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Jacobsen SA, Frostholm L, Buhmann CB, Petersen MW, Ørnbøl E, Dantoft TM, Bjerregaard AA, Eplov LF, Carstensen TBW. Are Sexual Assaults Related to Functional Somatic Disorders? A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6947. [PMID: 37887685 PMCID: PMC10606494 DOI: 10.3390/ijerph20206947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
An increasing number of sexual assaults (SAs) are being reported. This study investigated associations between SA and FSD, conceptualized as bodily distress syndrome (BDS), and five functional somatic syndromes (FSSs): chronic widespread pain (CWP), irritable bowel (IB), chronic fatigue (CF), multiple chemical sensitivity (MCS), and whiplash-associated disorder (WAD). Participants (n = 7493) from the population-based cohort Danish Study of Functional Disorders (DanFunD) completed questionnaires on FSD, emotional distress, SA, and sociodemographics. Risk ratios (RRs) for each FSD and emotional distress were calculated in nine models with SA as the primary exposure using generalized linear models with binomial family and log link and were adjusted for other potential risk factors. The results showed that SA was associated with single-organ FSD (RR = 1.51; 95% CI = 1.22-1.87), multi-organ FSD (RR = 3.51; 95% CI = 1.89-6.49), CWP (RR = 1.28; 95% CI = 0.83-1.98), IB (RR = 2.00; 95% CI = 1.30-3.07), CF (RR = 1.81; 95% CI = 1.42-2.32), WAD (RR = 2.62; 95% CI = 1.37-5.03), MCS (RR = 3.04; 95% CI = 1.79-5.17), emotional distress (RR = 1.75; 95% CI = 1.21-2.54), and health anxiety (RR = 1.65; 95% CI = 1.10-2.46). Overall, SA victims experienced significantly more somatic symptoms than individuals not exposed to SA. Adjusting for physical and emotional abuse did not change the observed associations. Our results suggest a large impact of SA on the overall somatic and mental health of SA victims. Due to the cross-sectional study design, further studies are required.
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Affiliation(s)
- Sofie Abildgaard Jacobsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | | | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, 2000 Frederiksberg, Denmark; (T.M.D.); (A.A.B.)
| | - Anne Ahrendt Bjerregaard
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, 2000 Frederiksberg, Denmark; (T.M.D.); (A.A.B.)
- Department of Epidemiology Research, Statens Serum Institute, 2300 Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health—CORE (Eplov), Mental Health Centre Copenhagen, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
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Abstract
ABSTRACT One prior study suggests that traumatic events before Lyme disease play an important role in symptom severity. We examined this hypothesis among 60 individuals with persistent symptoms after Lyme disease using validated measures of trauma history, mental and physical symptoms, and functional status. Analysis of variance with Tukey-Kramer multiple comparisons test revealed that a greater number of traumatic events were significantly associated with greater symptom severity on the scales of mood (stress, depression, and anxiety), cognition, multisystem symptom burden, and functional status (mental and physical), but not on measures of pain and fatigue. The effect sizes-meaningful but not large (0.17-0.29)-were mostly produced by comparison with individuals reporting multiple prior traumatic events, representing half of the posttreatment Lyme disease syndrome (PTLDS) group. In conclusion, although PTLDS may be exacerbated by past trauma, trauma plays a role in only a subgroup of PTLDS. Whether addressing prior trauma can improve outcomes in this subgroup requires study.
