Anxiety and depression in CFS/ME: Examining the incidence of health anxiety in CFS/ME.

[hixxy]

Psychol Psychother. 2017 Feb 28. doi: 10.1111/papt.12118. [Epub ahead of print]

Anxiety and depression in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): Examining the incidence of health anxiety in CFS/ME.

Daniels J, Brigden A, Kacorova A.

Abstract

OBJECTIVES:
There is a lack of research examining the incidence of health anxiety in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), despite this being an important research area with potentially significant clinical implications. This preliminary study aimed to determine the incidence of anxiety and depression, more specifically health anxiety, in a sample of CFS/ME patients over a 3-month period.

DESIGN:
The research was a cross-sectional questionnaire-based study, using a consecutive sample of patients who were assessed in a CFS/ME service.

METHOD:
Data were taken from the Short Health Anxiety Inventory and the Hospital Anxiety and Depression Scale to identify incidence of anxiety, depression, and health anxiety.

RESULTS:
Data were collected from 45 CFS/ME patients over the sampling period. Thirty-one patients (68.9%) scored above the normal range but within the subclinical range of health anxiety, and 19 patients (42.2%) scored within the clinically significant health anxiety range. Anxiety and depression were common, with prevalence rates of 42.2% and 33.3% respectively, which is comparable to data found in a recent large-scale trial.

CONCLUSIONS:
Health anxiety in CFS/ME patients is likely to be common and warrants further investigation to provide a better insight into how this may influence treatment and symptom management.

PRACTITIONER POINTS:
Anxiety and depression were common in a sample of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) patients, with a high proportion meeting criteria for severe health anxiety. While CFS/ME and health anxiety are distinct and separate conditions, it is unsurprising that patients with CFS/ME, who commonly report feeling 'delegitimized', may experience high levels of anxiety relating to their physical symptoms. Clinicians should consider screening for health anxiety due to the possible clinical implications for treatment; mutual maintenance may negatively influence treatment success in a complex condition such as CFS/ME. Health anxiety has been found to be common across other chronic medical conditions but has been shown to be effectively treated with appropriately tailored interventions.

© 2017 The British Psychological Society.

KEYWORDS:
anxiety; chronic fatigue syndrome/myalgic encephalomyelitis; depression; health anxiety

https://www.ncbi.nlm.nih.gov/pubmed/28244209
http://onlinelibrary.wiley.com/doi/10.1111/papt.12118/abstract

 

[Snow Leopard]

The health anxiety usually goes away if the underlying medical condition is effectively treated...

 

[adreno]

Isn't it natural to worry about your health when you are sick?

 

[Snowdrop]

Someone didn't read the memo sent to them by reality.
This is useless no matter what their outcome states.
Cure ME---problem solved.

ETA: I know everyone needs to make a living somehow. But please, have some self respect while earning it. Do something useful.

 

[user9876]

I don't think this is work worth taking seriously. HADS is a discredited scale also the questions will just pick up on disability rather than anything else for example:

I still enjoy the things I used to enjoy? --- Too ill to do stuff
I can sit at ease and feel relaxed? --- Not good for people too ill to sit up for long
I look forward with enjoyment to things --- Too ill to do stuff and hence look forward to it.
I can enjoy a good book or radio or TV program: -- No to ill to concentrate for too long
I have lost interest in my appearance: -- "I don't take as much care as I should" - too ill to
I feel as if I am slowed down: -- That's what being ill does

The other questions may be less disability dependent
I get a sort of frightened feeling like 'butterflies' in the stomach: - Being ill without help is quite frightening
I feel tense or 'wound up': -- Probably when filling out questionnaires for pointless research
I get a sort of frightened feeling as if something awful is about to happen: -- Something awful like loosing benefits or medical care
I feel restless as I have to be on the move: -- This one probably doesn't match ME.
Worrying thoughts go through my mind: -- Like whats wrong with my body or what happens if I can't do the basic things I need to do.
I get sudden feelings of panic:
I feel cheerful:

So making conclusions about anxiety from such questions seems very dodgy.

 

[Diwi9]

I could not access the full article without payment, so that is a limitation to my commentary.

However, I don't think we need a study to validate our experience, and frankly a practitioner should be treating their patient, not normative data. All one needs to do is practice good medicine and ask about a patient's feelings and experience. That said, one day this article *may* be cited in a medical textbook to help validate our collective experience.

Personally, of course, I feel anxiety over this condition on a daily basis...how could one not without social or medical understanding and sans treatment? Additionally, I have extreme anxiety spikes when I flare. One cannot even begin to measure the effects of this disease until they understand its course/stages/subgroups.

