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

oceanblue

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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.
 

oceanblue

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The main problem with this study is that it relies on patient self-report
Self-report diagnoses of CFS/ME were available at 42 years using an item measuring long-standing health conditions: Have you ever had CFS/ME? Participants who answered yes to having CFS/ME also reported the age of onset of the condition.
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.
 
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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?

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.
 

WillowJ

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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
 

Snow Leopard

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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.
Psychopathology at ages 23, 33, and 42 years was measured using the Malaise Inventory.

In this study, a 17-item version of this measure was used, after excluding the seven somatic symptoms that could overlap with the outcome variable of CFS/ME. A cut-off of greater than or equal to seven has been used previously to indicate a high level of psychological distress (20), which represents 29% of the total score of 24 items, therefore an equivalent cut off of greater than or equal to five was used in this study after the exclusion of seven items, which also represents 29% of the total score of 17 items. Examples of items that were excluded from the scale include: do you feel tired most of the time?, Do you often have bad headaches? The internal consistency for the amended scale in this sample was 0.75, compared with 0.83 for the 24-item scale. A cumulative variable was derived to measure the chronicity of psychopathology between 16 to 33 years (03 reports).

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.

Strengths and Limitations

There are a number of strengths to this prospective cohort study. This design allowed us to examine risk and preventive markers for CFS/ME measured before the onset of CFS/ME, compared to previous cross-sectional studies using retrospectively gathered data. The 1958 cohort also has more participants than the 1946 cohort and, furthermore, in the current study missing data was addressed using multiple imputation. This enabled us to deal with the potential attrition bias, which the previous cohort analyses do not, whilst increasing the power of the data further. Finally, the benefit of comparing across the cohorts is that any consistent risk or preventive markers can be concluded as being stable markers for CFS/ME, but if there is mixed evidence across the cohorts then this highlights an area requiring further investigation.

The main limitation of this study is the difference between the three cohort studies in the measures used, and the potential cultural and social differences between individuals born in the different eras. There may also be differences in risk factors for CFS/ME between individuals who develop CFS/ME in early-adulthood compared to those who develop CFS/ME in mid- to late-adulthood that cannot be identified in this replication study. A further limitation is the reliance on a self-report of CFS/ME. However, the outcome was also self-report in the 1946 and 1970 cohorts so the outcome measurement should not have resulted in the cohort differences observed. As with any self-report of health, there remains a potential for misdiagnosis, but the prevalence rates reported in this data are very similar to prevalence estimates in England 32, suggesting that there was not a high number of participants reporting a diagnosis that they did not have. Finally, there are weaknesses with the self-report nature of these national cohort studies, and possible issues of social desirability, which is an unavoidable weakness for a data set of this size and power.

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?
 

alex3619

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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
 

oceanblue

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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

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...
 
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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.

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.
 

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.
 

Sean

Senior Member
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7,378
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.

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.
 

Sherlock

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...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. :D

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.