARTICIPANTS Studies were selected if participants were <18 years old, diagnosed with CFS/ME (using US Centers for Disease Control and Prevention, the National Institute for Health and Care Excellence or Oxford criteria) and had a valid assessment of anxiety. INTERVENTIONS We included observational studies and randomised controlled trials. COMPARISON Any or none. OUTCOMES Change in anxiety diagnostic status and/or change in anxiety severity on a validated measure of anxiety from pretreatment to post-treatment. RESULTS The review identified nine papers from eight studies that met the inclusion criteria. None of the studies specifically targeted anxiety but six studies tested an intervention and measured anxiety as a secondary outcome. Of these studies, four used a cognitive behavioural therapy (CBT)-type approach to treat CFS/ME, one used a behavioural approach and one compared a drug treatment, gammaglobulin with a placebo. Three of the CBT-type studies described an improvement in anxiety as did the trial of gammaglobulin. As none of the studies stratified outcomes according to anxiety diagnostic status or severity, we were unable to determine whether anxiety changed prognosis or whether treatments were equally effective in those with comorbid anxiety compared with those without. CONCLUSION We do not know what treatment should be offered for children with both anxiety and CFS/ME. Further research is therefore required to answer this question. TRIAL REGISTRATION NUMBER This review was registered on Prospective Register of Systematic Review Protocols (PROSPERO) and the protocol is available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016043488.
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Affiliation(s)
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Victoria Richards
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Nishita Lal
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Amberly Brigden
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
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Norris T, Collin SM, Tilling K, Nuevo R, Stansfeld SA, Sterne JAC, Heron J, Crawley E. Natural course of chronic fatigue syndrome/myalgic encephalomyelitis in adolescents. Arch Dis Child 2017; 102:522-528. [PMID: 28104625 PMCID: PMC5466925 DOI: 10.1136/archdischild-2016-311198] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/08/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Little is known about persistence of or recovery from chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adolescents. Previous studies have small sample sizes, short follow-up or have focused on fatigue rather than CFS/ME or, equivalently, chronic fatigue, which is disabling. This work aimed to describe the epidemiology and natural course of CFS/ME in adolescents aged 13-18 years. DESIGN Longitudinal follow-up of adolescents enrolled in the Avon Longitudinal Study of Parents and Children. SETTING Avon, UK. PARTICIPANTS We identified adolescents who had disabling fatigue of >6 months duration without a known cause at ages 13, 16 and 18 years. We use the term 'chronic disabling fatigue' (CDF) because CFS/ME was not verified by clinical diagnosis. We used multiple imputation to obtain unbiased estimates of prevalence and persistence. RESULTS The estimated prevalence of CDF was 1.47% (95% CI 1.05% to 1.89%) at age 13, 2.22% (1.67% to 2.78%) at age 16 and 2.99% (2.24% to 3.75%) at age 18. Among adolescents with CDF of 6 months duration at 13 years 75.3% (64.0% to 86.6%) were not classified as such at age 16. Similar change was observed between 16 and 18 years (75.0% (62.8% to 87.2%)). Of those with CDF at age 13, 8.02% (0.61% to 15.4%) presented with CDF throughout the duration of adolescence. CONCLUSIONS The prevalence of CDF lasting 6 months or longer (a proxy for clinically diagnosed CFS/ME) increases from 13 to 18 years. However, persistent CDF is rare in adolescents, with approximately 75% recovering after 2-3 years.
