Coping and other predictors of outcome in chronic fatigue syndrome: a 1-year follow-up

Factors associated with fatigue among people who have returned to work after stroke: an exploratory study

OBJECTIVE

To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke.

DESIGN

A cross-sectional exploratory study.

SUBJECTS

87 working stroke survivors.

METHODS

This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score ≥ 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created.

RESULTS

Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue.

CONCLUSION

Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.

Factors Influencing the Prognosis of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term debilitating multisystem condition with poor prognosis. Studies that examined predictors of ME/CFS outcomes yielded contradictory results. We aimed to explore epidemiological and clinical prognostic factors of ME/CFS using operationalized criteria for recovery/improvement. Adult ME/CFS patients who attended the Internal Medicine Department of Angers University Hospital, Angers, France between October 2011 and December 2019, and were followed up until December 2020, were included retrospectively. Their medical records were reviewed for data collection. Patients were classified into two groups according to the presence or absence of recovery/improvement (R/I) and compared for epidemiological characteristics, fatigue features, post-exertional malaise severity, clinical manifestations, and comorbidities. The subgroups of recovered and significantly improved patients were then compared. 168 patients were included. Recovery and improvement rates were 8.3% and 4.8%, respectively. Older age at disease onset was associated with R/I (OR 1.06 [95% CI 1.007-1.110] (p = 0.028)), while diagnostic delay was inversely associated with R/I (OR 0.98 [95% CI 0.964-0.996] (p = 0.036)). The study findings confirmed the poor prognosis of ME/CFS and the deleterious effect of diagnostic delay on disease progression. Interestingly, being older at disease onset was associated with better outcomes, which offers hope to patients for recovery/improvement even at an advanced age.

Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome leads to severe functional impairment and work disability in a considerable number of patients. The majority of patients who manage to continue or return to work, work part-time instead of full time in a physically less demanding job. The prognosis in terms of returning to work is poor if patients have been on long-term sick leave for more than two to three years. Being older and more ill when falling ill are associated with a worse employment outcome. Cognitive behavioural therapy and graded exercise therapy do not restore the ability to work. Consequently, many patients will eventually be medically retired depending on the requirements of the retirement policy, the progress that has been made since they have fallen ill in combination with the severity of their impairments compared to the sort of work they do or are offered to do. However, there is one thing that occupational health physicians and other doctors can do to try and prevent chronic and severe incapacity in the absence of effective treatments. Patients who are given a period of enforced rest from the onset, have the best prognosis. Moreover, those who work or go back to work should not be forced to do more than they can to try and prevent relapses, long-term sick leave and medical retirement.

Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study

Many patients with chronic fatigue syndrome(CFS) and/or fibromyalgia(FM) have little understanding of their condition, leading to maladaptive pain cognitions and coping strategies. These should be tackled during therapy, for instance by pain neurophysiology education (PNE). Although positive effects of PNE are well-established, it remains unclear why some patients benefit more than others. This paper aims at exploring characteristics of patients responding poor to PNE to further improve its effectiveness. Data from two RCT's were pooled to search for baseline predictors. Subjects (n = 39) suffering from CFS/FM, as defined by the American College of Rheumatology, underwent PNE treatment. The Pain Catastrophizing Scale (PCS); Pain Coping Inventory (PCI); and Tampa Scale of Kinesiophobia (TSK) were defined as outcome measures. There was a significant negative relationship between baseline TSK and the change in both PCS total score (r = -0.584; p < 0.001) and PCS rumination (r = -0.346; p < 0.05). There was a significant negative relationship between the change in PCS total score and baseline PCI worrying (r = -0.795; p < 0.001) and retreating (r = -0.356; p < 0.05). FM/CFS patients who tend to worry allot about their pain and with high levels of kinesiophobia are likely to experience less reductions in catastrophizing following PNE. It seems that PNE alone is insufficient to reduce catastrophic thinking regarding pain, and supplementary treatment is needed.

Chronic Fatigue Syndrome: An Evaluation of an Occupational Therapy Inpatient Intervention

It has been stated that, although most chronic fatigue syndrome (CFS) patients can be treated in primary care and that cognitive behaviour therapy and prescribed, graded aerobic exercise appear to be promising in outpatient management, a minority of patients will require inpatient care (Royal Colleges of Physicians, General Practitioners and Psychiatrists 1996). To date, little has been written on the need for and impact of an inpatient approach for patients with CFS. This study builds on previous work to show how patients with complex CFS responded to a specifically designed occupational therapy inpatient programme, using the principles of cognitive behaviour therapy and graded activity.

A quasi-experimental study was carried out using current inpatients with those on the waiting list as a comparison. At 6 months following discharge, a significant difference between the groups in terms of symptoms and level of ability was not demonstrated. However, a significant effect was shown in patients' perceived health, length of time tired and management of the illness. Thirty-one (72%) of the inpatient group, compared with 10 (53%) of the comparison group, stated that they felt better than the previous year. Thirty-one (72%) of the inpatient group, compared with 7 (37%) of the comparison group, indicated better management of their illness. These findings give some evidence of the need for an inpatient CFS management programme for specific patients with complex CFS.

