Factors determining fatigue in the chronic fatigue syndrome: a path analysis

[Kyla]

http://www.tandfonline.com/doi/abs/10.1080/17843286.2016.1165396
(paywalled)

Factors determining fatigue in the chronic fatigue syndrome: a path analysis

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DOI:
10.1080/17843286.2016.1165396
Els Tobbackab*, Ignace Hanoullea, An Marimanab, Liesbeth Delesieab, Dirk Pevernagiecd & Dirk Vogelaersabd

Publishing models and article dates explained

• Published online: 03 May 2016

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Abstract
Objectives: To explore the interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with chronic fatigue syndrome (CFS).
Methods: Patients meeting the Fukuda criteria of CFS filled out two independent fatigue scales (Fatigue Questionnaire, FQ and Checklist Individual Strength, CIS), NEO-Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-item Short Form Health Survey (SF36). Exploratory and confirmatory path analyses were performed.
Results: Out of 226 eligible patients, 167 subjects were included (mean age 39.13 years, SD 10.14, 92% female). In a first exploratory path analysis, using FQ for assessment of fatigue, night-time PSQI sleep quality had a direct effect on SF36 physical quality of life (PQoL) and no effect on FQ fatigue. This was confirmed by a subsequent path analysis with CIS fatigue and by confirmatory path analyses in 81 patients. These unexpected results raised the question whether FQ or CIS fatigue sufficiently operationalizes fatigue in CFS patients.
Conclusions: Poor sleep quality seems to directly impact on mental quality of life (MQoL) and PQoL without mediation of fatigue assessed with FQ and CIS. A more cohesive framework needs to be developed with more comprehensive clinical tools for the different dimensions in the construct of CFS.

 

[Effi]

These are all psychiatrists and psychologists with a specialisation in MUPS and/or sleep specialists/psychologists. I'm pretty sure they're all from a department called 'pathological fatigue' at the University hospital in Ghent. They have a VERY bad name in the patient community. Pretty much every patient story I've heard ends with a referral to a psychologist/psychiatrist, after an exhausting series of useless tests, where patients are treated in a very demeaning way. Textbook BPS.

Similar study from the same people (2003) - http://www.smrv-journal.com/article/S1087-0792(12)00073-1/abstract

Whilst complaints of NRS persist over time, there is no demonstrable neurophysiological correlate to substantiate a basic deficit in sleep function in CFS. Polysomnographic findings have not shown to be significantly different between subjects with CFS and normal controls. Discrepancies between subjectively poor and objectively normal sleep suggest a role for psychosocial factors negatively affecting perception of sleep quality.

 

[Kyla]

These are all psychiatrists and psychologists with a specialisation in MUPS and/or sleep specialists/psychologists. I'm pretty sure they're all from a department called 'pathological fatigue' at the University hospital in Ghent. They have a VERY bad name in the patient community. Pretty much every patient story I've heard ends with a referral to a psychologist/psychiatrist, after an exhausting series of useless tests, where patients are treated in a very demeaning way. Textbook BPS.

Similar study from the same people (2003) - http://www.smrv-journal.com/article/S1087-0792(12)00073-1/abstract

Hi Effi,

I figured as much based on some of the language but haven't read the full article as it is behind a paywall.
Figured it was worth posting to keep track of this sort of thing.
If anyone has access to read it I can add some detail / description to the original post
I'm not willing to pay to read psychobabble

 

[worldbackwards]

Discrepancies between subjectively poor and objectively normal sleep suggest a role for psychosocial factors negatively affecting perception of sleep quality.

Blimey. I've never been told I can't even be trusted to know whether I've slept well or not. Then again, why not, it's not like anyone believes anything I tell them anyway.
​

 

[Hutan]

Objectives: To explore the interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with chronic fatigue syndrome (CFS).

But no mention of neuroticism in the Conclusions?

Just maybe because measured neuroticism wasn't related to anything else? As in maybe, despite perhaps what the authors wish and Fukuda criteria, neuroticism has nothing to do with being ill with CFS?

If anyone does read the full paper, I'd be interested to know what they found out about this. My son and I regularly fill out questionnaires for a Royal Children's Hospital, Melbourne study that seems determined to find a relationship between neuroticism and CFS in children and adolescents. As in 'Do you repeat words or numbers in order to stop bad things happening?' 'Are you scared of the dark?' There is a sleep quality component in this study too - some children were selected to wear sleep quality monitors.