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Affiliation(s)
- Tom Norris
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Simon M Collin
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Roberto Nuevo
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Stephen A Stansfeld
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Jonathan AC Sterne
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Jon Heron
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
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Norris T, Deere K, Tobias JH, Crawley E. Chronic Fatigue Syndrome and Chronic Widespread Pain in Adolescence: Population Birth Cohort Study. THE JOURNAL OF PAIN 2016; 18:285-294. [PMID: 27845196 PMCID: PMC5340566 DOI: 10.1016/j.jpain.2016.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 10/21/2016] [Accepted: 10/31/2016] [Indexed: 11/03/2022]
Abstract
Although many studies have investigated the overlap between pain phenotypes and chronic fatigue syndrome (CFS) in adults, little is known about the relationship between these conditions in adolescents. The study's aim was therefore to identify whether a relationship exists between chronic widespread pain (CWP) and CFS in adolescents and investigate whether the two share common associations with a set of covariates. A questionnaire was administered to offspring of the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 17, asking about site, duration, and pain intensity, from which participants with CWP were identified. At the same research clinic, a computer-based Revised Clinical Interview Schedule was filled out, from which a classification of CFS was obtained. The relationship between selected covariates and CFS and CWP was investigated using a variety of logistic, ordinal logistic, and multinomial regressions. We identified 3,214 adolescents with complete data for all outcomes and covariates. There were 82 (2.6%) individuals classified as CFS and 145 (4.5%) as CWP. A classification of CFS resulted in an increased likelihood of having CWP (odds ratio = 3.87; 95% confidence interval, 2.05-7.31). Female adolescents were approximately twice as likely to have CFS or CWP, with multinomial regression revealing a greater sex effect for CWP compared with CFS. Those with exclusive CFS were more likely to report higher levels of pain and greater effect of pain compared with those without CFS, although associations attenuated to the null after adjustment for covariates, which did not occur in those with exclusive CWP. Multinomial regression revealed that relative to having neither CFS nor CWP, a 1-unit increase in the depression and anxiety scales increased the risk of having exclusive CFS and, to a greater extent, the risk of having comorbid CFS and CWP, but not exclusive CWP, which was only related to anxiety. PERSPECTIVE In this cohort, 14.6% of adolescents with CFS have comorbid CWP. The likely greater proportion of more mild cases observed in this epidemiological study means that prevalence of overlap may be underestimated compared with those attending specialist services. Clinicians should be aware of the overlap between the 2 conditions and carefully consider treatment options offered.
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Affiliation(s)
- Tom Norris
- Centre for Child and Adolescent Health, School of Social and Community Medicine, Bristol, United Kingdom.
| | - Kevin Deere
- Musculoskeletal Research Unit, School of Clinical Sciences, Bristol, United Kingdom
| | - Jon H Tobias
- Musculoskeletal Research Unit, School of Clinical Sciences, Bristol, United Kingdom
| | - Esther Crawley
- Centre for Child and Adolescent Health, School of Social and Community Medicine, Bristol, United Kingdom
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18
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Collin SM, Norris T, Nuevo R, Tilling K, Joinson C, Sterne JAC, Crawley E. Chronic Fatigue Syndrome at Age 16 Years. Pediatrics 2016; 137:e20153434. [PMID: 26810786 DOI: 10.1542/peds.2015-3434] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, chronic disabling fatigue lasting ≥6 months affected 1.3% of 13-year-olds, was equally common in boys and girls, and became more prevalent with increasing family adversity. METHODS ALSPAC data were used to estimate the prevalence of chronic fatigue syndrome (CFS) at age 16 years, defined by parental report of unexplained disabling fatigue lasting ≥6 months. We investigated gender and a composite 14-item family adversity index as risk factors. School absence data were obtained from the National Pupil Database. Multiple imputation was used to address bias caused by missing data. RESULTS The prevalence of CFS was 1.86% (95% confidence interval [CI]: 1.47 to 2.24). After excluding children with high levels of depressive symptoms, the prevalence was 0.60% (95% CI: 0.37 to 0.84). Authorized school absences were much higher (mean difference: 35.6 [95% CI: 26.4 to 44.9] half-day sessions per academic year) and reported depressive symptoms were much more likely (odds ratio [OR]: 11.0 [95% CI: 5.92 to 20.4]) in children with CFS than in those without CFS. Female gender (OR: 1.95 [95% CI: 1.33 to 2.86]) and family adversity (OR: 1.20 [95% CI: 1.01 to 1.42] per unit family adversity index) were also associated with CFS. CONCLUSIONS CFS affected 1.9% of 16-year-olds in a UK birth cohort and was positively associated with higher family adversity. Gender was a risk factor at age 16 years but not at age 13 years or in 16-year-olds without high levels of depressive symptoms.