Coping and Occupational Participation in Chronic Fatigue Syndrome

Existing studies have shown that individuals with chronic fatigue syndrome demonstrate functional impairment in several domains related to occupational participation. Researchers have not yet explored whether coping styles may be associated with occupational participation in individuals with this condition. The aim of this study was to examine the effects of coping styles on occupational participation among adults with chronic fatigue syndrome. The authors hypothesized that occupational participation would be associated with coping strategies oriented toward information seeking and maintaining activity, and that this relationship would endure despite individual differences in illness severity. The study used a cross-sectional design to describe the associations between coping and occupational participation for 47 individuals diagnosed as having chronic fatigue syndrome. Findings from linear regression analysis revealed that the coping style of maintaining activity was positively associated with occupational participation, whereas illness accommodation was negatively associated. Implications of the findings for continued research and clinical practice in occupational therapy are discussed.

Metacognitions Are Associated with Subjective Memory Problems in Individuals on Sick Leave due to Chronic Fatigue

Background: Subjective cognitive impairments are frequent, but poorly understood in patients with chronic fatigue. We hypothesized that maladaptive metacognitive beliefs at baseline were associated with baseline subjective cognitive impairments, that they predict subjective cognitive impairments at treatment termination, and that a reduction in maladaptive metacognitive beliefs was associated with less subjective cognitive impairments at treatment termination, independent of changes in fatigue, pain, insomnia, depression, and anxiety.

Methods: In this non-controlled study, patients (n = 137) on sick leave due to chronic fatigue received a 3.5-week inpatient RTW rehabilitation program. Of these patients 69 (50.4%) was referred with a ICPC-2 diagnosis of chronic fatigue. Patients completed questionnaires about metacognitive beliefs, somatic complaints, psychological complaints, and cognitive impairments before and after treatment. To test the hypotheses we performed paired t-tests of change, as well as seven hierarchical linear regressions.

Results: Results showed that baseline maladaptive metacognitive beliefs were significantly associated with subjective cognitive impairments at baseline, controlling for symptoms. Score on baseline metacognitive beliefs did not predict impairments post-treatment. Testing specific maladaptive beliefs, pre-treatment scores on cognitive confidence were associated with subjective cognitive impairments both pre and post-treatment, controlling for symptoms. Post-treatment metacognitive beliefs and post-treatment cognitive confidence were associated with post-treatment subjective cognitive impairments, controlling for pre-treatment impairments and pre-treatment metacognitive beliefs, as well as pre and post-scores on symptom measures.

Conclusion: This study reports associations between maladaptive metacognitive beliefs and subjective cognitive impairments in patients with chronic fatigue. Targeting metacognitive beliefs could prove an effective therapeutic intervention for subjective cognitive impairments in these patients.

The Relationship between Age and Illness Duration in Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a debilitating illness, but it is unclear if patient age and illness duration might affect symptoms and functioning of patients. In the current study, participants were categorized into four groups based upon age (under or over age 55) and illness duration (more or less than 10 years). The groups were compared on functioning and symptoms. Findings indicated that those who were older with a longer illness duration had significantly higher levels of mental health functioning than those who were younger with a shorter or longer illness duration and the older group with a shorter illness duration. The results suggest that older patients with an illness duration of over 10 years have significantly higher levels of mental health functioning than the three other groups. For symptoms, the younger/longer illness duration group had significantly worse immune and autonomic domains than the older/longer illness group. In addition, the younger patients with a longer illness duration displayed greater autonomic and immune symptoms in comparison to the older group with a longer illness duration. These findings suggest that both age and illness duration need to be considered when trying to understand the influence of these factors on patients.

Functional status in patients with medically unexplained physical symptoms: Coping styles and their relationship with depression and anxiety

This study examined how coping styles are related to functional status in patients with medically unexplained physical symptoms and to what extent depression and anxiety account for this relationship. In 90 Dutch adult patients presenting medically unexplained physical symptoms, coping styles, health-related functional status, anxiety, and depression were measured. Multiple regression analyses and mediation analysis showed that coping styles were directly and indirectly related to functional status. In this relationship, depression and anxiety played an important role. The findings highlight the relevance of addressing coping styles, depression, and anxiety when targeting the functional status of patients with medically unexplained physical symptoms in clinical practice.

Depressive symptom trajectories during and after adjuvant treatment for breast cancer

BACKGROUND

The course of depressive symptoms during and after breast cancer treatment is not well understood.

PURPOSE

We identified patient subgroups based on distinct trajectories of depressive symptoms and determined whether subgroups could be distinguished by personal characteristics and coping strategies.

METHODS

Breast cancer patients completed the Center for Epidemiologic Studies-Depression Scale on clinically meaningful occasions and during the posttreatment period. The Illness Management Questionnaire was completed prior to treatment.

RESULTS

A three-class mixture model provided the best fit to the data. Subgroup membership was significantly (p < .05) associated with marital status, history of depression, and focusing on symptoms. In multivariate analysis, marital status and focusing on symptoms remained significant (p < .05) predictors of subgroup membership.

CONCLUSIONS

Distinct trajectories can be identified during and after adjuvant breast cancer therapy. Predictors of these trajectories have implications for addressing depressive symptoms in this clinical population and for future research.

