Is there any solid evidence that the prevalence of depression is higher in CCC-defined ME/CFS patien

[Hip]

Instead, they were compiling all of the diagnoses made for those patients by other doctors or therapists. In the case of ME, many doctors will unfortunately misdiagnose the disease itself as a primary mood disorder, and often treat it accordingly.

That does not sound like good study design, especially as you say, since ME/CFS may be initially misdiagnosed as depression.

As an aside: it is interesting that the study in question found low testosterone in 36% and hypothyroidism in 35% of ME/CFS patients. I wonder if that is an error of misdiagnosis (because hypothyroidism, and perhaps also low testosterone, can be mistaken for ME/CFS), or whether these conditions are really that frequently found in ME/CFS patients. If they are, it suggests ME/CFS patients should be routinely tested for both, and treated if necessary.

Depression as a co- morbid condition is notably high in patients with chronic illness (15–25%) compared to healthy primary care patients (5–10%), and the highest rates (40–50%) are in patients with neurological illness.

To me it is not at all that surprising that comorbid depression is quite high in neurological diseases. Once you have neurological dysfunction, it seems fairly obvious that there would be a potential for causing mood disorders and mental symptoms.


Perhaps this high comorbidity is one the reasons ME/CFS sometimes gets misdiagnosed as depression: if an ME/CFS patient presents to the doctor with comorbid depression, it's probably going to be the depression that the doctor may pick up on first, because that's easier to spot in a person's demeanor. Whereas as we know, those with ME/CFS usually do not look ill on the outside. ME/CFS diagnosis requires careful questioning of the patient, and testing for orthostatic intolerance symptoms.

 

[JaimeS]

Abso-freaking-loutely, @mango.

I'm referring to Unger's presentation at the CDC in the first half of that. From my (personal) RFI response:

Psychosomatic model leads to bias
Elizabeth Unger (2016) performed a seven-center study in which she compared the functional status of CFS patients and healthy controls. Patients’ mental health and emotional role functioning was not statistically different from that of controls, though they performed far more poorly on other markers of functional status, including physical functioning, bodily pain, general health perceptions, vitality, physical role functioning, and social role functioning (Unger, 2016).

Figure 2: Functional status is substantially impaired in comparison to healthy controls, with the exception of mental health and emotional function (Unger, 2016)

I am going to have to search around for the second study -- I read it literally years ago. I'm going to have to hunt.

Now, to answer the general question (initially asked in this thread) of whether patients with CCC definitions are actually more depressed, we would need to look at more than one study.

Also from my RFI response:

If ME were a psychosomatic illness, one would expect that functional impairment would correlate with mental health functioning; however, Jason et al. (2016) also found that mental health scores did not correlate to symptom severity or any other impairment.

Ok, with me so far? Final nail:

Multiple studies have now made the case for ME being a separate illness from CFS, or perhaps a subset, with 40-60% of those who meet the Fukuda criteria (1994) also meeting the more stringent CCC and ICC criteria (Maes, Twisk, & Johnson, 2012).

Jason et al. (2016) found that patients who met the ICC or CCC criteria had significantly more functional impairment than those who met the Fukuda criteria alone. These patients tested lower on physical functioning, role physical, bodily pain, general health, and vitality than their CFS counterparts. Symptoms experienced by the ME group were found to be more severe (Jason et al., 2016). Johnston et al. (2014) also found that patients who met the ICC or CCC criteria were more functionally impaired than those who met the CDC criteria alone.

Another study divided patients into three groups: a group that experienced chronic fatigue as a symptom but did not meet the Fukuda criteria (CF); a group that met the Fukuda criteria but did not experience PEM (CFS); and a group that experienced PEM (ME). The researchers found that patients with ME had higher scores on concentration difficulties as well as the highest levels of IL-1, TNF-α, and neopterin; CFS patients had significantly lower levels of these inflammatory markers, and CF patients had even lower levels, which were still statistically different from that of controls (Maes, Twisk, & Johnson, 2012).