 

[Luther Blissett]

http://sci-hub.cc/10.1080/17843286.2016.1165396 for the masochistic

 

[Luther Blissett]

However, the validity of the concepts could be questioned (i.e. what is understood by fatigue as the major element in the syndromal definition of CFS). This may indicate insufficient current understanding of the true content of the ill-defined concepts of fatigue and sleep quality in this patient sample.

Along the same line, it may be hypothesized that the fatigue scales, which are currently used in the assessment of these patients, do not sufficiently reflect their experienced fatigue and the relative contribution of feeling of illness and functional impairment. The FQ and CIS fatigue mainly measure the feeling of fatigue, the SF36 the performance capacity and both may insufficiently assess the lack of tolerance to mental and/or physical effort, typically reported by CFS patients.

The FQ and CIS fatigue questionnaires contain questions about the problems the person had in the last month with feeling tired, weak, lacking energy, having difficulties concentrating and to start activities. They do not contain questions about the person’s possibilities to do certain specific activities.

In contrast, the SF36 physical health quality of life questionnaire contains 14 questions concerning the specific possibilities to do certain activities (e.g. the possibility of walking more than one mile). It does not contain any question about feelings of tiredness or weakness. Both FQ and CIS and SF36 PQoL lack any question on negative consequences of activities such as post-exertional physical and mental malaise, as implicated in the Canadian guidelines.3

Hence, new variables may be needed to take into account the full scope of these dimensions.

 

[TiredSam]

Do you repeat words or numbers in order to stop bad things happening?

That looks like an OCD question.

 

[Effi]

On my little search to find out who these people are, I came across some pretty disturbing quotes from them. 'Doctors shouldn't be too eager to give patients a CFS diagnosis. Patient might have an actual problem that needs treatment!' Doesn't that say it all?

I have to say though, the Ghent sleep clinic (purely as a sleep clinic) has a good reputation. I figure at some point they started to get loads of CFS patients and didn't know what to do with them. In came the psych brigade. (my speculation, but probably pretty close to what happened)

 

[valentinelynx]

full text at: http://sci-hub.bz/10.1080/17843286.2016.1165396

Sci-hub.io is shut down, but sci-hub is still available at sci-hub.bz or sci-hub.cc.

Rats... i just saw that someone else already posted that.

 

[Luther Blissett]

full text at: http://sci-hub.bz/10.1080/17843286.2016.1165396

Sci-hub.io is shut down, but sci-hub is still available at sci-hub.bz or sci-hub.cc.

Rats... i just saw that someone else already posted that.

Better to have two willing to help than none .

Thanks for further info @TiredSam (happy birthday!) and @Effi .

I spotted at least 2 Chalders and a Wesseley in the references, for those who can't read the whole thing.

 

[Chrisb]

'Doctors shouldn't be too eager to give patients a CFS diagnosis. Patient might have an actual problem that needs treatment!' Doesn't that say it all?

Are you implying that CBT/GET might be recognised as not being a treatment?

This is a very interesting quote. Is it part of a considered written piece, or was it just an off the cuff remark that someone noted, and passed on, and to which too much importance should not be attached?

 

[Effi]

@Chrisb I read it in an article that talks about the study from 2003 that I posted above. Not sure where the article comes from, or when it was written, but I'm guessing not long after publication of said study, in a professional magazine of some sort. What they keep implying is that CFS is not a physical illness. But they don't say it's psychiatric either. Almost as if it doesn't really exist? Back then they were very convinced of CBT/GET as the only way to go. Not sure how it is now, but this most recent paper they've published looks like they haven't learned anything new in the past 13 years.

Another thing I read, written by one of the psychiatrists in this study was this (paraphrased): This idea of CFS becomes a part of patients identity in such a way that it is psychologically and socially perpetuated. When this happens, their situation becomes virtually irreversible. High quality drivel.

 

[worldbackwards]

Another thing I read, written by one of the psychiatrists in this study was this (paraphrased): This idea of CFS becomes a part of patients identity in such a way that it is psychologically and socially perpetuated. When this happens, their situation becomes virtually irreversible. High quality drivel.

Rather convenient for the inept physician-about-town as well.