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.

Observed Findings

• 35% of adolescents with CFS/ME met diagnostic criteria for at least one anxiety or depressive disorder
• 20% had major depressive disorder; 27% had an anxiety disorder (social anxiety and generalised anxiety most common)
• 61% of participants with depression also met criteria for at least one anxiety disorder
• Questionnaires showed only moderate accuracy (AUC >0.7), with only RCADS-anxiety meeting the predefined sensitivity (0.8) and specificity (0.7) targets
• Parent-reported measures (RCADS-P) were included but questionnaires overall had variable and insufficient accuracy for reliable screening

Inferred Conclusions

• Mental health comorbidities are particularly prevalent in adolescents with CFS/ME, affecting more than one-third of this population
• Standard screening questionnaires cannot be relied upon alone to detect clinically significant anxiety and depression in CFS/ME patients due to moderate accuracy and symptom overlap with fatigue
• Comprehensive psychological or psychiatric assessment must supplement questionnaire screening to ensure accurate detection and appropriate treatment of mental health problems in this group
• The high rate of anxiety-depression comorbidity (61%) suggests integrated mental health assessment approaches may be necessary

Remaining Questions