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Reduced Heart Rate Variability in Patients With Medically Unexplained Physical Symptoms: A Meta-Analysis of HF-HRV and RMSSD. Psychosom Med 2021; 83:2-15. [PMID: 33065584 DOI: 10.1097/psy.0000000000000874] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Medically unexplained physical symptoms (MUPS) and related syndromes are common and place a substantial burden on both patients and society. Chronic psychological distress and dysregulation of the autonomic nervous system may be common factors associated with MUPS, although previous studies have reported mixed results. The aims of this meta-analysis are to provide an updated synthesis of studies investigating heart rate variability (HRV) indices associated with autonomic nervous system functioning in three common MUPS syndromes and to explain inconsistencies in previous study findings. METHODS Literature search yielded 58 studies comparing HRV indices of reduced parasympathetic activity of healthy individuals with those of patients with chronic fatigue syndrome (npatients = 271), irritable bowel syndrome (npatients = 1005), and fibromyalgia (npatients = 534). Separate random-effects meta-analyses were conducted on studies measuring root mean square of successive differences (RMSSD) and high-frequency HRV (HF-HRV). RESULTS Regardless of syndrome type, patients had significantly lower RMSSD (k = 22, Hedges g = -0.37 [-0.53 to -0.21], p < .001) and HF-HRV (k = 52, Hedges g = -0.69 [-1.03 to -0.36], p < .001) than did healthy individuals. Sample age and publication year explained a substantial variation in RMSSD, whereas controlling for confounders in statistical analyses explained variation in HF-HRV. CONCLUSIONS Lower RMSSD and HF-HRV in patients with MUPS versus healthy controls indicates that autonomic nervous system dysregulation, particularly lower parasympathetic activity, may play a role in patients with these conditions. This conclusion may have important implications for the underlying mechanisms and treatment of MUPS and related syndromes.
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A logistic regression analysis of risk factors in ME/CFS pathogenesis. BMC Neurol 2019; 19:275. [PMID: 31699051 PMCID: PMC6839177 DOI: 10.1186/s12883-019-1468-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/16/2019] [Indexed: 12/20/2022] Open
Abstract
Background Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease, whose exact cause remains unclear. A wide range of risk factors has been proposed that helps understanding potential disease pathogenesis. However, there is little consistency for many risk factor associations, thus we undertook an exploratory study of risk factors using data from the UK ME/CFS Biobank participants. We report on risk factor associations in ME/CFS compared with multiple sclerosis participants and healthy controls. Methods This was a cross-sectional study of 269 people with ME/CFS, including 214 with mild/moderate and 55 with severe symptoms, 74 people with multiple sclerosis (MS), and 134 healthy controls, who were recruited from primary and secondary health services. Data were collected from participants using a standardised written questionnaire. Data analyses consisted of univariate and multivariable regression analysis (by levels of proximity to disease onset). Results A history of frequent colds (OR = 8.26, P <= 0.001) and infections (OR = 25.5, P = 0.015) before onset were the strongest factors associated with a higher risk of ME/CFS compared to healthy controls. Being single (OR = 4.41, P <= 0.001), having lower income (OR = 3.71, P <= 0.001), and a family history of anxiety is associated with a higher risk of ME/CFS compared to healthy controls only (OR = 3.77, P < 0.001). History of frequent colds (OR = 6.31, P < 0.001) and infections before disease onset (OR = 5.12, P = 0.005), being single (OR = 3.66, P = 0.003) and having lower income (OR = 3.48, P = 0.001), are associated with a higher risk of ME/CFS than MS. Severe ME/CFS cases were associated with lower age of ME/CFS onset (OR = 0.63, P = 0.022) and a family history of neurological illness (OR = 6.1, P = 0.001). Conclusions Notable differences in risk profiles were found between ME/CFS and healthy controls, ME/CFS and MS, and mild-moderate and severe ME/CFS. However, we found some commensurate overlap in risk associations between all cohorts. The most notable difference between ME/CFS and MS in our study is a history of recent infection prior to disease onset. Even recognising that our results are limited by the choice of factors we selected to investigate, our findings are consistent with the increasing body of evidence that has been published about the potential role of infections in the pathogenesis of ME/CFS, including common colds/flu.