Metabolism in chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is a poorly understood condition that presents as long-term physical and mental fatigue with associated symptoms of pain and sensitivity across a broad range of systems in the body. The poor understanding of the disorder comes from the varying clinical diagnostic definitions as well as the broad array of body systems from which its symptoms present. Studies on metabolism and CFS suggest irregularities in energy metabolism, amino acid metabolism, nucleotide metabolism, nitrogen metabolism, hormone metabolism, and oxidative stress metabolism. The overwhelming body of evidence suggests an oxidative environment with the minimal utilization of mitochondria for efficient energy production. This is coupled with a reduced excretion of amino acids and nitrogen in general. Metabolomics is a developing field that studies metabolism within a living system under varying conditions of stimuli. Through its development, there has been the optimisation of techniques to do large-scale hypothesis-generating untargeted studies as well as hypothesis-testing targeted studies. These techniques are introduced and show an important future direction for research into complex illnesses such as CFS.

Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program

Background

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term, debilitating condition that impacts numerous areas of individuals’ lives. The two predominant treatment options for ME/CFS are cognitive behavioral therapy and graded exercise therapy; however, many people have found these techniques unacceptable or even damaging. This pilot study aimed to evaluate the utility of a specialized online symptom management program for ME/CFS in comparison to an online meditation program in an effort to ascertain whether this tool could be a further option for those with ME/CFS.

Methods

This experimental design consisted of two interventions: a specialized online symptoms management program (N=19) and a control intervention based on an online meditation website (N=9). A battery of questionnaires, including measures of multidimensional fatigue, illness-specific symptoms, perceived control, and mindful awareness, were completed before the participants commenced use of the programs and following 8 weeks’ use.

Results

Significant differences were found in the areas of chance and powerful others’ locus of control, and sleeping difficulties, but not in ME/CFS symptomatology overall.

Conclusion

The specialized online program described in this study warrants further investigation, as it appears to influence perceived control and key ME/CFS symptoms over time.

The status of and future research into Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups

Although Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are used interchangeably, the diagnostic criteria define two distinct clinical entities. Cognitive impairment, (muscle) weakness, circulatory disturbances, marked variability of symptoms, and, above all, post-exertional malaise: a long-lasting increase of symptoms after a minor exertion, are distinctive symptoms of ME. This latter phenomenon separates ME, a neuro-immune illness, from chronic fatigue (syndrome), other disorders and deconditioning. The introduction of the label, but more importantly the diagnostic criteria for CFS have generated much confusion, mostly because chronic fatigue is a subjective and ambiguous notion. CFS was redefined in 1994 into unexplained (persistent or relapsing) chronic fatigue, accompanied by at least four out of eight symptoms, e.g., headaches and unrefreshing sleep. Most of the research into ME and/or CFS in the last decades was based upon the multivalent CFS criteria, which define a heterogeneous patient group. Due to the fact that fatigue and other symptoms are non-discriminative, subjective experiences, research has been hampered. Various authors have questioned the physiological nature of the symptoms and qualified ME/CFS as somatization. However, various typical symptoms can be assessed objectively using standardized methods. Despite subjective and unclear criteria and measures, research has observed specific abnormalities in ME/CFS repetitively, e.g., immunological abnormalities, oxidative and nitrosative stress, neurological anomalies, circulatory deficits and mitochondrial dysfunction. However, to improve future research standards and patient care, it is crucial that patients with post-exertional malaise (ME) and patients without this odd phenomenon are acknowledged as separate clinical entities that the diagnosis of ME and CFS in research and clinical practice is based upon accurate criteria and an objective assessment of characteristic symptoms, as much as possible that well-defined clinical and biological subgroups of ME and CFS patients are investigated in more detail, and that patients are monitored before, during and after interventions with objective measures and biomarkers.

Examining the energy envelope and associated symptom patterns in chronic fatigue syndrome: does coping matter?

OBJECTIVE/Hypothesis The objective of this study was to examine sub-types of individuals with chronic fatigue syndrome based on variables that are associated with the energy envelope theory and to examine the role of coping strategies in explaining the differences found between the subtypes. METHODS Cluster analysis was used. Grouping variables included physical functioning, post-exertional malaise severity, and the extent to which an individual was outside of the energy envelope. These clusters were evaluated using discriminant function analysis to determine whether they could be differentiated based on coping styles. RESULTS Cluster analysis identified three groups. Clusters 1 and 2 were consistent with the energy envelope theory. However, Cluster 3 was characterized by patients with the most impairment, but they were to a lesser extent exceeding their energy envelope. Coping strategies explained a small percentage (10%) of the variance in differentiating the clusters. DISCUSSION Energy maintenance may be associated with improved functioning and less severe symptoms for some. However, patients in Cluster 3 were closer to remaining within their energy envelope and also used higher levels of adaptive coping but were more impaired than Cluster 2. This suggests that adaptive coping strategies were not associated with improved health, as members of Cluster 3 were severely limited in functioning.

An approach to persons with chronic fatigue syndrome based on the model of human occupation: part one, impact on occupational performance and participation

Chronic fatigue syndrome (CFS) is a prevalent and disabling condition that involves six or more months of unexplained fatigue severe enough to interfere with previous levels of occupational, educational, and/or social performance. The fatigue is accompanied by at least four of eight additional physical and cognitive symptoms (Fukuda et al., 1994). This paper conceptualizes the multiple factors that affect occupational adaptation in persons with CFS. The Model of Human Occupation (MOHO) if used as a framework for understanding the synergistic and evolving relationships between motivation, roles, habits, performance capacities, and the environment as they influence individuals with CFS. Examples from the literature, autobiographical accounts, and from practice experience are used to illustrate the experience and impact of CFS on everyday life.

