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Depression in paediatric chronic fatigue syndrome (Crawley)

Discussion in 'Latest ME/CFS Research' started by Bob, Aug 8, 2013.

  1. Bob

    Bob

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    This is not a brand new paper (published 25 April 2013), but I don't think I've seen it before, and the results are quite interesting, especially because the numbers are large (542 subjects). Charles Shepherd recently highlighted this paper on the MEA's facebook page.


    Depression in paediatric chronic fatigue syndrome
    Helen Bould, Simon M Collin, Glyn Lewis, Katharine Rimes, Esther Crawley

    Arch Dis Child 2013;98:425-428
    doi:10.1136/archdischild-2012-303396

    Published Online First: 25 April 2013

    Full article:
    http://adc.bmj.com/content/98/6/425.long

    Full PDF:
    http://adc.bmj.com/content/98/6/425.full.pdf html
  2. Bob

    Bob

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    I think the results are helpful because it clearly demonstrates that CFS is not the same as depression, and that depression is not necessarily a factor in CFS. Not that we need to know the difference, but it's helpful evidence, nonetheless.

    I haven't read it in full yet, but the study seems quite sensible, until they get to the discussion, when typical Crawley interests get aired...

    From the above extract:
    They unhelpfully conflate two issues here...
    1. Living with a chronic illness.
    2. Living with a stigmatising condition.

    I'm more interested in how severity of symptoms, severity of disability, and cognitive/neurological symptoms are correlated to depression. Correlation of severity of symptoms with depression may well indicate that depression is a consequence of living with a severe chronic illness... Or looking at the correlation of cognitive symptoms with depression might indicate that severity of neurological issues in ME correlate with depression...
    Still reading...


    Edited three times, to correct.
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  3. peggy-sue

    peggy-sue

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    Or it could simply be that not everybody is prone to depression even with such a disabling disease.

    Does everybody with MS, Lupus, Sjorgen's, Motor Neuron disease - or any other life-altering illness or disability develop depression?
    No.

    They really are desperate to hang onto every shred of any potential correlation with something "psychological".
  4. Bob

    Bob

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    Indeed. They were my initial thoughts after reading the abstract... That depression is independent of CFS... Simple.
    That's why I think it's quite a helpful paper.
  5. Valentijn

    Valentijn Activity Level: 3

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    This study is using the HADS to diagnose depression, which contains the following questions:

    They ignored the "slowed down" question and gave it a score equal to the average of the other scores.

    But that still leaves a few questions that are problematic: it's a bit silly to ask someone if they still enjoy things that they can no longer do. If housebound and sick, appearance takes a back seat (sorry psychobabblers, basic hygiene is getting priority). And cognitive problems can make it very hard to enjoy a book or TV show.

    Each of those three questions is going to get somewhere between 1-3 points, depending on how the kids interpret the questions, and how disabled they are. That can account for the 9 points used as a depression cut-off right there.

    And even 9 points is a "borderline case", not actual depression. Which would suggest that a very small proportion of the kids made it into the 11+ score required for actual depression, otherwise they wouldn't have had to move the bar for depression.

    They're also saying that the normal rate of depression for kids is 2-3%, and concluding that depression rates are 10x higher in CFS kids. But those 2-3% of depressed kids are probably actually depressed, rather than borderline, and not having symptoms of a physical and cognitive disability being used to diagnose depression.

    How about "clinicians should treat physical and cognitive symptoms so that adolescents with ME/CFS don't get depressed in the first place and/or develop symptoms which psychobabblers like to equate with depression."
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  6. peggy-sue

    peggy-sue

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    o_O
    I thought it was most unhelpful - after this comment
    "This may constitute evidence against the idea that depression is a consequence of living with the chronic stigmatising condition of CFS/ME."

    Because for some folk, (including myself) it did cause depression. After 4-5 yeards. I am unaware of how much of it is because of the disease, or because of the stigma and ignorance and not being believed and there being no help.

    (posting at the same time Valentijn)

    I agree completely - basic hygeine takes precidence over appearance - and getting out sometimes often takes precidence over basic hygeine.
    (it's good for my mental well-being - even if I do look a sight!)
    I think age has also affected how important I think my appearance is, I care less about what I look like and more about who I am, these days.
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  7. Bob

    Bob

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    Valentijn, thanks for pointing that out, about the depression questionnaires. I keep forgetting that the depression questionnaires can't separate depression symptoms from ME symptoms. You've done really helpful work showing how/why depression questionnaires are inappropriate for ME patients. (I wish you'd write a research paper about it!) :)

    Edited
  8. Bob

    Bob

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    So, as Valentijn pointed out, they used the HADS questionnaire in this study:
    1. I still enjoy the things I used to enjoy
    2. I can laugh and see the funny side of things
    3. I feel cheerful
    4. I feel as if I am slowed down (ignored for this study)
    5. I have lost interest in my appearance
    6. I look forward with enjoyment to things
    7. I can enjoy a good book or radio or TV programme

    As an ME patient, without depression, I think I would sometimes answer negatively to all of these questions, depending on the severity of my symptoms.

    How can you be interested in your appearance, if you are struggling to stand up in the kitchen long enough to make a sandwich, let along make it to a shop to buy some food? And you haven't got the strength to have a shower. Other concerns would be more pressing, such as eating, and cleaning yourself.

