Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort

Dolphin

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I've just read this. Can't say I find it particularly exciting but will post some notes. Here's the abstract:

Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort.

Br J Psychiatry. 2011 Oct;199:323-9. doi: 10.1192/bjp.bp.110.083956. Epub 2011 Aug 18.

Clark C, Goodwin L, Stansfeld SA, Hotopf M, White PD.

Source
Centre for Psychiatry, Barts & the London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, UK. c.clark@qmul.ac.uk
Abstract

BACKGROUND:
Little is known about the aetiology of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME); prospective studies suggest a role for premorbid mood disorder.

AIMS:
To examine childhood and early adult adversity, ill health and physical activity as premorbid risk markers for CFS/ME by 42 years, taking psychopathology into account.

METHOD:
Data were from the 1958 British birth cohort, a prospective study from birth to 42 years (n = 11 419). The outcomes were self-reported CFS/ME (n = 127) and operationally defined CFS-like illness (n = 241) at 42 years.

RESULTS:
Adjusting for psychopathology, parental physical abuse (odds ratio (OR) = 2.10, 95% CI 1.16-3.81), childhood gastrointestinal symptoms (OR = 1.58, 95% CI 1.00-2.50) and parental reports of many colds (OR = 1.65, 95% CI 1.09-2.50) were independently associated with self-reported CFS/ME. Female gender and premorbid psychopathology were the only risk markers for CFS-like illness, independent of comorbid psychopathology.

CONCLUSIONS:
This confirms the importance of premorbid psychopathology in the aetiological pathways of CFS/ME, and replicates retrospective findings that childhood adversity may play a role in a minority.

PMID: 21852302 [PubMed - in process]
 

Dolphin

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Parental physical abuse was measured retrospectively

The abstract gives the impression that the "parental physical abuse" finding was a prospective one i.e. the data was collected when the individuals were children. However, it is actual based on a retrospective question, asked when the individuals were 45. This leaves open the possibility of what is called "recall bias". I think this is an important issue with ME/CFS - I've been severely affected with ME/CFS for 17 years now and have found my mind wander back to occasions before I was ill (or severely affected). I have remembered all sorts of situations which stressed me a little - not so much that I put much thought into them at the time or even in the years after they occurred, but they've come back now. For example, I remember when I was around 9 or 10, a man who was a neighbour came out and complained that we shouldn't be playing ball outside my house as there was plenty of green area. It wasn't as if this stopped us playing as there was plenty of road so if we didn't want to play on the green e.g. we were playing curbs where one tries to get the ball to bounce of the ball, we played elsewhere on the road. So really a minor incident but it comes back to my mind now and again and I think I would have completely forgotten about incidents like this if I had never got ME/CFS. So the illness could alter what people report - two people could go through the same type of situation but the person with ME/CFS might remember it but the other person might not; or might not see it as "physical abuse" as it didn't seem particularly bad while the person with ME/CFS nows sees it all as a bit traumatic.

This is what they looked at in this paper:
Childhood adversity
Prospective measures of childhood adversity were available at 7, 11
and 16 years, including doctor-reported neglected/underfed
appearance, along with parental reports of being in care and
maternal and paternal absence.16 Parental divorce was reported
by parents in childhood and by the cohort-member at 33 years.
Parental physical or sexual abuse were self-reported retrospectively
at 45 years. Cumulative adversity counted the number of
adversities reported from 7 to 16 years (0, 1, 2, 3+).16
Even in the results in Table 1 (i.e. only adjusted for gender), for the CFS/ME group (which I find the most interesting), there were only three significant odds ratios. Two of them are parental physical abuse (reported at age 45) and parental sexual abuse (reported at age 45). The third one, cumulative adversity, appears to combine the two types i.e. prospective and retrospective, judging by the abstract for reference 16:

Clark C, Caldwell T, Power C, Stansfeld SA. Does the influence of childhood
adversity on psychopathology persist across the lifecourse? A 45 year
prospective epidemiologic study. Ann Epidemiol 2010; 20: 38594.
Also, it's only increased for 3+ adversities, which only covers 6.3% of CFS/ME cases.

