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Depression in pediatric chronic fatigue syndrome

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By Helen Bould et al. • • May 9, 2013

Editor’s Comment: The Hospital Anxiety and Depression Scale (HADS) is a measure of psychological distress used to determine levels of anxiety and depression. HADS was specifically designed to avoid common physical symptoms of illness, such as fatigue, insomnia and hypersomnia. By leaving out physical symptoms, it was hoped that HADS would serve as a tool for the detection of psychological distress in people with physical health. The use for which HADS was originally intended does not encompass ME/CFS.

Depression in paediatric chronic fatigue syndrome

By Helen Bould et al.


Objective: To describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability, pain and school attendance.

Design: Cross-sectional survey data using the Hospital Anxiety and Depression Scale (HADS) collected at assessment.

Setting: Specialist paediatric CFS/ME service in the South West.

Patients: Children aged 12–18 years with CFS/ME.

Main outcome measure: Depression was defined as scoring >9 on the HADS depression scale.

Results: 542 subjects had complete data for the HADS and 29% (156/542) (95% CI 25% to 33%) had depression. In a univariable analysis, female sex, poorer school attendance, and higher levels of fatigue, disability, pain, and anxiety were associated with higher odds of depression. Age of child and duration of illness were not associated with depression. In a multivariable analysis, the factors most strongly associated with depression were disability, with higher scores on the physical function subscale of the 36 item Short Form (SF-36).

Conclusions: Depression is commonly comorbid with CFS/ME, much more common than in the general population, and is associated with markers of disease severity. It is important to screen for, identify and treat depression in this population.

Source: Arch Dis Child doi:10.1136/archdischild-2012-303396. Helen Bould, Simon M Collin, Glyn Lewis, Katharine Rimes, Esther Crawley. School of Social and Community Medicine, University of Bristol, Bristol, UK. Institute of Psychiatry, King's College London, London, UK

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