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Psychopathology as a predictor of CFS: 1958 Birth Cohort (inc Peter White)

Discussion in 'Latest ME/CFS Research' started by oceanblue, Jun 14, 2011.

  1. oceanblue

    oceanblue Senior Member

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    Psychopathology as a predictor of CFS: 1958 Birth Cohort (authors inc Peter White)

    Expansion of the previous studies on UK Birth Cohorts to include the 1958 birth cohort, and now with a guest appearance from Peter White.

    Psychopathology and physical activity as predictors of chronic fatigue syndrome in the 1958 british birth cohort: a replication study of the 1946 and 1970 birth cohorts.
    Goodwin L, White PD, Hotopf M, Stansfeld SA, Clark C. Free full text

    Abstract

    PURPOSE:
    In this study, we investigate whether prospective associations between psychopathology, physical activity, and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) observed in the 1946 and 1970 birth cohorts were replicable in the 1958 British birth cohort.

    METHODS:
    Prospective study using the 1958 British birth cohort, which included 98.7% of births from 1 week in March 1958 in England, Wales, and Scotland. The outcome was self-reported CFS/ME by the age of 42 years, at which point 11,419 participants remained in the study. Psychopathology was assessed by the Rutter scales in childhood and the Malaise Inventory in adulthood. Physical activity was reported by the cohort member, mother and teacher in childhood and adulthood.
    RESULTS:

    The prevalence of CFS/ME was 1.0% (95% confidence interval [CI] = 0.9-1.3) and the median age of onset was 34 years. Premorbid psychopathology at 23 years (odds ratio [OR] = 1.85, 95% CI = 1.06-3.22) and 33 years (OR = 2.81, 95% CI = 1.28-6.18) significantly increased the odds of developing CFS/ME, supporting the 1946 cohort findings. Childhood psychopathology, sedentary behavior in childhood, and persistent exercise in adulthood were not associated with CFS/ME.

    CONCLUSIONS:
    In cohort studies premorbid psychopathology in adulthood is a replicated risk marker for CFS/ME, whereas premorbid extremes of physical activity are not.
     
  2. oceanblue

    oceanblue Senior Member

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    The main problem with this study is that it relies on patient self-report
    And self-report is unreliable, which is why there are specific research definition of CFS.

    But even allowing for a moment the diagnosis and findings, these effects are not very big, with Odds Ratio for Psychopathology predicitng CFS of 1.9 (at age 23) and 2.8 (at age 33). If my maths is right, with a 1% prevalence the odds of getting CFS are 100:1 for the whole sample (ie you're not going to get CFS) or 36:1 (you're still not going to get CFS) if you have 'psychopathology' at age 33. When is it going to dawn on these people that even with the best spin possible their findings show they are fiddling at the margins, not getting to the heart of the matter?

    Overall we have dodgy diagnoses and a small effect, which amounts to not very much.
     
  3. Esther12

    Esther12 Senior Member

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    Particularly as both psychological and physical problems are know to cause fatigue. Those with EDS are more likely to be diagnosed with CFS... but EDS causes fatigue. Studies like this seem pretty pointless to me. Hopeful it didn't take much time/money.
     
  4. WillowJ

    WillowJ Senior Member

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    the important part of that study is "whereas premorbid extremes of physical activity are not" indicators of getting CFS. Not from deconditioning, and not from crazy-lady-maniac-doesn't-know-how-to-rest
     
  5. Snow Leopard

    Snow Leopard Senior Member

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    This study is an attempted replication of previous birth cohorts, but there is some inconsistency in the findings.

    http://www.bmj.com/content/329/7472/941.long
    http://www.psychosomaticmedicine.org/content/70/4/488
    http://www.ncbi.nlm.nih.gov/pubmed/17976252

    I personally would like to see data on employment status as that would give us an idea of the severity of the condition. If all of those people were not working, then I wouldn't worry so much about the specificity of the diagnosis. But given rates of 0.8-1%, I suspect a high proportion will be working over 30 hours.
    There was 71% participation of the original birth cohort at age 42.
    It is interesting then that the study they cited recommended a 15 item version be used due to the unreliability of the somatic questions.
    http://www.ncbi.nlm.nih.gov/pubmed/10422488

    These are the 24 items:
    1. Do you often have back-ache?-
    2. Do you feel tired most of the time?
    3. Do you often feel miserable or depressed?
    4. Do you often have bad headaches?-
    5. Do you often get worried about things?
    6. Do you usually have great difficulty in falling or staying asleep?
    7. Do you usually wake unnecessarily early in the morning?
    8. Do you wear yourself out worrying about your health?
    9. Do you often get into a violent rage?
    10. Do people often annoy and irritate you?
    11. Have you at times had a twitching of the face, head or shoulders?-
    12. Do you often suddenly become scared for no good reason?
    13. Are you scared to be alone when there are no friends near you?
    14. Are you easily upset or irritated?
    15. Are you frightened of going out alone or of meeting people?
    16. Are you constantly keyed up and jittery?
    17. Do you suffer from indigestion?-
    18. Do you suffer from an upset stomach?-
    19. Is your appetite poor?
    20. Does every little thing get on your nerves and wear you out?
    21. Does your heart often race like mad?--
    22. Do you have bad pains in your eyes?-
    23. Are you troubled with rheumatism or fibrositis?-
    24. Have you ever had a nervous breakdown?--