For the other prospective categories: Divorce of parents; In care (716); Paternal absence (716); Maternal absence (716); Neglected/underfed appearance (711) and Illness in the household (716), there was no increased risk for CFS/ME cases.

The respective percentages for parental physical abuse (reported at age 45) and parental sexual abuse (reported at age 45) are just 16.2% and 6.6% respectively so they can't explain most of the cases. They dont give a figure for the percentage with neither which could be anything from 77.2% to 83.8%.
 

Dolphin

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Two definitions used: self-reported CFS/ME and CFS-like

Self-reported diagnoses of CFS/ME (Have you ever had CFS/
ME?) were available at 42 years, along with the age at onset.

The prevalence of self-reported CFS/ME in this cohort was 1.0%
(95% CI 1.01.2) (n = 127: 75 female, 52 male), with a median
age at onset of 34 years (mean 32.5, s.d.= 6.9).
[Comment: the female: male ratio is usually higher]
----------
The other definition looks suspect to me:
CFS-like illness was defined independently of self-reported
diagnosis at 42 years. The criteria used were broadly equivalent
to the Centers for Disease Control and Prevention (CDC) criteria
for CFS,1 requiring a self-report of feeling tired most of the time,
in addition to >=4 from the following symptoms from the
Malaise Inventory:13 bad headaches, difficulty falling asleep/
staying asleep, backache, rheumatism/fibrositis and being
unable to concentrate from the (General Health Questionnaire)
GHQ-12.14 The Malaise Inventory and the GHQ-12 assess these
symptoms in the weeks prior to the interview.14,15 For the
comparison group, participants who met the CDC exclusion
criteria for CFS/ME (self-reported anorexia/bulimia at 42 years,
ulcerative colitis, any cancer, Crohns disease, alcohol/substance
misuse, BMI 440) were excluded (n = 2157).1
13. Rutter ML. Psycho-social disorders in childhood, and their outcome in adult
life. J R Coll Physicians Lond 1970; 4: 2118.

14. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, et al. The
validity of two versions of the GHQ in the WHO study of mental illness in
general health care. Psychol Med 1997; 27: 1917.

15. Rodgers B, Pickles A, Power C, Collishaw S, Maughan B. Validity of the
Malaise Inventory in general population samples. Soc Psychiatry Psychiatr
Epidemiol 1999; 34: 33341.
I'm not familiar with the Malaise Inventory but it seems to be designed to measure distress but all 24 items including the seven used for the CFS-like being part of the system:
Psychopathology at 23, 33 and 42 years was measured using
the Malaise Inventory,13 which assesses self-reports of 24
psychological and somatic symptoms. The inventory focuses on
symptoms but has demonstrated validity to discriminate those
with recent psychiatric diagnoses and contact with services.15 A
17-item adapted version of the inventory was used, after excluding
7 somatic symptoms found with CFS/ME, to avoid tautological
defining characteristics of CFS/ME such as fatigue being used to
predict CFS/ME. On the complete inventory >=7 indicates a high
level of distress
, representing 29% of the total score of 24,15
therefore an equivalent cut-off of >= is 5 representing 29% of the
revised total score of 17 was used.
So the measure they used to measure psychopathology includes:
feeling tired most of the time, bad headaches, difficulty falling asleep/
staying asleep, backache, rheumatism/fibrositis (and possibly
and being unable to concentrate (although I'm thinking that comes from the GHQ12 from the wording above?))
It certainly says 7 symptoms are involved.

One has to wonder if this is a good inventory to measure either the CDC symptoms (could it be measuring a depressive type illness?) or indeed whether it is good to measure psychopathology (if anyone has the questions, please post them - I haven't looked around myself).

CFS-like illness was reported by 2.0% (95% CI 2.02.2) (n = 241: 167 female, 74 male).
Female gender was significantly associated with CFS/ME (odds ratio (OR) = 1.50, 95% CI 1.042.14, P= 0.029) and with CFS-like illness (OR = 2.36, 95% CI 1.793.11, P= 0.001).
 