Metacognitive factors in chronic fatigue syndrome

Chronic fatigue syndrome (CFS), which is characterized by fatigue and flu-like symptoms that are not alleviated by rest, is a poorly understood condition and an often controversial diagnosis. Earlier research has indicated that general metacognitions are associated with the severity of symptoms in patients with CFS. In the current study, we aimed to determine whether specific metacognitive factors are implicated in CFS. Using the metacognitive profiling interview template we investigated the following: (1) whether patients held positive or negative metacognitions about conceptual processes; (2) what their goals with respect to engaging in these processes were; and (3) what indicated that it was appropriate to stop. We also examined attention focus when experiencing CFS symptoms, and its advantages and disadvantages. Results showed that patients endorsed positive and negative metacognitions pertaining to conceptual processes. The goals of engaging in these processes were to identify the cause of, and devise strategies to cope with, symptoms. Patients were either unable to identify a stop signal for conceptual processing or identified an improvement in fatigue-related symptoms as representing the stop signal. Finally, patients reported that their attention focus when experiencing symptoms included distraction and monitoring of symptoms. Advantages to these strategies included symptom management, whereas disadvantages included an escalation of negative affect. The present findings provide preliminary evidence that specific metacognitive factors may be involved in CFS.

KEY PRACTITIONER MESSAGE

Metacognitive profiling that may aid assessment and conceptualisation of psychological distress in CFS.

Metacognitions and negative emotions as predictors of symptom severity in chronic fatigue syndrome

OBJECTIVE

Chronic fatigue syndrome (CFS) describes a condition that is primarily characterized by fatigue and flu-like symptoms that are not alleviated by rest. This study investigated the relationship among metacognitions, negative emotions, and symptom severity in CFS.

METHODS

A total of 96 patients who had received a diagnosis of CFS according to the Oxford Criteria completed a battery of self-report measures that consisted of the Depression Anxiety Stress Scales, the 30-Item Metacognitions Questionnaire, the Chalder Fatigue Questionnaire (CFQ), and the RAND 36-Item Short-Form Health Survey-Physical Functioning.

RESULTS

Correlation analyses showed that negative emotions and metacognitions were positively correlated with measures of symptom severity and that metacognitions were a better predictor of symptom severity than anxiety and depression. Hierarchical regression analyses indicated that (1) lack of cognitive confidence predicted both mental and physical factors of the CFQ and physical functioning independently of negative emotions and (2) beliefs about the need to control thoughts predicted the mental factor of the CFQ independently of negative emotions and lack of cognitive confidence.

CONCLUSION

The data support the potential application of the metacognitive model of psychological disorder to understanding CFS.

Differential effects of self-efficacy and perceived control on intention to perform skin cancer-related health behaviours

Previous research using the Theory of Planned Behaviour (TPB) for predicting skin cancer-related health behaviours has not adequately incorporated empirical advances in the conceptualization of the perceived behavioural control (PBC) component of the theory. This study examined the role of self-efficacy and controllability for predicting sunscreen and sunbed use intentions. Five hundred and ninety young adults completed a questionnaire on beliefs and intentions regarding sunscreen and sunbed use. Analysis using confirmatory factor analysis and multiple regression supported a conceptual distinction between two PBC subcomponents: controllability and self-efficacy. While self-efficacy--but not controllability--emerged as a significant predictor of intentions to use sunscreen, the opposite pattern was observed for the prediction of intentions to use sunbeds, whereby lower controllability beliefs were associated with higher intentions. Campaigns aimed at influencing health behaviours should consider the differential effects of the components of perceived control.

Personality and perfectionism in chronic fatigue syndrome: a closer look

OBJECTIVE

To test the hypothesis that people with chronic fatigue syndrome (CFS) would differ significantly from a healthy control group on measures of general personality and perfectionism, specifically on measures of neuroticism and unhealthy perfectionism.

METHOD

A total of 27 female CFS outpatients and 30 female healthy controls completed questionnaires, including the NEO Personality Inventory-Revised, the Multi-dimensional Perfectionism Scale and measures of anxiety and depression.

RESULTS

The CFS group was significantly more fatigued, anxious and depressed than healthy controls. They scored significantly higher on neuroticism and unhealthy perfectionism. Healthy and unhealthy perfectionism were positively correlated in the CFS group, but not in the control group.

CONCLUSION

The present study confirms the link between neuroticism and fatigue and finds a link between unhealthy perfectionism and fatigue. A 'healthy trait', such as healthy perfectionism, when coupled with evaluative concerns is not necessarily healthy in a fatigued population. Researchers and clinicians should note the context in which apparently benign traits are expressed, and how they interact with other traits.

Illness trajectories in the chronic fatigue syndrome: a longitudinal study of improvers versus non-improvers

The natural progression of chronic fatigue syndrome (CFS) in adults is not well established. The aims of this longitudinal study were to (a) compare CFS Improvers and Non-Improvers; (b) determine whether an initial diagnosis of fibromyalgia (FM) was associated with CFS nonimprovement; and (c) determine whether this effect could be explained by the presence of nonspecific physical symptoms. Consecutive referrals to a tertiary clinic that satisfied case criteria for CFS were invited to enroll in a longitudinal study. After an initial on-site physical examination and psychiatric interview, a total of 94 female care-seekers completed biannual telephone surveys, including the Short Form-36 physical functioning (PF) scale, over a period of 2(1/2) years. There were very few differences between Improvers and Non-Improvers at baseline but at final assessment Improvers had less disability, less fatigue, lower levels of pain, fewer symptoms of depressed mood, and fewer nonspecific physical complaints. Participants with FM at baseline were 3.23 times (p < 0.05) more likely to become Non-Improvers than those without FM. Participants identified initially as Somatizers were 3.33 times (p < 0.05) more likely to become Non-Improvers. Patients with CFS who bear the added burden of FM are at greater risk of a negative outcome than patients with CFS alone. This effect could not be explained by the presence of multiple, nonspecific symptoms.