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Clark JE, Davidson SL, Maclachlan L, Newton JL, Watson S. Rethinking childhood adversity in chronic fatigue syndrome. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2017; 6:20-29. [PMID: 29392095 PMCID: PMC5774185 DOI: 10.1080/21641846.2018.1384095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/20/2017] [Indexed: 11/23/2022]
Abstract
Background: Previous studies have consistently shown increased rates of childhood adversity in chronic fatigue syndrome (CFS). However, such aetiopathogenic studies of CFS are potentially confounded by co-morbidity and misdiagnosis particularly with depression. Purpose: We examined the relationship between rates of childhood adversity using two complimentary approaches (1) a sample of CFS patients who had no lifetime history of depression and (2) a modelling approach. Methods: Childhood trauma questionnaire (CTQ) administered to a sample of 52 participants with chronic fatigue syndrome and 19 controls who did not meet criteria for a psychiatric disorder (confirmed using the Structured Clinical Interview for DSM-IV). Subsequently, Mediation Analysis (Baye’s Rules) was used to establish the risk childhood adversity poses for CFS with and without depression. Results: In a cohort of CFS patients with depression comprehensively excluded, CTQ scores were markedly lower than in all previous studies and, in contrast to these previous studies, not increased compared with healthy controls. Post-hoc analysis showed that CTQ scores correlated with the number of depressive symptoms during the lifetime worst period of low mood. The probability of developing CFS given a history of childhood trauma is 4%, a two-fold increased risk compared to the general population. However, much of this risk is mediated by the concomitant development of major depression. Conclusions: The data suggests that previous studies showing a relationship between childhood adversity and CFS may be attributable to the confounding effects of co-morbid or misdiagnosed depressive disorder. Abbreviations: CFS: Chronic fatigue syndrome; CTQ: Childhood trauma questionnaire; MDD: Major depressive disorder; CA: Childhood adversity; P: Probability
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Affiliation(s)
- James E Clark
- Wolfson Research Unit, Newcastle University, Newcastle, UK
| | | | | | - Julia L Newton
- Newcastle Hospitals, NHS Foundation Trust and Newcastle University, Institute for Cellular Medicine, Newcastle, UK
| | - Stuart Watson
- Wolfson Research Unit, Newcastle University, Newcastle, UK.,NTW NHS Foundation Trust, Newcastle, UK
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Bansal AS. Investigating unexplained fatigue in general practice with a particular focus on CFS/ME. BMC FAMILY PRACTICE 2016; 17:81. [PMID: 27436349 PMCID: PMC4950776 DOI: 10.1186/s12875-016-0493-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/13/2016] [Indexed: 01/23/2023]
Abstract
Unexplained fatigue is not infrequent in the community. It presents a number of challenges to the primary care physician and particularly if the clinical examination and routine investigations are normal. However, while fatigue is a feature of many common illnesses, it is the main problem in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This is a poorly understood condition that is accompanied by several additional symptoms which suggest a subtle multisystem dysfunction. Not infrequently it is complicated by sleep disturbance and alterations in attention, memory and mood. Specialised services for the diagnosis and management of CFS/ME are markedly deficient in the UK and indeed in virtually all countries around the world. However, unexplained fatigue and CFS/ME may be confidently diagnosed on the basis of specific clinical criteria combined with the normality of routine blood tests. The latter include those that assess inflammation, autoimmunity, endocrine dysfunction and gluten sensitivity. Early diagnosis and intervention in general practice will do much to reduce patient anxiety, encourage improvement and prevent expensive unnecessary investigations. There is presently an on-going debate as to the precise criteria that best confirms CFS/ME to the exclusion of other medical and psychiatric/psychological causes of chronic fatigue. There is also some disagreement as to best means of investigating and managing this very challenging condition. Uncertainty here can contribute to patient stress which in some individuals can perpetuate and aggravate symptoms. A simple clinical scoring system and a short list of routine investigations should help discriminate CFS/ME from other causes of continued fatigue.
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Affiliation(s)
- Amolak S Bansal
- Department of Immunology and Allergy, St. Helier Hospital, Carshalton, Surrey, SM5 1AA, UK. .,The Sutton CFS Service, Sutton Hospital, Cotswold Rd, Sutton, SM2 5NF, UK.
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McBeth J, Tomenson B, Chew-Graham C, Macfarlane G, Jackson J, Littlewood A, Creed F. Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue. J Psychosom Res 2015; 79:484-91. [PMID: 26652592 PMCID: PMC4678257 DOI: 10.1016/j.jpsychores.2015.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety. METHODS We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms. RESULTS Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N=93) had unexplained chronic widespread pain and 12.6% (N=125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression. DISCUSSION This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression.