Dolphin

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Free data supplement

There's a free data supplement at: http://bjp.rcpsych.org/content/suppl/2011/08/16/bjp.bp.110.083956.DC1/DS83956.pdf
where one can see some of the other risk factors they looked at.

As one can see, they checked for lots of risk factors (remember these aren't them all). And they used a 95% CI. One can find things by chance if one does this without them being real risk factors.

------
I'm not sure how much more time on I want to spend writing up notes on this so might leave it for now.
 

Esther12

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Thanks D.

It's a bit cheeky for them to make it sound like the child abuse thing was prospective.
 
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Dolphin

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Can we be sure the CFS/ME measuresments are all pre-morbid (i.e. before the illness)

One of my big concerns about these sorts of study is whether the measurements are really pre-morbid i.e. before the person got sick with "CFS/ME".
If in fact some people were actually ill with undiagnosed CFS/ME, this would greatly influence how they and other people would be behaving and how other people would see their behaviour.
The authors claim they adjust for this for the CFS/ME group but can we really be sure. These are people who were born in 1958. The diagnosis only started becoming common in the mid- to late-1980s. And still large numbers would be missed.

Some people could also be still comparatively well but still not be "pre-morbid" e.g. they had an ME-type illness for a while, largely got over it but still had it in the background/have to be careful how they live their life (which could be stressful if one never got a diagnosis).

I think they don't even try to adjust for it at all for the CFS-like group (because many of these people don't have a diagnosis so it's not clear how they would do it).
 

Dolphin

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Heres some of their lovely speculation:
Childhood illness
Evidence for childhood illness as a risk marker from previous
studies is equivocal.9,10 We found few associations, using more
detailed measures of childhood illness. Risk markers included
gastrointestinal symptoms, many colds, headaches/migraines,
throat infections and chronic illness. However, few associations
were independent of psychopathology and physiological pathways
between these illnesses and CFS/ME remain unclear. Early illness
experience, vicarious or the childs own, is linked with the
development of medically unexplained symptoms in adulthood,30
reflecting possible pathways for CFS/ME via social learning and/or
reinforcement of illness behaviour
.31 The childhood illness
measures may reflect the overprotectiveness of the parent, rather
than illness per se. Overprotective parenting may be relevant to
the formation of belief systems, such as negative schemata
associated with response to illness, that may predispose to the
development of CFS/ME in adulthood
.31 Overall, evidence from
population cohort studies regarding childhood illness as a risk
marker is not strong.
 

Enid

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Thanks for looking Dolphin - I agree with KFG - the b....s..t express is leaving platform 1 shortly.
 

Nielk

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In addition, I would think that if you studied any group of ill patients like for example people with heart disease or people with cancer, etc.. you would probably find similar statistics. I'm sure that people who had a lot of trauma that they went through in their early years, had the stress affects their immune systems somehow and they are prone for many illnesses. You don't have to be a brain surgeon to realize that. I don't think that CFS stands out compared to any other illness.
 

Dolphin

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In addition, I would think that if you studied any group of ill patients like for example people with heart disease or people with cancer, etc.. you would probably find similar statistics. I'm sure that people who had a lot of trauma that they went through in their early years, had the stress affects their immune systems somehow and they are prone for many illnesses. You don't have to be a brain surgeon to realize that. I don't think that CFS stands out compared to any other illness.
They give one reference:
Childhood physical abuse is associated with a wide-range of
adverse physical health outcomes in adulthood,23 suggesting that
distress associated with abuse may be expressed through later
physical symptoms.
Walker EA, Gelfand A, Katon WJ, Koss MP, Von Korff M, Bernsterin D, et al.
Adult health status of women with histories of childhood abuse and neglect.
Am J Med 1999; 107: 3329.

Abstract
PURPOSE:
Several recent studies have found associations between childhood maltreatment and adverse adult health outcomes. However, methodologic problems with accurate case determination, appropriate sample selection, and predominant focus on sexual abuse have limited the generalizability of these findings.