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Affiliation(s)
- Simon M Collin
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Tom Norris
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Roberto Nuevo
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | | | - Carol Joinson
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | | | - Esther Crawley
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
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19
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Sulheim D, Fagermoen E, Sivertsen ØS, Winger A, Wyller VB, Øie MG. Cognitive dysfunction in adolescents with chronic fatigue: a cross-sectional study. Arch Dis Child 2015; 100:838-44. [PMID: 25791841 PMCID: PMC4552915 DOI: 10.1136/archdischild-2014-306764] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 02/26/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare cognitive function in adolescents with chronic fatigue with cognitive function in healthy controls (HC). STUDY DESIGN Cross-sectional study. SETTING Paediatric department at Oslo University Hospital, Norway. PARTICIPANTS 120 adolescents with chronic fatigue (average age 15.4 years; range 12-18) and 39 HC (average age 15.2 years; range 12-18). METHODS The adolescents completed a neurocognitive test battery measuring processing speed, working memory, cognitive inhibition, cognitive flexibility, verbal learning and verbal memory, and questionnaires addressing demographic data, depression symptoms, anxiety traits, fatigue and sleep problems. Parents completed the Behaviour Rating Inventory of Executive Function (BRIEF), which measures the everyday executive functions of children. RESULTS Adolescents with chronic fatigue had impaired cognitive function compared to HC regarding processing speed (mean difference 3.3, 95% CI 1.1 to 5.5, p=0.003), working memory (-2.4, -3.7 to -1.1, p<0.001), cognitive inhibition response time (6.2, 0.8 to 11.7, p=0.025) and verbal learning (-1.7, -3.2 to -0.3, p=0.022). The BRIEF results indicated that everyday executive functions were significantly worse in the chronic fatigue group compared to the HC (11.2, 8.2 to 14.3, p<0.001). Group differences remained largely unaffected when adjusted for symptoms of depression, anxiety traits and sleep problems. CONCLUSIONS Adolescents with chronic fatigue had impaired cognitive function of clinical relevance, measured by objective cognitive tests, in comparison to HC. Working memory and processing speed may represent core difficulties.
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Affiliation(s)
- Dag Sulheim
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway,Department of Paediatrics, Innlandet Hospital Trust, Lillehammer, Norway
| | - Even Fagermoen
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | - Anette Winger
- Medical Faculty, Institute of NursingSciences, Oslo and Akershus University College of Applied Sciences, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vegard Bruun Wyller
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway,Division of Medicine and Laboratory Sciences, Medical Faculty, University of Oslo, Oslo, Norway,Department of Paediatrics, Akershus University Hospital, Nordbyhagen, Norway
| | - Merete Glenne Øie
- Innlandet Hospital Trust, Lillehammer, Norway,Institute of Psychology, University of Oslo, Oslo, Norway
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20
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Winger A, Kvarstein G, Wyller VB, Ekstedt M, Sulheim D, Fagermoen E, Småstuen MC, Helseth S. Health related quality of life in adolescents with chronic fatigue syndrome: a cross-sectional study. Health Qual Life Outcomes 2015; 13:96. [PMID: 26138694 PMCID: PMC4490669 DOI: 10.1186/s12955-015-0288-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/17/2015] [Indexed: 11/22/2022] Open
Abstract
Aim To study health related quality of life (HRQOL) and depressive symptoms in adolescents with chronic fatigue syndrome (CFS) and to investigate in which domains their HRQOL and depressive symptoms differ from those of healthy adolescents. Background and objective Several symptoms such as disabling fatigue, pain and depressive symptoms affect different life domains of adolescents with CFS. Compared to adolescents with other chronic diseases, young people with CFS are reported to be severely impaired, both physiologically and mentally. Despite this, few have investigated the HRQOL in this group. Method This is a cross-sectional study on HRQOL including 120 adolescents with CFS and 39 healthy controls (HC), between 12 and 18 years. The Pediatric Quality of Life Inventory™, 4.0 (PedsQL) was used to assess HRQOL. The Mood and Feelings Questionnaire assessed depressive symptoms. Data were collected between March 2010 and October 2012 as part of the NorCAPITAL project (Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial). Linear and logistic regression models were used in analysis, and all tests were two-sided. Results Adolescents with CFS reported significantly lower overall HRQOL compared to HCs. When controlling for gender differences, CFS patients scored 44 points lower overall HRQOL on a scale from 0–100 compared to HCs. The domains with the largest differences were interference with physical health (B = −59, 95 % CI −54 to −65) and school functioning (B = −52, 95 % CI −45 to −58). Both depressive symptoms and being a patient were independently associated with lower levels of HRQOL Conclusion The difference in HRQOL between CFS patients and healthy adolescents was even larger than we expected. The large sample of adolescents with CFS in our study confirms previous findings from smaller studies, and emphasizes that CFS is a seriously disabling condition that has a strong impact on their HRQOL. Even though depressive symptoms were found in the group of patients, they could not statistically explain the poor HRQOL.