The central role of cognitive processes in the perpetuation of chronic fatigue syndrome

OBJECTIVE

Chronic fatigue syndrome (CFS) is considered to be one of the functional somatic syndromes (FSS). Cognitions and behavior are thought to perpetuate the symptoms of CFS. Behavioral interventions based on the existing models of perpetuating factors are quite successful in reducing fatigue and disabilities. The evidence is reviewed that cognitive processes, particularly those that determine the perception of fatigue and its effect on behavior, play a central role in the maintenance of symptoms.

METHOD

Narrative review.

RESULTS

Findings from treatment studies suggest that cognitive factors mediate the positive effect of behavioral interventions on fatigue. Increased fitness or increased physical activity does not seem to mediate the treatment response. Additional evidence for the role of cognitive processes is found in studies comparing the subjective beliefs patients have of their functioning with their actual performance and in neurobiological research.

CONCLUSION

Three different cognitive processes may play a role in the perpetuation of CFS symptoms. The first is a general cognitive representation in which fatigue is perceived as something negative and aversive and CFS is seen as an illness that is difficult to influence. The second process involved is the focusing on fatigue. The third element is formed by specific dysfunctional beliefs about activity and fatigue.

Stress and coping styles are associated with severe fatigue in medical students

Fatigue is a common complaint among medical students and researchers consider it to be related to poor academic outcomes. The authors' goal in the present study was to determine whether stress and coping strategies were associated with fatigue in medical students. The study group consisted of 73 second-year healthy students attending the Osaka City University Graduate School of Medicine. Participants completed a questionnaire about fatigue (Japanese version of Chalder Fatigue Scale), stress, stress coping (Japanese version of the Coping Inventory for Stressful Situations), overwork, and nocturnal sleeping hours. On univariate and multivariate logistic regression analyses adjusted for age and gender, stress was positively associated with fatigue. In addition, after adjustment for age, gender, and emotion- and task-oriented stress coping activities, avoidance-oriented stress coping activity was associated with fatigue. The results suggest that stress and the coping style are correlated with fatigue in medical students.

Learning to cope with chronic illness. Efficacy of a multi-component treatment for people with chronic fatigue syndrome

OBJECTIVE

The aim of this study was to determine the efficacy of an out-patient, multi-component programme developed for patients with chronic fatigue syndrome (CFS).

METHODS

Twenty-two patients were assessed before and after six months of treatment. Findings were compared with 22 individuals on the waiting list. The programme offered medical care as well as information and counselling to help patients to understand, accept and cope with their illness.

RESULTS

At six months, there were significant differences between the groups for fatigue, self-efficacy and anxiety. Overall, 82% of the treated patients reported feeling better and 23% had improved to such a degree that they were discharged from the clinic. The gains were maintained at twelve months.

CONCLUSION

This programme was found to be both helpful and acceptable and may provide a useful first-line intervention for many patients with CFS.

PRACTICE IMPLICATIONS

Short, pragmatic programmes may be as effective as cognitive-behaviour therapy.

Neuropsychological functioning, illness perception, mood and quality of life in chronic fatigue syndrome, autoimmune thyroid disease and healthy participants

BACKGROUND

This study attempted to longitudinally investigate neuropsychological function, illness representations, self-esteem, mood and quality of life (QoL) in individuals with chronic fatigue syndrome (CFS) and compared them with both healthy participants and a clinical comparison group of individuals with autoimmune thyroid disease (AITD).

METHOD

Neuropsychological evaluation was administered at two time points, five weeks apart. Twenty-one individuals with CFS, 20 individuals with AITD and 21 healthy participants were matched for age, pre-morbid intelligence, education level and socio-economic status (SES). All groups also completed measures of illness perceptions, mood, self-esteem and QoL at both time points.

RESULTS

The CFS group showed significantly greater impairment on measures of immediate and delayed memory, attention and visuo-constructional ability, and reported significantly higher levels of anxiety and depression. After controlling for the effects of mood, the CFS group still demonstrated significant impairment in attention. The CFS group also reported significantly lower self-reported QoL than the AITD and healthy participants. In terms of illness perceptions, the AITD group believed that their condition would last longer, that they had more treatment control over their condition, and reported less concern than the CFS group.

CONCLUSIONS

These results suggest that the primary cognitive impairment in CFS is attention and that this is not secondary to affective status. The lower treatment control perceptions and greater illness concerns that CFS patients report may be causally related to their affective status.

Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults

Widespread pain and chronic fatigue are common in the general population. Previous research has demonstrated co-occurrence of syndromes that are associated with pain and fatigue (fibromyalgia and chronic fatigue syndrome), but there is limited existing data on the co-occurrence of these symptoms in general. This study investigates the co-occurrence of pain and fatigue, and characterises people with these symptoms individually, and in combination. A postal questionnaire was sent to a random sample of 4741 community dwelling Dutch adults registered with five general practices. There were 2447 participants (adjusted response=53.5%). Persistent fatigue was reported by 60% of the 451 subjects with chronic widespread pain. Chronic widespread pain was reported by 33% of the 809 responders with persistent fatigue. Anxiety and depression were more common in subjects who reported both symptoms than those who reported either one or neither. Participants who had chronic disease, high body mass index, low activity levels or did not perceive ability to influence health had higher adjusted odds of reporting both symptoms (but not one alone) than subjects not having these characteristics. Pain and fatigue occur more often than would be expected by chance and there are a number of reasons for this. Clinicians should be aware that co-occurrence of the symptoms is common, especially in people who have high BMI or chronic disease, and that people with both symptoms are often anxious or depressed. Further work should address longitudinal associations of pain and fatigue.

The Japanese version of the Coping Orientation to Problems Experienced: a study of Japanese schoolteachers

To investigate the internal consistency reliability and three types of validity of the Coping Orientation to Problems Experienced (COPE), a survey was conducted among 209 English schoolteachers in Japan. The Japanese version of the COPE Inventory was developed through a back-translation process. Cronbach coefficients alpha for the Japanese version were above .70 for all subscales except five, including Acceptance and Restraint, so internal consistencies for these five were insufficient. Goodness of fit indexes for a confirmatory factor analysis were acceptable except for the Comparative Fit Index. Scores on COPE subscales were significantly correlated with scores on other tests (29 of 75 correlations were in the expected directions). Further exploration is required for several subscales and for generalization to Japanese-speaking populations in careers other than teaching to ensure the Japanese version of the COPE will be useful in assessing coping strategies. Given the limitations, present data for Japanese teachers are encouraging.

Longitudinal change in chronic fatigue syndrome: what home-based assessments reveal

The purpose of this 2-year prospective study was to compare standard self-report and ecologically-based outcome measures in patients with chronic fatigue syndrome (CFS). Standard measures assessed physical function, fatigue impact, psychological variables, and global impression of change ratings. Ecological measures included actigraphy, a structured activity record, and an electronic fatigue/energy diary. Results for this high functioning sample (N = 75) revealed that self-report global improvement was significantly associated with lower momentary fatigue and fatigue impact, and a higher frequency of standing up (at home), but not with actigraphy or psychological variables. However, actigraphy change was significantly correlated with change in self-report physical function. At follow-up, only a small minority (<20%) scored in the healthy adult range for fatigue impact and physical function. The findings suggest that home-based measures of symptom severity and physical functioning may provide evidence of change (or lack of change) that is important for interpreting standard self-report outcomes in CFS.

Efficacy of an Emotion-Focused Treatment for Prolonged Fatigue

Previous research findings have suggested a relationship between less adaptive emotional functioning and fatigue. The present study used a research design involving multiple baselines across participants to evaluate the efficacy of a new emotion-focused treatment for prolonged fatigue delivered in a cognitive behavioral therapy framework. The 13 adults participating in the study met the criteria for prolonged fatigue and provided fatigue baselines of 2, 5, or 8 weeks. The results indicated that the treatment was effective, with fatigue severity levels after the initiation of treatment significantly lower than that predicted by baseline patterns, as determined by the split median method of trend estimation. At 3—4 months after treatment, 8 of 11 clients who completed the treatment no longer met the criteria for prolonged fatigue.

Memory for fatigue in chronic fatigue syndrome: relationships to fatigue variability, catastrophizing, and negative affect

Fatigue in chronic fatigue syndrome (CFS) is usually assessed with retrospective measures rather than real-time momentary symptom assessments. In this study, the authors hypothesized that in participants with CFS, discrepancies between recalled and momentary fatigue would be related to catastrophizing, anxiety, and depression and to variability of momentary fatigue. They also expected that catastrophizing, anxiety, and depression would be associated with momentary fatigue. The authors asked 53 adults with CFS to carry electronic diaries for 3 weeks and record their experiences of momentary fatigue. The authors assessed participants' fatigue recall with weekly ratings and administered questionnaires for catastrophizing, depression, and anxiety. Recall discrepancy was significantly related to the variability of momentary fatigue. In addition, catastrophizing, depression, and momentary fatigue were all significantly related to recall discrepancy. Catastrophizing, depression, anxiety, and momentary negative affect were all significantly associated with momentary fatigue. The findings suggest that momentary fatigue in patients with CFS is related to modifiable psychological factors.

Psychological, lifestyle and coping contributors to chronic fatigue in shift-worker nurses

AIM

This paper is a report of a study to assess the following in shift-worker nurses: (1) the relationships amongst chronic fatigue and psychological variables including anxiety, mood and locus of control; (2) the relationships amongst chronic fatigue and a number of lifestyle factors such as shiftwork, sleep and exercise; and (3) various coping behaviours that best predict chronic fatigue.

BACKGROUND

In the shift-working population, individual psychological, lifestyle and coping differences influence fatigue levels. However, some of these factors are somewhat unexplored and their relative contribution to fatigue remains poorly understood. Methods. An exploratory design was adopted with 111 eldercare shift-worker nurses. Data were collected during 2006. Nurses completed self-administered questionnaires examining fatigue, anxiety, mood disturbance, locus of control, sleep, work, lifestyle and coping characteristics.