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Affiliation(s)
- J. McBeth
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK,Corresponding author.
| | - B. Tomenson
- Biostatistics Unit, Institute of Population Health, The University of Manchester, Manchester, UK
| | - C.A. Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs, ST5 5BG, UK
| | - G.J. Macfarlane
- Musculoskeletal Research Collaboration (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - J. Jackson
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - A. Littlewood
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
| | - F.H. Creed
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
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Sáez-Francàs N, Calvo N, Alegre J, Castro-Marrero J, Ramírez N, Hernández-Vara J, Casas M. Childhood trauma in Chronic Fatigue Syndrome: focus on personality disorders and psychopathology. Compr Psychiatry 2015; 62:13-9. [PMID: 26343462 DOI: 10.1016/j.comppsych.2015.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 06/01/2015] [Accepted: 06/13/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Personality Disorders (PDs) and childhood traumatic experiences have been considered risk factors for Chronic Fatigue Syndrome (CFS). However, the relationship between these factors and their associated psychopathological impact has not been explored in this population. This study was designed to evaluate the association between different childhood traumas and the presence and number of PDs and current psychopathology in a sample of CFS patients. MATERIAL AND METHODS For this purpose, 166 CFS patients were evaluated with the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Child Trauma Questionnaire. Other instruments were used to assess the associated psychopathology and the impact of fatigue. RESULTS Of the total sample, 55 (33.1%) presented childhood trauma, the most frequent of which were emotional neglect (21.7%) and emotional abuse (18.1%). Considering PD presence, 79 (47.6%) patients presented some PD. There were no differences in frequency of physical childhood trauma in patients with and without PD. However, patients with PD had more frequently experienced emotional childhood trauma (OR=2.18, p=0.034). Severity of childhood trauma was related to a higher number of PDs, more severe depressive symptoms (p=0.025) and suicide risk (p=0.001). Patients with PD and any childhood trauma presented more severe depressive and irritable symptoms and a higher suicide risk than those without any PD and non-childhood traumatic event. These patients' psychopathological symptoms were similar to those of patients with childhood trauma and without PD. CONCLUSIONS These results suggest that emotional childhood trauma but not physical childhood trauma is related to higher frequency of PD presence. More severe childhood emotional and physical traumas are related to a higher number of PDs and to more severe psychopathological symptoms.
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Affiliation(s)
- Naia Sáez-Francàs
- Servei de Psiquiatria, Hospital Sant Rafael, FIDMAG, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 107-117, 08035, Barcelona, Spain.
| | - Natalia Calvo
- Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - José Alegre
- Servei de Medicina Interna, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - Jesús Castro-Marrero
- Servei de Medicina Interna, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - Nicolás Ramírez
- Servei de Psiquiatria, Hospital Sant Rafael, FIDMAG, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 107-117, 08035, Barcelona, Spain.
| | - Jorge Hernández-Vara
- Servei de Neurologia, Hospital Universitari Vall d´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - Miguel Casas
- Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Universitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
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Borsini A, Hepgul N, Mondelli V, Chalder T, Pariante CM. Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research. Psychol Med 2014; 44:1809-1823. [PMID: 24093427 DOI: 10.1017/s0033291713002468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both highly prevalent conditions associated with extreme disability and with the development of co-morbid psychiatric disorders, such as depression and anxiety. Childhood stressors have been shown to induce persistent changes in the function of biological systems potentially relevant to the pathogenesis of both CFS and FM, such as the inflammatory system and the hypothalamic-pituitary-adrenal (HPA) axis. In this review, we examined whether multiple forms of childhood stressors are contributing factors to the development of these disorders, and of the associated psychiatric symptoms. METHOD Using PubMed, we identified 31 papers relevant to this narrative review. We included cohort studies and case-control studies, without any exclusion in terms of age and gender. No study characteristics or publication date restrictions were imposed. RESULTS Most studies across the literature consistently show that there is a strong association between experiences of childhood stressors and the presence of CFS and FM, with rates of CFS/FM being two- to three-fold higher in exposed than in unexposed subjects. We also found evidence for an increased risk for the development of additional symptoms, such as depression, anxiety and pain, in individuals with CFS and FM with a previous history of childhood stressors, compared with individuals with CFS/FM and no such history. CONCLUSIONS Our review confirms that exposure to childhood stressors is associated with the subsequent development of fatigue syndromes such as CFS and FM, and related symptoms. Further studies are needed to identify the mechanisms underlying these associations.
