How common are depression and anxiety in adolescents with chronic fatigue syndrome (CFS) and how should we screen for th
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ORIGINAL CONTRIBUTION
How common are depression and anxiety in adolescents with chronic fatigue syndrome (CFS) and how should we screen for these mental health co‑morbidities? A clinical cohort study Maria E. Loades1,2 · Rebecca Read1 · Lucie Smith1 · Nina T. Higson‑Sweeney1 · Amanda Laffan3 · Paul Stallard4 · David Kessler2 · Esther Crawley2,3 Received: 13 November 2019 / Accepted: 12 September 2020 © The Author(s) 2020
Abstract Adolescents with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) appear to be more likely to experience anxiety and/or depression using Patient Reported Outcome Measures (PROMs). However, we do not know how accurate these are at detecting problems in this patient group given the primary symptom of fatigue. We aimed to accurately determine the prevalence of anxiety/depression using gold-standard diagnostic interviews and evaluate the accuracy of PROMs measuring mood disorders in this patient group. We conducted a cross-sectional epidemiological study in a specialist tertiary paediatric CFS/ME service, England. The participants were164 12–18-year olds with clinician confirmed CFS/ME and their parents. The measures were a semi-structured diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, K-SADS, and questionnaires (Revised Children’s Anxiety and Depression Scale, RCADS; Spence Children’s Anxiety Scale, SCAS; Hospital Anxiety and Depression Scale, HADS). Parents completed the RCADS-P. 35% met the criteria for at least one common mental health problem. 20% had major depressive disorder, and 27% an anxiety disorder, with social anxiety and generalised anxiety being the most common. There was high co-morbidity, with 61% of those who were depressed also having at least one anxiety disorder. The questionnaires were moderately accurate (AUC > 0.7) at detecting clinically significant anxiety/depression, although only the RCADS-anxiety reached the predefined 0.8 sensitivity, 0.7 specificity target. Mental health problems are particularly common amongst adolescents with CFS/ME. Most screening tools were not sufficiently accurate in detecting clinically significant anxiety and depression, so these should be used with care in combination with thorough psychological/psychiatric assessment. Keywords Prevalence · CFS · Mood · Depression · Anxiety · Screeni
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00787-020-01646-w) contains supplementary material, which is available to authorized users. * Maria E. Loades [email protected] 1
Department of Psychology, University of Bath, Bath BA2 7AY, UK
2
Bristol Medical School, University of Bristol, Bristol, UK
3
Royal United Hospital, Bath, UK
4
Department of Health, University of Bath, Bath, UK
Abbreviations CFS/ME Chronic Fatigue Syndrome/Myalgic Encephalomyelitis DSM-5 Diagnostic and Statistical Manual of Mental Disorders version 5 GAD Generalised anxiety disorder KSADS Kiddie schedule for affective disorders and schizophrenia MDD Majo
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