http://bjp.rcpsych.org/content/early/2012/07/25/bjp.bp.111.107474.abstract
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Research Articles
Depressive symptoms and pragmatic rehabilitation for chronic fatigue syndrome
A. J. Wearden,
G. Dunn,
C. Dowrick and
R. K. Morriss
+ Author Affiliations
A. J. Wearden, PhD, School of Psychological Sciences, University of
Manchester, Manchester; G. Dunn, PhD, School of Community Based
Medicine, University of Manchester, Manchester; C. Dowrick, MD,
Institute of Psychology, Health and Society, University of Liverpool,
Liverpool; R. K. Morriss, MD, School of Community Health Sciences,
University of Nottingham, Nottingham, UK
Correspondence: A. J. Wearden, University of Manchester, School of
Psychological Sciences, Coupland 1 Building, Oxford Road, Manchester
M13 9PL, UK. Email: Alison.wearden@manchester.ac.uk
Declaration of interest: None.
Abstract*
Background
Previous research has suggested that depressed mood may predict
outcome and moderate response to treatment in chronic fatigue
syndrome, although findings have differed between studies.
Aims
To examine potential moderators of response to pragmatic
rehabilitation v. general practitioner treatment as usual in a recent
randomised trial for patients with chronic fatigue syndrome in primary
care (IRCTN74156610).
Method
Simple regressions, with weighting adjustments to allow for missing
data, were calculated. Demographic, medical and psychological
variables, and treatment arm, were entered separately and as an
interaction term. The outcome variable in each case was change in
Chalder Fatigue Scale scores, from baseline to 1-year follow-up, our
primary outcome point.
Results
Longer illness durations predicted poorer outcome across the two
treatment arms. For patients allocated to pragmatic rehabilitation
compared with those allocated to treatment as usual, higher levels of
depressive symptoms at baseline were associated with smaller
improvements in fatigue (P = 0.022).
Conclusions
For patients in primary care with higher levels of depressive
symptoms, either more intensive or longer pragmatic rehabilitation, or
cognitive–behavioural therapy, may be required in order to show a
significant improvement in fatigue.