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Affiliation(s)
- A Borsini
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - N Hepgul
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - V Mondelli
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - C M Pariante
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
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Abstract
OBJECTIVE This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship. METHODS Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random-effects model was used to estimate the pooled odds ratio and 95% confidence interval. Planned subgroup analyses and meta-regression examined potential moderators. RESULTS Individuals who reported exposure to trauma were 2.7 (95% confidence interval = 2.27-3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than that with sexual or physical abuse. The association of reported trauma with chronic fatigue syndrome was larger than the association with either irritable bowel syndrome or fibromyalgia. Studies using nonvalidated questionnaires or self-report of trauma reported larger associations than did those using validated questionnaires. CONCLUSIONS Findings are consistent with the hypothesis that traumatic events are associated with an increased prevalence of functional somatic syndromes. The analyses also highlight limitations of the existing literature and emphasize the importance of prospective studies, examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.
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Gotts ZM, Deary V, Newton J, Van der Dussen D, De Roy P, Ellis JG. Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis. BMJ Open 2013; 3:e002999. [PMID: 23794547 PMCID: PMC3669720 DOI: 10.1136/bmjopen-2013-002999] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Despite sleep disturbances being a central complaint in patients with chronic fatigue syndrome (CFS), evidence of objective sleep abnormalities from over 30 studies is inconsistent. The present study aimed to identify whether sleep-specific phenotypes exist in CFS and explore objective characteristics that could differentiate phenotypes, while also being relevant to routine clinical practice. DESIGN A cross-sectional, single-site study. SETTING A fatigue clinic in the Netherlands. PARTICIPANTS A consecutive series of 343 patients meeting the criteria for CFS, according to the Fukuda definition. MEASURES Patients underwent a single night of polysomnography (all-night recording of EEG, electromyography, electrooculography, ECG and respiration) that was hand-scored by a researcher blind to diagnosis and patient history. RESULTS Of the 343 patients, 104 (30.3%) were identified with a Primary Sleep Disorder explaining their diagnosis. A hierarchical cluster analysis on the remaining 239 patients resulted in four sleep phenotypes being identified at saturation. Of the 239 patients, 89.1% met quantitative criteria for at least one objective sleep problem. A one-way analysis of variance confirmed distinct sleep profiles for each sleep phenotype. Relatively longer sleep onset latencies, longer Rapid Eye Movement (REM) latencies and smaller percentages of both stage 2 and REM characterised the first phenotype. The second phenotype was characterised by more frequent arousals per hour. The third phenotype was characterised by a longer Total Sleep Time, shorter REM Latencies, and a higher percentage of REM and lower percentage of wake time. The final phenotype had the shortest Total Sleep Time and the highest percentage of wake time and wake after sleep onset. CONCLUSIONS The results highlight the need to routinely screen for Primary Sleep Disorders in clinical practice and tailor sleep interventions, based on phenotype, to patients presenting with CFS. The results are discussed in terms of matching patients' self-reported sleep to these phenotypes in clinical practice.