    -(excluded in 15, 17 item versions)
    --(excluded in 15 item version, but not 17 item version)

    As you can see, there is inconsistency between the 17 item scale specified in the cited article and the CFS study. If question 2 was removed, which one was put in its place? The stomach upset question!?!

    Anyway, psychopathy at 16 was measured using "the teacher version of the Rutter scales", "A score in the top 13% defined a case...".

    Roughly 2% (imputed) of those who met 23 reports of psychopathy reported they had CFS, compared with 1% who did not have any reports.

    Physical activity as an adult was based on self report of activity levels at work and participation in sports.

    In terms of the specificity of the diagnosis, I guess it depends on how CFS is diagnosed in the UK - ie. do they stick to loose Oxford definitions or more strict definitions?
     
  6. alex3619

    alex3619 Senior Member

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    Hi, another problem in interpreting this is attributing causation versus association. While only anecdotal, it has been observed that many who get ME or CFS (Fukuda, CCC etc, not Oxford as far as I know) are not well long before they have an overt diagnosis. There is often a sudden crash, but there is a question about whether or not they have an underlying disease process long before acute onset. Therefore, they might have had problems that can either aggravate psychopathology, or be misdiagnosed as psychopathology.

    In other words, its valid to say that pre-clinical ME or CFS might cause risk of apparent psychopathology. How do they objectively determine which is which?

    It is disturbing to me that they associate potential risk factors, then infer causation, as though it were a done deal. It is possible that something is going wrong that independently gives rise to psychopathology, ME or CFS.

    Another problem with psychopathology is that there is no hard physical evidence unless they can find brain damage. It is mostly educated guesswork. I find the trend in neuroscience for displacing psychological causation as refreshing - I suspect many psychiatric disorders will disappear decade by decade as research advances. Maybe this is another reason why they fight so hard to claim CFS is psychopathology.

    Bye,
    Alex
     
  7. Enid

    Enid Senior Member

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    They will be proving the moon is a lump of cheese soon.
     
  8. oceanblue

    oceanblue Senior Member

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    Thanks for digging out all the information and the psychopathology scale.

    Yes, inconsistency on the link between sedentary activity or exercise and self-reported CFS. But no studies found a link between childhood psychopathology and CFS, which is odd given all that evidence on the link between childhood trauma/abuse and CFS...
     
  9. Esther12

    Esther12 Senior Member

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    True. Wessely seems to talk as if prior medical problems are necessarily indicative of somatisation, rather than (for example) some initial genetic problem which left the patient particularly unable to recover from a severe viral infection. It seems that there is a genetic component for some CFS, and we do not know how this will have manifested prior to the onset of illness.
     
  10. jen1177

    jen1177

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    Had to crack open the dictionary to figure out what "birth cohort" meant...and I'm assuming that "psychopathology" means depression, anxiety, mood problems? ...because I consider happy people to be mentally ill, but that's just me. :)

    Anyway...I agree with alex3619 in that an association does not mean causation. I remember reading a study recently about the association of childhood emotional trauma and an increased risk of developing CFS later in life. I think this goes back to the "canary in the coal mine" analogy. Certain people are simply more sensitive to everything in life and things impact us negatively more than other people. Emotional traumas, physical traumas, viruses, toxins, infections, everyday stressors, medications, foods, etc. etc. Life, basically.

    How sedentary a person is depends on their energy level. People who are worn out by all the above stressors are going to be tired and more likely to be sedentary.

    Basicallly I think that we were sick long before we knew we were sick. I think people with "psychopathologies" and "sedentariness" are already physiologically ill from their sensitivity to their environment and/or genetic predisposition. The mood problems and low energy are symptoms, not a cause.

    I also think that healthy people like to think that their choices are what keep them healthy. When really it is just mostly up to luck.
     
  11. Sean

    Sean Senior Member

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    It a serious possibility that any underlying organic pathology was in place, but at a sub-clinical level, for long periods before the main recorded 'onset' occurred.
     
  12. Sherlock

    Sherlock bicarb for exercise recovery and taming candida

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    You broke me up with that :)


    Anyway, back to the study: those confidence intervals seem excessively wide to me, yes? Which I'd say generally means the results are not very reliable... Just a thought.

    Unless in psych science, that's the norm.
     

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