SUBJECTS AND METHODS:
We administered a survey to 1,225 women who were randomly selected from the membership of a large, staff model health maintenance organization in Seattle, Washington. We compared women with and without histories of childhood maltreatment experiences with respect to differences in physical health status, functional disability, numbers and types of self-reported health risk behaviors, common physical symptoms, and physician-coded ICD-9 diagnoses.

RESULTS:
A history of childhood maltreatment was significantly associated with several adverse physical health outcomes. Maltreatment status was associated with perceived poorer overall health (ES = 0.31), greater physical (ES = 0.23) and emotional (ES = 0.37) functional disability, increased numbers of distressing physical symptoms (ES = 0.52), and a greater number of health risk behaviors (ES = 0.34). Women with multiple types of maltreatment showed the greatest health decrements for both self-reported symptoms (r = 0.31) and physician coded diagnoses (r = 0.12).

CONCLUSIONS:
Women with childhood maltreatment have a wide range of adverse physical health outcomes.
That may or may not be a representative study.
 

Nielk

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It's interesting to me that the study was performed only on women. I would think that men who were abused or had childhood traumas would have similar consequences. why define it by sex?
 

Dolphin

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It's interesting to me that the study was performed only on women. I would think that men who were abused or had childhood traumas would have similar consequences. why define it by sex?
Who knows. Men can be victims of domestic violence - but there's much more focus on women with a lot of the studies just being done on female victims. And "women's studies" is a much more bigger area than "men's studies". So perhaps it was influenced by such attitudes/done by researchers who often look at women-only groups (or used that sort of fund).

In terms of ME/CFS, it is slightly frustrating how many studies in recent years are just done on women. Although hopefully it should much difference and at the moment, I'm generally happy that there are any studies done at all.
 

SilverbladeTE

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When I was 4 years old, my Dad punched me so hard in the mouth I went flying across the room, and had to get surgery because he'd punched my lips through my teeth...
Dad by way wasn't a drug/booze user or evil, just very screwed up by particularly horrible childhood, plus diabetes TypeII lazy stupid docs hadn't diagnosed despite frequent warnings, and he'd just "flip out" at times and barely remember doing it.
Very wrong of course, but he's not evil, if you know him long enough you realize someone took a very kind, generous 5 year old kid, and wrecked him :/

That and fact I was kind hearted, very intelligent, big (*) and live in one of the roughest places in Europe = "interesting" childhood. :rolleyes:
(*) you often find small, nasty little ratbags love picking on someone bigger than them to make them feel bigger, those typoes cause more damn trouble, sigh. they also "squish" good :victory::thumbsup:

thus on the surface that would tend to confirm the psychobabblers crap...

problem is, it ain't so simple. I didn't knuckleunder, I knuckled back :p
though with actual violence as I keep telling folk, best weapon is yer feet...used for not BEING there, locomotion, in the damn first place! lol. He who walks away, lives another day and ain't a stupid idiot. Violence suuuuucks, even if you "win", it's ugly and corrosive
such stuff isn't good for folk, hell no, ugh, but many folk end up being better able to cope with the crap life throws at 'em, in fact
though mostly it's philosophical that was the best thing all the crap taught me: how to escape it, how to think about it, understand why such occured, how to avoid such, aid others etc
nothing beats dozing at the riverside, fishing rod in hand, and yer pooch beside ya: true nirvana :)

I was doing fine until damn flu-like bug/toxic damp proofing resulted in ME, blech :(
and living next door to "heavy metal polluted hell" didn't help

if it was largely childhood abuse that leads ot ME, then in my part of the world MOST folk would bloody well have it! so that hypothesis is BULL-F*****-SH*T!
to suggest though, that the stress/problematic issues may worsen ME symptoms if you get it, that I'd say is logical, as stress, of all forms, does worsen it.

thsoe with higher levels of stress, less experience in coping with woes, those who push themselves through the early period (*), I suggest will have worse outcomes in general
(me! damn idiot but heck I didn't know better, doctors SHOULD have if not for the damn Weasels)