    How can you look forward to participating in activities if your pain means that you can't enjoy anything? How can you 'enjoy' activities if your symptoms are severe and causing distress?

    'Not laughing', and 'not feeling cheerful' is not necessarily a sign of depression; It can be a sign of stress or distress, as a result of pain etc.

    Surely the authors must be aware that ME/CFS affects patients' participation in activities, and quality of life, because of exhaustion, pain, malaise and cognitive symptoms.

    (I still haven't read the whole paper.)
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  9. peggy-sue

    peggy-sue

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    Bob said;
    "Surely the authors must be aware that ME/CFS affects patients' participation in activities, and quality of life, because of exhaustion, pain, malaise and cognitive symptoms."

    Not when it doesn't suit their purposes. It is very hard to get somebody to change their opinion - especially when their income depends on them holding that opinion.
  10. Valentijn

    Valentijn Activity Level: 3

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    I'm pretty sure the BPS "experts" are aware of it. These sorts of questionnaires are used almost exclusively by them, which seems unlikely to be completely coincidental. They want to use the questionnaires which will support their assumptions.
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  11. Snow Leopard

    Snow Leopard Senior Member

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    Some patients are depressed independent of CFS, some are depressed as a result of CFS. It is not rocket science, (not precise) but it seems some academics want to look at it in that way.
    Depression has a lot of interacting factors, it is strange that these researchers would not take a bio-psycho-social approach to depression. They seem to have ignored social and biological factors as usual... Why don't they use questionnaires exploring whether patients feel they are getting appropriate medical support, have a supporting family environment, are able to feel like they are achieving something in their life (whether it be school or whatever they can manage)?

    Sorry for venting, but I feel frustrated when social scientists seem to ignore the social side!
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  12. Bob

    Bob

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    Please vent away! That's what the forum is for! :)
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  13. biophile

    biophile Places I'd rather be.

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    It does seem strange that proponents of the BPS model would fail to consider that depression is a comorbid issue with its own BPS components, rather than being just a psychological component of the bioPSYCHOsocial approach to CFS.

    Snow Leopard's idea of using questionnaires to tease out the social impact of illness is a good suggestion. Researchers could then test the association between depression and social factors/impacts of illness. That said, if ME/CFS involves neuroimmune factors, it would not be surprising if it does biologically increase the risk of depression when faced with additional social factors. However, as others have noted, questionnaires for depression tend to give false positives in ME/CFS, because of the way impacts of physical and cognitive symptoms are interpreted as signs of depressive mood.
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  14. Snow Leopard

    Snow Leopard Senior Member

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    Not just questionnaires, but structured interviews by unbiased social workers as well. Of course this isn't a usual practice because they'd claim it costs too much money etc. But why not do a trial that is patient-centred?
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  15. alex3619

    alex3619 Senior Member

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    I was under the impression that there is a lot of literature on social impact both from and toward disease. I just haven't read a lot of it. Has anyone gone looking? Its been on my to do list, but not for this year.
  16. Snow Leopard

    Snow Leopard Senior Member

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    But why not at the same time as investigating the other factors? Many of them talk about this bps paradigm, but seem to interpret everything within the biases of their own school in practise and the field suffers for it.
  17. alex3619

    alex3619 Senior Member

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    Yes Snow Leopard , BPS is code for P and not much else. They say one thing, and do another, and if anyone disputes them they say how can you dispute B+P+S. If it were really BPS in rational balance I would not have much of a problem with it. I will be reviewing a lot of the founding literature of BPS in my book. There is something else missing though. The BPS paradigm was founded as a systems theoretic paradigm, yet I suspect most who practice it know next to nothing about systems theory. If they did they would not make so many outrageous claims, or use such flawed methodologies. If BPS really did live up to its name and its theoretical underpinnings it would probably be of great benefit. As it stands its primarily a rebranding of old dogmatic psychogenic medicine, which was and probably still is seriously dying. Its ideological, economic and political support that helps prop it up, that and systemic distortion in public rhetoric about what they are really doing.

    We had Zombie Science, and Zombie Politics, and more recently Zombie Economics. This is Zombie Psychiatry, even when dead it still keeps going.

    To my understanding much of the literature I would think interesting on disease and society is not from BPS psychiatry, but from sociology.
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  18. Roy S

    Roy S former DC ME/CFS lobbyist

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    Yes, I've been looking for decades and haven't found much at all about it. More specifically, the impact on family and friends and what to do about it to try to improve things. Especially in activism for our disease because we need far more healthy people involved.
    I was hoping you'd know, Alex.
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  19. biophile

    biophile Places I'd rather be.

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    zombie-science-quotes_01a.jpg

    zombie-science-quotes_02a.jpg

    zombie-science-quotes_03a.jpg

    zombie-science-quotes_04a.jpg

    zombie-science-quotes_05a.jpg
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  20. Bob

    Bob

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    lol biophile, great stuff.

    Here's a couple more:
    "With CBT/GET you can deteriorate your way to recovery"
    "After CBT/GET, you can be severely disabled and recovered at the same time!"
    Last edited: Jan 23, 2014

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