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Affiliation(s)
- Zoe M Gotts
- Northumbria Centre for Sleep Research, Department of Psychology, Northumbria University, Newcastle, UK
| | - Vincent Deary
- Northumbria Centre for Sleep Research, Department of Psychology, Northumbria University, Newcastle, UK
| | - Julia Newton
- Institute for Ageing and Health, Newcastle University, Newcastle, UK
| | | | - Pierre De Roy
- Fatigue Service, VermoeidheidCentrum Nederland bv, Lelystad, The Netherlands
| | - Jason G Ellis
- Northumbria Centre for Sleep Research, Department of Psychology, Northumbria University, Newcastle, UK
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The prevalence and impact of early childhood trauma in Chronic Fatigue Syndrome. J Psychiatr Res 2013; 47:664-9. [PMID: 23421962 DOI: 10.1016/j.jpsychires.2013.01.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although some studies have found high rates of early childhood trauma in Chronic Fatigue Syndrome (CFS), the role of early trauma in this condition remains controversial. METHODS This study examined the prevalence of early childhood trauma and its impact on daily fatigue and pain levels over a 14-day period in a sample of 90 carefully screened CFS patients using a diary method approach. Data were analyzed using multilevel analysis. RESULTS More than half of the patients (54.4%) had experienced at least one type of early trauma, with the majority of these patients reporting multiple traumas. Prevalence rates were particularly high for emotional trauma (i.e., emotional abuse and/or emotional neglect) (46.7%). Moreover, total trauma scores and emotional abuse significantly predicted higher levels of daily fatigue and pain over the 14-day period, even when controlling for demographic features and depressed mood. CONCLUSIONS This is the first study to demonstrate that early childhood trauma predicts increasing levels of core symptoms of CFS in the daily flow of life. Moreover, findings of this study suggest that emotional trauma may be particularly important in CFS.
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Abstract
Chronic fatigue syndrome (CFS) is an illness characterized by disabling fatigue of at least 6 months. The aetiology of the condition has been hotly debated. In this chapter the evidence for CFS as a post viral condition and/or a neurological condition is reviewed. Although there is evidence that CFS is triggered by certain viruses in some patients and that neurobiological changes such as hypocortisolism are associated with the syndrome, neither mechanism is sufficient to explain the extent of the symptoms or disability experienced by patients. It is unlikely that CFS can be understood through one aetiological mechanisms. Rather it is a complex illness which is best explained in terms of a multifactorial cognitive behavioural model. This model proposes that CFS is precipitated by life events and/or viral illness in vulnerable individuals, such as those who are genetically predisposed, prone to distress, high achievement, and over or under activity. A self perpetuating cycle where physiological changes, illness beliefs, reduced and inconsistent activity, sleep disturbance, medical uncertainty and lack of guidance interact to maintain symptoms. Treatments based on this model including cognitive behavioural therapy and graded exercise therapy are effective at significantly reducing fatigue and disability in CFS. This chapter provides a description of these approaches and details of the trials conducted in the area.
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Heins MJ, Knoop H, Lobbestael J, Bleijenberg G. Childhood maltreatment and the response to cognitive behavior therapy for chronic fatigue syndrome. J Psychosom Res 2011; 71:404-10. [PMID: 22118383 DOI: 10.1016/j.jpsychores.2011.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/27/2011] [Accepted: 05/10/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the relationship between a history of childhood maltreatment and the treatment response to cognitive behavior therapy for chronic fatigue syndrome (CFS). METHODS A cohort study in a tertiary care clinic with a referred sample of 216 adult patients meeting the Centers for Disease Control and Prevention criteria for CFS, and starting cognitive behavior therapy. Main outcome measures changes between pre- and post therapy in fatigue (Checklist Individual Strength fatigue subscale), disabilities (Sickness Impact Profile total score), physical functioning (short form 36 health survey subscale) and psychological distress (Symptom checklist 90 total score). RESULTS At baseline, patients with a history of childhood maltreatment had significantly more limitations and a higher level of psychological distress, but were not more severely fatigued. Change scores on the outcome measures after cognitive behavior therapy did not differ significantly between patients with or without a history of childhood maltreatment, or between the different types of childhood maltreatment. However, patients with a history of childhood maltreatment still experienced more limitations and a higher level of psychological distress after CBT. CONCLUSIONS A history of childhood maltreatment was not related to the treatment response of cognitive behavior therapy for CFS. In patients with a history of childhood maltreatment CFS symptoms can be treated with CBT just as well as those without.
