E2 ModerateModerate confidencePEM unclearCross-SectionalPeer-reviewedMachine draft
Do adolescents with chronic fatigue syndrome (CFS/ME) and co-morbid anxiety and/or depressive symptoms think differently to those who do not have co-morbid psychopathology?
Loades, Maria E, Stallard, Paul, Morris, Richard et al. · Journal of affective disorders · 2020 · DOI
Quick Summary
This study looked at how adolescents with ME/CFS think about their symptoms, comparing those who also have anxiety or depression with those who don't. Teenagers with both ME/CFS and anxiety/depression were more likely to have negative thoughts in general and worry more about their fatigue causing damage or embarrassment. The thinking patterns of both groups together explained about 43% of why some teens developed anxiety or depression alongside their ME/CFS.
Why It Matters
Understanding whether adolescents with ME/CFS develop distinct thinking patterns when anxiety or depression co-occurs is important for tailoring psychological treatments. This research suggests that targeting both general negative thinking and fatigue-specific catastrophic beliefs may help address the high rates of mental health problems in young people with ME/CFS.
Observed Findings
- Adolescents with CFS/ME and co-morbid anxiety/depression endorsed stronger general negative cognitive errors compared to those without co-morbidity (effect sizes 0.61–1.31)
- This group more strongly endorsed damage beliefs (d = 0.49), embarrassment avoidance (d = 1.05), catastrophising (d = 0.97), and symptom focusing (d = 0.75) in response to fatigue
- Fear avoidance in response to fatigue did not significantly differ between groups
- Combined negative cognitive errors and unhelpful symptom responses explained 43% of variance in anxiety and depression severity
Inferred Conclusions
- Adolescents with ME/CFS who develop co-morbid anxiety or depression exhibit a more negatively biased thinking style both generally and specifically about fatigue symptoms
- Unhelpful thinking patterns—particularly catastrophising, damage beliefs, and symptom focusing—may be relevant targets for psychological intervention
- Cognitive and behavioural strategies addressing both general negative thoughts and fatigue-specific cognitions may be necessary to effectively treat adolescents with ME/CFS and concurrent mental health conditions
Remaining Questions
- Does negative thinking cause or result from anxiety/depression in adolescents with ME/CFS, and what is the temporal relationship between these factors?
- Would cognitive-behavioural interventions specifically targeting these identified thinking patterns reduce anxiety and depression in this population?
What This Study Does Not Prove
This study cannot establish whether negative thinking patterns cause anxiety/depression or result from it, nor does it prove these thoughts are specific to ME/CFS rather than anxiety disorders alone. The cross-sectional design means we cannot determine the temporal sequence of symptom development or whether addressing these thought patterns would reduce psychopathology.
Tags
Symptom:Cognitive DysfunctionFatigue
Phenotype:Pediatric
Method Flag:PEM Not DefinedWeak Case DefinitionExploratory Only
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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