FINDINGS

Multiple regressions showed that mood disturbance, locus of control and trait anxiety are statistically significant predictors of chronic fatigue. Poor sleep quality was the lifestyle factor which most strongly contributed to fatigue. Other lifestyle predictors included higher workload perception, lack of exercise and the non-availability of support. Whilst problem-focused coping behaviours were not associated with fatigue, coping by using alcohol, letting emotions out and avoiding the situation significantly predicted chronic fatigue.

CONCLUSION

The challenge for improving the fatigue outcomes requires further investigation of the profile of a nurse who is at a high risk of fatigue, and then integrating this profile into a fatigue management programme which considers relative contributions of the psychological, lifestyle and coping factors.

Alexithymia in chronic fatigue syndrome: associations with momentary, recall, and retrospective measures of somatic complaints and emotions

OBJECTIVE

The relationship between alexithymia and real-time momentary symptom assessments has not been reported. This cross-sectional study hypothesized that alexithymia would be a predictor of somatic symptoms using three different types of symptom measurement (momentary, recall, and retrospective) in the medically unexplained illness of chronic fatigue syndrome (CFS). In addition, it was hypothesized that negative affect would be a significant mediator of the relationship between alexithymia and somatic symptoms. Finally, the relation of alexithymia to physical illness attribution (a CFS illness predictor) was explored.

METHODS

Participants were 111 adults with CFS. Alexithymia was assessed with the Toronto Alexithymia Scale. Momentary ratings of current symptoms and affect were recorded in electronic diaries carried for 3 weeks. Weekly recall of these momentary reports was also recorded. Retrospective measures included 6-month ratings of fatigue and pain, the Fatigue Severity Scale, the Brief Pain Inventory-Short Form, a CFS symptom measure, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and an illness attribution rating.

RESULTS

Partial correlations, controlling for age and sex, yielded no significant associations between general or specific forms of alexithymia and momentary ratings of fatigue or pain. On the other hand, a significant association, partially mediated by anxiety scores, was found between a specific form of alexithymia and a retrospective pain measure. Finally, physical illness attribution was not significantly associated with alexithymia.

CONCLUSION

Based on assessments of real-time and retrospectively measured symptoms, these data provided only modest support for the alexithymia construct as a predictor of somatic symptoms in people with CFS.

Well-being in patients with chronic fatigue syndrome: the role of acceptance

OBJECTIVE

Research in chronic pain patients has shown that accepting the chronic nature of their illness is positively related to quality of life. The aim of this study was to investigate whether acceptance is also associated with better well-being in patients suffering from chronic fatigue syndrome (CFS).

METHODS

Ninety-seven patients completed a battery of questionnaires measuring fatigue, functional impairment, psychological distress, and acceptance.

RESULTS

Results indicated that acceptance has a positive effect upon fatigue and psychological aspects of well-being. More specifically, acceptance was related to more emotional stability and less psychological distress, beyond the effects of demographic variables, and fatigue severity.

CONCLUSION

We suggest that promoting acceptance in patients with CFS may often be more beneficial than trying to control largely uncontrollable symptoms.

Psychological Correlates of Quality of Life in Atrial Fibrillation

OBJECTIVE

Atrial fibrillation (AF) is associated with significant health-related quality of life (QoL) impairments. Markers of heart disease severity have explained little variance in QoL and it is unclear what other factors will better account for the observed differences in adjustment. We examined whether specific personality traits and illness management styles would help explain the severity of QoL impairments reported in this population.

METHODS

Patients with AF (N = 93) completed validated questionnaires measuring disease burden (dependent variables: physical and mental QoL, symptom severity, psychological distress), personality (independent variables: anxiety sensitivity, optimism), and illness management style (mediating variable: symptom preoccupation). Hypothesized relationships were evaluated using mediation models.

RESULTS

Anxiety sensitivity was associated with poorer physical and mental QoL, greater symptom severity, and higher distress. Optimism was correlated with better mental QoL and lower distress, but unrelated to physical QoL and symptom severity. Symptom preoccupation significantly mediated the relationships between anxiety sensitivity and each of the QoL measures, as well as the relationships between optimism and mental well-being.

CONCLUSIONS

Personality traits and illness management styles are important to consider when assessing the impact of AF on QoL. The data support a cognitive-behavioral model that explains the direct and indirect relationships between psychological predictors and multiple indices of QoL.

Direct and indirect relationships between emotional intelligence and subjective fatigue in university students

OBJECTIVE

The aim of this study was to examine the direct and indirect relationships between emotional intelligence and subjective fatigue.

METHODS

One hundred sixty seven university students completed questionnaires assessing subjective fatigue, emotional intelligence, and a range of other psychosocial factors. A series of regression analyses were used to examine the direct and indirect relationships between subjective fatigue and psychosocial factors.

RESULTS

Higher emotional intelligence was associated with less fatigue. The psychosocial variables depression, anxiety, optimism, internal health locus of control, amount of social support, and satisfaction with social support each partially mediated between emotional intelligence and fatigue. Additionally, sleep quality partially mediated between emotional intelligence and fatigue.

CONCLUSION

These findings regarding the association between subjective fatigue, emotional intelligence, and other psychosocial factors may facilitate an understanding of the aetiology of fatigue and contribute to future research examining interventions aimed at helping individuals cope with fatigue.