 

[CFS_for_19_years]

I could not access the full article without payment, so that is a limitation to my commentary.

Enjoy (or not):
Full article:
http://sci-hub.cc/10.1111/papt.12118

 

[Diwi9]

While I value that they stated this is a preliminary study, here are the nuggets I found:

"With uncertain prognosis, heterogeneous manifestation, as well as health professionals viewing the condition as contentious and lacking confidence and knowledge (Bayliss et al., 2016), it is understandable that CFS/ME may cause patients to worry about their health."

----- This is the issue that should be studied! Why is this happening? Study the cognitions of doctors and medical establishment.


"Anecdotal feedback from the service lead indicated that a number of patients declined to participate due to the perceived implication that anxiety was the primary complaint rather than chronic fatigue, with one patient remarking on the questionnaire: ‘I’m not a hypochondriac’ (P. Gladwell, personal communication, 2014). This is consistent with feelings of delegitimisation and high illness convictions commonly found amongst patients with CFS/ME (Moss-Morris, 2005; Moss-Morris & Petrie, 2000); patients may have interpreted the questionnaire as a rejection of an underlying physiological explanation for CFS/ME, however this was not intended the implication."

----- If they acknowledge this concern, then here is the real issue to study...where research and intervention is really needed. Child wets the bed, parent beats the child, our study shows child has anxiety over concerns of bed wetting. Not to be crass, but the examination needs to be why the parent is beating the child to address bed-wetting.

 

[Valentijn]

The health anxiety usually goes away if the underlying medical condition is effectively treated...

Being treated by incompetent quacks is the primary cause of any anxiety I have about my health.

 

[alex3619]

50 out of 45 patients with health anxiety!!! They must be wizards to determine this!

Is the commentary wrong but the paper more sensible? You cannot have higher than 100% unless there is overlap, and there isn't the way its described.

 

[alex3619]

Uncertainty abounds with ME and CFS. Uncertainty over progress, recovery, relapse, changing symptoms, income, medical competence ... its a huge list. I would have to say that some level of mild anxiety is normal with these issues, that lacking any anxiety may be the more obvious sign of emotional issues.

Its a similar argument for depression.

I wonder if medical professionals who are not anxious about misdiagnosing and mistreating patients, such as with CBT or GET, have serious psychiatric issues?

This is the issue that should be studied! Why is this happening? Study the cognitions of doctors and medical establishment.

Precisely. Also what is it that turns educated professionals into professionals who diagnose and treat based on hypothetical ideas, without any objective evidence at all.

 

[Dolphin]

50 out of 45 patients with health anxiety!!! They must be wizards to determine this!

No, the 19 were in both groups

 

[Dolphin]

HAI


name: ______________________________ date: _______


Each question is this section consists of a group of four statements. Please read each group of statements carefully and then select the one which best describes your feelings, over the past six months (or other agreed time period). Identify the statement by ringing the letter next to it, i.e. if you think that statement a.) is correct, ring statement a.). It may be that more than one statement applies, in which case, please ring any that are applicable.


1. a.) I do not worry about my health.

b.) I occasionally worry about my health.

c.) I spend much of my time worrying about my health.

d.) I spend most of my time worrying about my health.


2. a.) I notice aches/pains less than most other people (of my age).

b.) I notice aches/pains as much as most other people (of my age).

c.) I notice aches/pains more than most other people (of my age).

d.) I am aware of aches/pains in my body all the time.


3. a.) as a rule I am not aware of bodily sensations or changes.

b.) sometimes I am aware of bodily sensations or changes.

c.) I am often aware of bodily sensations or changes.

d.) I am constantly aware of bodily sensations or changes.


4. a.) resisting thoughts of illness is never a problem.

b.) most of the time I can resist thoughts of illness.

c.) I try to resist thoughts of illness but am often unable to do so.

d.) thoughts of illness are so strong that I no longer even try to resist them.


5. a.) as a rule I am not afraid that I have a serious illness.

b.) I am sometimes afraid that I have a serious illness.

c.) I am often afraid that I have a serious illness.

d.) I am always afraid that I have a serious illness.


6. a.) I do not have images (mental pictures) of myself being ill.

b.) I occasionally have images of myself being ill.

c.) I frequently have images of myself being ill.

d.) I constantly have images of myself being ill.


7. a.) I do not have any difficulty taking my mind off thoughts about my health.

b.) I sometimes have difficulty taking my mind off thoughts about my health.

c.) I often have difficulty in taking my mind off thoughts about my health.

d.) Nothing can take my mind off thoughts about my health.