As usual the psychobabblers divorce from real experience and logic is profound, sigh
 

Nielk

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I'm sorry silver that you had to go through those horrible experiences. I think your intelligence is what pulled you through. You used your brain to outsmart thugs. You used your brain to understand your father's shortcomings. although I doubt that at the age of 5, you really understood that. Now, with hindsight, it makes sense to you but, as a 5 year old, all you know is that you have been hurt by someone who was supposed to love you. I think that you talk tough but, you are a really sensitive caring individual. The more sensitive or empathic of a personality one has the more hurt they absorb. I'm only saying that because i also had traumatic experiences as a child and also later. They were situations I couldn't avoid and I have a super sensitive nature. I don't think that automatically that means that it is the cause of disease. I first came down with Crohn's at age a5 and was very ill with it for 15 years and then when I was 47, I came down with CFS. I think that maybe my background made it easier for me to have a weak immune system and when these diseases struck me, I was in a weakened state and they were able to take over my body. I have such a high viral and inflammation load in my body. It all started with a terrible virus but, it could be that if I had a strong immune system I would have been able to fight it off? I really don't know.
 

SilverbladeTE

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Nielk
oh yeah I know I'm a big blowhard, no worries, hehe! ;)
Lot of folk alas suffered a lot worse :/
Most folk are soft, and that's *GOOD*, it's the crap they get that makes them troubled and "hard", nearly everyone takes things very much to heart, and thus can get hurt so we all develop ways to cope.
Problem is many of the folk who don't care are often, monsters, ick, or just damn useless (they'd walk over a dying man rather than give aid)

yeah I was lucky I not only had the wits, but most of my family were fantastic folks, full of humour, play, art, cuddles etc :) I miss playing cards, Scrabble etc with Grandpa and all the folks who've passed on, sigh
When you see so many of the screwed up folk round my way, it's no wonder we have problems like "Neds", sigh :/

Folk tend ot forget that kids are often loaded with bugs, because they're young and thus immune system is "learning" so it's weak, and we cram hundreds of kids into tight proximity (schools. and I think that's damn stupid beyond belief, big shcools = more problems)
And I suspect the huge number of vaccinations plus agricultural poisons in food don't help.

ick, sorry you have that form such a young age :(
 

Nielk

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Hi Silver,

Sounds like you had a very loving upbringing with the extended family. That is great!!

Most folk are soft, and that's *GOOD*, it's the crap they get that makes them troubled and "hard", nearly everyone takes things very much to heart, and thus can get hurt so we all develop ways to cope.
"We all develop ways to cope". Yes, I agree but, some coping mechanisms are healthy and some are not. If for example, you were forced to repress your feelings and didn't have a voice, keeping all the hurt inside is not healthy. This is from a private study of one person who I know best of all.
 

SilverbladeTE

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Alas, you are correct :/
many of those weith genuine psychological problems get them form the abuse they suffer as kids.
And often abuse isn't violence, but sheer neglect, which can be a lot worse.
Violence is visible, "understandable" and thus usually provokes reaction, aid, intervention etc

but neglect, folk think of it as "kids locked in cellars" nope, more often it's kids excluded from a normal family life, sent away to school, live cold, sterile lives...
Where as direct abuse from one person but with plenty of love/warmth on the otherhand, you have much better rolemodels and comfort

Poor old dad, as a kid, he fell down a huge embankment, split his skull open on a concrete support at the base, his mum picked him up, slapped him, told him to stop crying...ye gods :/
 

Nielk

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It sounds like now as an adult, assimilating what your father had to endure gives you a better understanding of why he did what he did. It sounds like you feel sorry for what he had to go through. At least you have your mom to keep you company.
By the age of 29, I had lost both parents and two sons. Not an easy task for a young woman to live with. I guess it made me the person i am today. (for better or worse)

I'm just saying, there s a price to pay for tragedies that we go through. You have to be a robot not to have these things affect you. Additionally,if you are a sensitive type to begin with, it will leave it's scars. I truly believe that everything that happens was meant to happen but, it doesn't make it easier to live with it.