Coping styles in people with chronic fatigue syndrome identified from the general population of Wichita, KS

OBJECTIVE

Studies of primary and tertiary care patients suggest that maladaptive coping styles contribute to the pathogenesis and maintenance of chronic fatigue syndrome (CFS). We assessed coping styles in persons with unexplained fatigue and nonfatigued controls in a population-based study.

METHODS

We enrolled 43 subjects meeting the 1994 Research Case Definition of CFS, matching them with 61 subjects with chronic unexplained fatigue who did not meet criteria for CFS [we term them insufficient symptoms or fatigue (ISF)] and 60 non-ill (NI) controls. Coping styles and clinical features of CFS were assessed using standard rating scales.

RESULTS

Subjects with CFS and ISF reported significantly more escape-avoiding behavior than NI controls. There were no differences between the CFS and ISF subjects. Among participants with CFS, escape-avoiding behavior was associated with fatigue severity, pain, and disability.

CONCLUSIONS

We demonstrate significantly higher reporting of maladaptive coping in a population-based sample of people with CFS and other unexplained fatiguing illnesses defined by reproducible standardized clinical empirical means in comparison to NI controls.

Secondary control reviewed and defined

Conclusions about secondary control have been hindered by researchers' disparate interpretations of the construct. The current review offers a definition that reflects commonality among researchers and the spirit of the original article (F. Rothbaum, J. R. Weisz, & S. S. Snyder, 1982): Secondary control refers to the process by which people adjust some aspect of the self and accept circumstances as they are. The authors also identify a "fit versus control" dimension, along which secondary control research can be classified and reviewed. The authors conclude that fit-focused secondary control is adaptive for coping, is relatively preferred in interdependent cultural contexts, and may serve the motivation for relatedness. Control-focused definitions lead to different interpretations of the function and cultural nature of secondary control. The proposed definition and dimension should enable researchers to articulate assumptions about the function and correlates of secondary control.

Poststroke fatigue: course and its relation to personal and stroke-related factors

OBJECTIVES

To describe the course of fatigue during the first year poststroke and to determine the relation between fatigue at 1 year poststroke and personal characteristics, stroke characteristics, and poststroke impairments.

DESIGN

Inception cohort.

SETTING

Rehabilitation center.

PARTICIPANTS

Patients (N=167) with a first-ever supratentorial stroke admitted for inpatient rehabilitation.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The Fatigue Severity Scale measured the presence and impact of fatigue at admittance for inpatient rehabilitation, as well as at 6 months and 1 year poststroke.

RESULTS

At admission, 6 months and 1 year poststroke, fatigue was present in 51.5%, 64.1%, and 69.5% of the patients, respectively. Fatigue impact 1 year poststroke was greater among patients with more depressive symptoms, higher age, women, and patients with a locus of control more directed to powerful others.

CONCLUSIONS

Because fatigue impact is an increasing problem during the first year poststroke, it deserves more attention in clinical practice and scientific research. Locus of control and depression are related to poststroke fatigue and might be important foci for future interventions.

Chronic Fatigue Syndrome: An Evaluation of a Community Based Management Programme for Adolescents and their Families

BACKGROUND

  Young people with chronic fatigue syndrome (CFS), families and clinicians may differ in their attributions about CFS and consequently in their approach to treatment. Research that clarifies the best treatment approaches is clearly needed. We have sought to develop a model that engages young people and their families in a collaborative way. The approach adopts an optimistic and holistic stance using an active rehabilitation model paying attention to the integrated nature of the physiological and psychological aspects of the illness.

METHOD

  This small study set out to evaluate this approach from a service user perspective. Semi-structured interviews were carried out with young people and their parents separately in order to elicit their views on key treatment elements and their perceived degree of recovery.

RESULTS

  Improvements are indicated in all key areas addressed and qualitative information suggests that families value this approach.

CONCLUSION

  Further research is needed to address treatment issues for families who choose not to opt into the service model.

Relationship of problem-focused coping strategies to changes in quality of life following treatment for early stage breast cancer

This study examined whether problem-focused coping strategies used by early stage breast cancer patients at the end of treatment could predict changes in quality of life six months later. One hundred forty-six women completed measures of problem-focused coping and quality of life at the end of early stage breast cancer treatment. Quality of life was reassessed six months later. Women who focused more on their symptoms at treatment end experienced less physical and mental quality-of-life improvement six months later. Women more likely to seek out information about their illness experienced greater physical quality-of-life improvement. The relationship of focusing on symptoms with quality of life was broad-based; the relationship of information seeking with quality of life was limited to improvements in physical functioning. Results suggest that focusing on symptoms is a maladaptive approach to illness, but that information seeking may yield benefits to physical recovery.

A randomized controlled graded exercise trial for chronic fatigue syndrome: outcomes and mechanisms of change

The aim of this study was to investigate the potential mechanisms underlying the efficacy of graded exercise therapy for chronic fatigue syndrome (CFS). Forty-nine CFS patients were randomized to a 12-week graded exercise programme or to standard medical care. At the end of treatment the exercise group rated themselves as significantly more improved and less fatigued than the control group. A decrease in symptom focusing rather than an increase in fitness mediated the treatment effect. Graded exercise appears to be an effective treatment for CFS and it operates in part by reducing the degree to which patients focus on their symptoms.