8. a.) I am lastingly relieved if my doctor tells me there is nothing wrong.

b.) I am initially relieved but the worries sometimes return later.

c.) I am initially relieved but the worries always return later.

d.) I am not relieved if my doctor tells me there is nothing wrong.


9. a.) if I hear about an illness I never think I have it myself.

b.) if I hear about an illness I sometimes think I have it myself.

c.) if I hear about an illness I often think I have it myself.

d.) if I hear about an illness I always think I have it myself.


10.a.) if I have a bodily sensation or change I rarely wonder what it means.

b.) if I have a bodily sensation or change I often wonder what it means.

c.) if I have a bodily sensation or change I always wonder what it means.

d.) if I have a bodily sensation or change I must know what it means.


[cont.]

11. a.) I usually feel at very low risk for developing a serious illness.

b.) I usually feel at fairly low risk for developing a serious illness.

c.) I usually feel at moderate risk for developing a serious illness.

d.) I usually feel at high risk for developing a serious illness.


12. a.) I never think I have a serious illness.

b.) I sometimes think I have a serious illness.

c.) I often think I have a serious illness.

d.) I usually think that I am seriously ill.


13. a.) if I notice an unexplained bodily sensation I don't find it difficult to think about other things.

b.) if I notice an unexplained bodily sensation I sometimes find it difficult to think about other things.

c.) if I notice an unexplained bodily sensation I often find it difficult to think about other things.

d.) if I notice an unexplained bodily sensation I always find it difficult to think about other things.


14. a.) my family/friends would say I do not worry enough about my health.

b.) my family/friends would say I have a normal attitude to my health.

c.) my family/friends would say I worry too much about my health.

d.) my family/friends would say I am a hypochondriac.

 

[Dolphin]

Participants completed questionnaires prior to their initial appointment; findings may reflect elevated anxiety associated with the assessment process.

Future studies should give consideration to other key variables such as illness duration which were not explored within this preliminary paper.

 

[alex3619]

No, the 19 were in both groups

I knew there would be an explanation, but the problem is that means that they consider some subclinical patients to have clinically significant symptoms and vice versa. This is the kind of logic they operate with. When definitions allow this I strongly suspect a problem with the definitions. We saw that in PACE. When such problems exist its difficult to determine anything with any certainty that is based on such overlapping definitions. Now this might just have been poor wording, the lack of a few qualifiers, I have not read the full paper, but even so its still a problem, and should be corrected.

Thirty-one patients (68.9%) scored above the normal range but within the subclinical range of health anxiety, and 19 patients (42.2%) scored within the clinically significant health anxiety range.

 

[Dolphin]

Correlational analysis between the SHAI and HADS-A indicated a moderate strength association, confirming expected levels of convergent validity, r(45) = .353, p = .017.

However table 3 does not show a great level of agreement for cases.

 

[Dolphin]

The mean SHAI score for the present sample (17.9) was higher than norms established for other health groups such as gastroenterology patients (11.4), general practice patients (11.2), and anxiety sufferers (14.9) (Salkovskis et al., 2002).

 

[Dolphin]

Concluding paragraph:

Results indicate that there may be high incidence of health anxiety in CFS/ME, which has been previously unreported. It is likely that severe health anxiety would impede treatment of CFS/ME [by treatment they presumably mean CBT and similar] if neglected as a clinical issue, particularly due to the complex and mutually maintaining nature [I remain to be convinced they are maintaining CFS] of the similar theoretical underpinnings which these conditions share (Daniels & Loades, 2016). A recent large-scale treatment trial CHAMP (Cognitive behaviour therapy for Health Anxiety in Medical Patients, Tyrer et al., 2014) yielded positive and cost-neutral outcomes in patients who experienced comorbid health anxiety and medical problems. Based on current findings, future research should build on Daniels and Loades (2016) work to establish whether adapted CBT for health anxiety in medical problems could optimize outcomes for the CFS/ME subgroup who experience significant levels of health focussed anxiety.

Daniels, J. and Loades, M., 2016. A Novel Approach to Treating CFS and Co-morbid Health Anxiety:a case study. Clinical Psychology & Psychotherapy

 

[Dolphin]

Data were normally distributed therefore a Pearson’s product moment correlation was used to assess association and convergent validity.

I'm not sure that this would this happen if a significant percentage had health anxiety and a percentage had not.

 

[Dolphin]

The study used the Fukuda et al (1994) criteria. However the criteria given in table 1 are the Holmes et al (1988) criteria.