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Affiliation(s)
- Anette Winger
- Institute of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4 St. Olavs plass, NO-0130, Oslo, Norway.
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, UIT The Arctic University of Norway, Tromso, Norway.
| | - Vegard Bruun Wyller
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. .,Department of Pediatrics, Oslo University Hospital, Oslo, Norway. .,Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway.
| | - Mirjam Ekstedt
- KTH, Royal Institute of Technology, School for Technology and Health, Stockholm, Sweden. .,Center for Shared Decision Making and Collaborative Care, Oslo University Hospital, Oslo, Norway.
| | - Dag Sulheim
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway. .,Department of Pediatrics, Innlandet Hospital Trust, Lillehammer, Norway.
| | - Even Fagermoen
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
| | - Milada Cvancarova Småstuen
- Institute of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4 St. Olavs plass, NO-0130, Oslo, Norway.
| | - Sølvi Helseth
- Institute of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4 St. Olavs plass, NO-0130, Oslo, Norway.
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21
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Collin SM, Tilling K, Joinson C, Rimes KA, Pearson RM, Hughes RA, Sterne JAC, Crawley E. Maternal and childhood psychological factors predict chronic disabling fatigue at age 13 years. J Adolesc Health 2015; 56:181-7. [PMID: 25448612 DOI: 10.1016/j.jadohealth.2014.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/05/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate whether premorbid maternal and childhood psychological problems are risk factors for chronic disabling fatigue at age 13 years among children in the Avon Longitudinal Study of Parents and Children birth cohort. METHODS Chronic disabling fatigue was defined as fatigue of at least 3-month, and up to 5-year, duration that prevented school attendance or hobbies/sport/leisure activities, and for which other causes were not identified. Maternal psychological factors were symptoms of anxiety and depression assessed up to eight times between pregnancy and age 6 years. We investigated critical periods for maternal effects and effects of paternal depression at three time points. Child psychological factors included internalizing and externalizing problems and upsetting life events occurring at age 7-8 years. RESULTS Of 5,657 children, 110 (1.9%) had chronic disabling fatigue at age 13 years. Maternal anxiety (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.09-1.31 per episode), maternal depression (AOR, 1.24; CI, 1.11-1.39 per episode), child psychological problems (AOR, 1.19; CI, 1.00-1.41 per problem), and upsetting events (AOR, 1.22; CI, .99-1.58 per event) were associated with chronic disabling fatigue. Associations of child psychological problems and upsetting events were attenuated (AOR, 1.12; CI, .93-1.33 per problem; AOR, 1.19; CI, .94-1.52 per event) after further adjusting for maternal anxiety and depression. CONCLUSIONS Pediatricians need to be aware that children whose mothers experience anxiety and/or depression between pregnancy and child's age 6 years have an increased risk of developing chronic disabling fatigue in early adolescence. Conversely, clinicians need to be alert to fatigue in children whose mothers have longstanding anxiety and depression. These findings suggest the importance of family-based approaches to treatment.
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Affiliation(s)
- Simon M Collin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom.