Le transitive property:

CCC and ICC patients are more impaired than controls.

Functional impairment does not correlate to psychological symptomology.

Therefore, CCC criteria is not associated with greater prevalence of psychological symptoms.

-J

Bibliography:

Jason, L. A., Sunnquist, M., Brown, A., Evans, M., & Newton, J. L. (2016, January). Are Myalgic Encephalomyelitis and chronic fatigue syndrome different illnesses? A preliminary analysis. J Health Psychol., 21(1), 3-15. http://doi.org/10.1177/1359105313520335

Johnston, S. C., Brenu, E. W., Hardcastle, S. L., Huth, T. K., Staines, D. R., & Marshall-Gradisnik, S. M. (2014). A comparison of health status in patients meeting alternative definitions for chronic fatigue syndrome/myalgic encephalomyelitis. Health and Quality of Life Outcomes, 12, 64. http://doi.org/10.1186/1477-7525-12-64

Maes, M., Twisk, F. M., & Johnson, C. (2012, December 30). Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and Chronic Fatigue (CF) are distinguished accurately: results of supervised learning techniques applied on clinical and inflammatory data. Psychiatry Res., 200(2-3), 754-760. http://doi.org/10.1016/j.psychres.2012.03.031

Unger, E.R. (2016, February 16). Proceedings from CDC Public Health Grand Rounds, Chronic Fatigue Syndrome: Advancing Research and Clinical Education. Public Health Approach to CFS. Retrieved from: http://www.cdc.gov/cdcgrandrounds/archives/2016/february2016.htm

 

[Sea]

@JaimeS
There was also another study by Jason that Cort wrote an article on:
http://www.healthrising.org/blog/20...oth-may-select-for-more-psychiatric-patients/

I don't have a link to the study though. I can't remember what the study actually involved

 

[Forbin]

[There was also another study by Jason that Cort wrote an article on:
http://www.healthrising.org/blog/20...oth-may-select-for-more-psychiatric-patients/

From the above, the argument seems to be that if your definition requires a lot of symptoms, then you will capture more people with psychiatric disorders - apparently because psychiatric cases somaticize a lot of symptoms (or at least they answer questionnaires in a way that suggests they do).

If you rely on fewer "core" symptoms, you will supposedly capture fewer cases of psychiatric illness. But if the same core symptoms are required by both the brief and extended questionnaires, I fail to see how reducing the "non-core" symptoms would exclude the previously captured psychiatric cases [unless psychiatric cases are just more likely to answer "yes" to everything when there are a lot of questions, but would somehow be more restrained when there are fewer questions.]

I think it's pretty clear the ME/CFS does cause a lot of symptoms, but the argument seems to be that that feature actually makes it hard to distinguish from psychiatric illness, if you make the great quantity of symptoms the criteria.

It's as though you are describing an assailant to the police and they tell you that your description is so detailed that they find it suspicious.

 

[worldbackwards]

This is a good blog from @Graham on a similar subject:

“Those who report a diagnosis of CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms.”

This quote comes from a study, by Harvey, Wadsworth, Wessely and Hotopf, published online in 2007...

Roughly the expected number of those 34 had not had any previous psychiatric or psychological problems, and again the expected number had some prior lesser psychiatric or psychological problems, such as more moderate depression or anxiety. But instead of finding 2 people in the group with severe psychiatric problems, there were 6. From a statistical point of view, that is quite unexpected: it is significant. But is it significant in the real world sense?

The key part is a little more buried: these were not diagnoses of ME/CFS, but were simply notes made by the interviewing nurses that the subjects said that they had ME/CFS. So, in essence, all of this hinges on a statement by 4 people, who had suffered severe psychiatric problems in the past, that they now had ME/CFS...

http://meanalysis.blogspot.co.uk/2016/02/p-margin-bottom-0.html

Standards, people, standards...

 

[mango]

Abso-freaking-loutely, @mango.

Thank you so much, @JaimeS! I really appreciate the very detailed reply!