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Carol Joinson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rebecca M Pearson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Rachael A Hughes
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Esther Crawley
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom
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22
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van Geelen SM, Fuchs CE, van Geel R, Luyten P, van de Putte EM. The Self beyond Somatic Symptoms: A Narrative Approach to Self-Experience in Adolescent Chronic Fatigue Syndrome. Psychopathology 2015; 48:278-86. [PMID: 26361007 DOI: 10.1159/000431258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The self and self-experience are often assumed to play an important role in adolescent patients presenting with severe somatic symptoms and bodily distress. Nonetheless, most empirical work on this subject is confined to studies of personality and patients' experience of negative emotionality. This study aims to move beyond mere descriptions of symptoms, traits and distress, and consequently adopts a narrative approach to self-experience in adolescent chronic fatigue syndrome (CFS). SAMPLING AND METHODS The self-confrontation method (SCM) is a well-validated instrument to systematically analyze narrative self-experience. The SCM was used to study 42 adolescents with CFS, compared to 36 adolescents with juvenile idiopathic arthritis (JIA) and 25 matched healthy controls. The Child Health Questionnaire (CHQ-CF87) was used to assess mental health, self-esteem, and physical and psychosocial functioning. RESULTS Both patient groups reported significantly less positive self-experience of autonomy and success compared to healthy controls. Furthermore, patients with CFS described significantly more negative self-experience of powerlessness, isolation and unfulfilled longing. In the CHQ-CF87, both patient groups scored significantly lower on physical functioning than controls. Adolescents with CFS also scored significantly lower on mental health and self-esteem. CONCLUSIONS Adolescent CFS entails a serious threat to the self, which might be inherent to the condition. Not only are patients more impaired in mental health, self-esteem, and physical and psychosocial functioning than patients with JIA, they also suffer from a distinct combination of high negative and low positive self-experience. These findings stress the need for strategies that empower patients towards a 'management of the self'.
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Affiliation(s)
- Stefan M van Geelen
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden
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Abstract
Most paediatricians regularly see children with chronic fatigue syndrome or myalgic encephalitis (CFS/ME) in their clinics and yet we know little about how common it is, who is affected, whether there are risk factors and how likely a child is to recover (or what might predict recovery). Recent research suggests that this illness is more complicated than previously thought and that rather than being an illness found in middle class families, it is more common in those who are socially deprived. This article reviews what is currently known about this important but little understood condition.
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Elgen I, Hikmat O, Aspevik TN, Hagen EM. CFS in Children and Adolescent: Ten Years of Retrospective Clinical Evaluation. Int J Pediatr 2013; 2013:270373. [PMID: 23843800 PMCID: PMC3697308 DOI: 10.1155/2013/270373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 11/17/2022] Open
Abstract
Aim. To estimate number of children being diagnosed with chronic fatigue syndrome (CFS). Methods. For a period of 10 years (2002-2011) data from children being referred for fatigue symptoms were collected retrospectively. Results. Thirty-seven children were referred. Four were excluded due to incorrect coding. Six (18%) patients received other diagnoses at the end of evaluation time. Of the 27 who received the diagnosis G93.3, four had a previous chronic illness, while 23 patients were previously healthy. All patients reported onset of fatigue symptom in relation to an infection, and all tested positive for IgG to either Epstein-Barr virus, cytomegalovirus or borrelia, indicating previous infection. There were 16 (59%) boys among the 27 patients. The mean age at the debut of fatigue symptoms was 141 months (SD 30) for boys and 136 months (SD 31) for girls, respectively. Being underweight, defined as BMI < 17.5, was found in 12 (44%) patients. Conclusion. An increasing number of children and adolescents are evaluated for CFS. The clinical assessment of children and adolescents with possible CFS need systematically evaluation. Nutritional status, possible eating disorder, and psychosocial issues need to be addressed and evaluated carefully. A multidisciplinary approach is essential when assessing CFS in children and adolescents. There is a need for European guidelines.
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Affiliation(s)
- Irene Elgen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, P.O Box 7804, 5020 Bergen, Norway
| | - Omar Hikmat
- Department of Paediatrics, Haukeland University Hospital, Jonas Lies Vei 65, 5021 Bergen, Norway
| | - Tora N. Aspevik
- Department of Clinical Medicine, University of Bergen, P.O Box 7804, 5020 Bergen, Norway
| | - Ellen Merete Hagen
- Department of Clinical Medicine, University of Bergen, P.O Box 7804, 5020 Bergen, Norway
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Abstract
OBJECTIVE To describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability, pain and school attendance. DESIGN Cross-sectional survey data using the Hospital Anxiety and Depression Scale (HADS) collected at assessment. SETTING Specialist paediatric CFS/ME service in the South West. PATIENTS Children aged 12-18 years with CFS/ME. MAIN OUTCOME MEASURE Depression was defined as scoring >9 on the HADS depression scale. RESULTS 542 subjects had complete data for the HADS and 29% (156/542) (95% CI 25% to 33%) had depression. In a univariable analysis, female sex, poorer school attendance, and higher levels of fatigue, disability, pain, and anxiety were associated with higher odds of depression. Age of child and duration of illness were not associated with depression. In a multivariable analysis, the factors most strongly associated with depression were disability, with higher scores on the physical function subscale of the 36 item Short Form (SF-36). CONCLUSIONS Depression is commonly comorbid with CFS/ME, much more common than in the general population, and is associated with markers of disease severity. It is important to screen for, identify and treat depression in this population.
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Affiliation(s)
- Helen Bould
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Adolescents and mothers value referral to a specialist service for chronic fatigue syndrome or myalgic encephalopathy (CFS/ME). Prim Health Care Res Dev 2013; 15:134-42. [PMID: 23731646 DOI: 10.1017/s1463423613000121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and disabling. Current guidance recommends referral to specialist services, although some general practitioners believe the label of CFS/ME is harmful and many are not confident about diagnosing CFS/ME. Aim Explore whether or not adolescents and their mothers value referral to a specialist service for young people with CFS/ME. METHODS A qualitative study nested within a feasibility study of interventions for CFS/ME [Specialist Medical Intervention and Lightning Evaluation (SMILE)]. In-depth interviews were undertaken with 13 mothers and 12 adolescents participating in the SMILE study. Transcripts were systematically assigned codes using the qualitative data organisation package NVivo and analysed thematically using techniques of constant comparison. RESULTS Gaining access to the specialist service was difficult and took a long time. Mothers felt that they needed to be proactive and persistent, partly because of a lack of knowledge in primary and secondary care. Having gained access, mothers felt the CFS/ME service was useful because it recognised and acknowledged their child's condition and opened channels of dialogue between health-care professionals and education providers. Adolescents reported that specialist medical care resulted in better symptom management, although some adolescents did not like the fact that the treatment approach limited activity. CONCLUSIONS Adolescents and their mothers value receiving a diagnosis from a specialist service and making progress in managing CFS/ME. General practitioners should support adolescents with CFS/ME in accessing CFS/ME specialist services, consistent with current guidance.
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Crawley E, Hughes R, Northstone K, Tilling K, Emond A, Sterne JAC. Chronic disabling fatigue at age 13 and association with family adversity. Pediatrics 2012; 130:e71-9. [PMID: 22711716 DOI: 10.1542/peds.2011-2587] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES 1) Estimate the prevalence of chronic disabling fatigue at age 13, and 2) investigate associations with early family adversity, using a population-based birth cohort study. METHODS The subjects were 10,001 children, of whom 5657 had sufficient data to define chronic disabling fatigue at age 13. Chronic disabling fatigue was defined as tiredness reported by mothers that had lasted for ≥ 3 months or ≥ 6 months, was disabling (school absence or prevented participation in hobbies/sport/leisure activities "quite a lot" or a "great deal"), and not due to another cause. Family adversity was defined by using 14 questions addressing housing, education, social relationships, and maternal health assessed prospectively at birth. We used multiple imputation to correct estimates of prevalence and association for loss to follow-up. RESULTS Overall, 1995 teenagers had been tired for the last month, of whom 117 and 53 had chronic disabling fatigue of ≥ 3 and ≥ 6 months' duration, respectively. The estimated prevalence of chronic disabling fatigue of ≥ 3 and ≥ 6 months' duration was 2.07% and 0.94%, respectively, but increased to 2.44% and 1.30%, respectively, after imputing missing data. Prevalence was similar in boys and girls. The risk of chronic disabling fatigue increased with family adversity score (odds ratios: 1.25 [95% confidence interval: 1.09, 1.43] and 1.23 [1.01, 1.51] for ≥ 3 and ≥ 6 months' duration, respectively). Only 36 (30.77%) children with chronic disabling fatigue had consulted a doctor about their fatigue. CONCLUSIONS Chronic disabling fatigue is more common in families who experienced early family adversity and is often not reported to health care services.
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Affiliation(s)
- Esther Crawley
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Clifton, Bristol, United Kingdom.
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Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012; 53:575-92. [PMID: 22404290 DOI: 10.1111/j.1469-7610.2012.02535.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. METHOD Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents. RESULTS FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. CONCLUSION Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.
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Affiliation(s)
- John V Campo
- Department of Psychiatry, Professor and chair, The Ohio State University, Columbus, Ohio, USA
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