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Affiliation(s)
- Marianne J Heins
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands.
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Eglinton R, Chung MC. The relationship between posttraumatic stress disorder, illness cognitions, defence styles, fatigue severity and psychological well-being in chronic fatigue syndrome. Psychiatry Res 2011; 188:245-52. [PMID: 21600664 DOI: 10.1016/j.psychres.2011.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/11/2011] [Accepted: 04/12/2011] [Indexed: 11/19/2022]
Abstract
This study investigated, firstly, the rate of posttraumatic stress disorder (PTSD) and the level of psychological well-being amongst people with chronic fatigue syndrome (CFS); and secondly, the extent to which illness cognitions, defence styles and PTSD symptom severity related to fatigue severity and psychological well-being. Seventy-eight participants with a diagnosis of CFS completed the Chalder Fatigue Scale, the General Health Questionnaire-28, the Posttraumatic Stress Diagnostic Scale, the Illness Cognition Questionnaire and the Defence Style Questionnaire. Fifty-nine participants were recruited from the general public to form the non-fatigued control group. CFS participants had significantly higher levels of PTSD symptoms, lower levels of psychological well-being and more traumatic life events compared to the non-fatigued controls. Trauma exposure and PTSD severity both predicted CFS status. However, regression analyses demonstrated no significant relationship between PTSD symptoms and fatigue severity or the degree of psychological well-being. 'Helplessness' predicted both physical and mental fatigue and psychological well-being, whilst the 'mature' defence styles predicted fatigue severity only. The results offer support to previous research showing that the rate of traumatic life events and PTSD are significantly higher amongst the CFS population. The lack of relationship between PTSD symptoms and fatigue severity or psychological well-being indicates that these processes may operate independently of one another, via different appraisal processes. This study focused on fatigue severity, but it may be that the role of pain in CFS is a key element in the previously reported association between PTSD and CFS.
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Affiliation(s)
- Rebekah Eglinton
- Independent Medical and Psychological Services, Taunton, United Kingdom
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Maghout Juratli S, Janisse J, Schwartz K, Arnetz BB. Demographic and lifestyle factors associated with perceived stress in the primary care setting: a MetroNet study. Fam Pract 2011; 28:156-62. [PMID: 21068192 DOI: 10.1093/fampra/cmq091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stress and stress-related disorders are common in primary care. The stress-related needs for patients are often unmet partially due to the time and resource constraints inherent to many primary care settings. We examined the relative significance of key demographic and lifestyle factors related to stress among primary care patients. This information is unknown and needed to strategize these increasingly limited resources. METHODS We distributed surveys to 100 consecutive adult patients in each of four family medicine centres in metropolitan Detroit between 2006 and 2007. Hierarchical multivariable regression analyses were used to assess the relative significance of the demographic and lifestyle factors related to stress. RESULTS Of the 400 distributed surveys, 315 (78.7%) answered a minimum of 70% of the questions and were included in the analysis. The lifestyle factors [exercise, body mass index (BMI), sleep, social support, recovery or self-care skills (such as the ability to rest, relax and recuperate)] explained 39% (P < 0.001) of the variance in stress compared to 10% (P < 0.001) by the demographic factors (age, gender, race, employment, education and marital status). Stress was inversely related to sleep (P < 0.001), recovery (P < 0.001) and social support (P = 0.02) and positively to education (P < 0.001). CONCLUSIONS The modifiable lifestyle factors explained significantly more of perceived stress among primary care patients than the demographic factors. Sleep and recovery had the biggest inverse relationship with stress, which suggests that they should be the primary target for assessment and intervention in patients who report stress or stress-related disorders.
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Affiliation(s)
- Sham Maghout Juratli
- Wayne State University, Department of Family Medicine and Public Health Sciences, Detroit, MI 48201, USA.
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Dhillon K, Boyd KC. The Effect of War Stressors and Life Events on Gulf War Veterans With Chronic Fatigue Syndrome Symptoms. MILITARY PSYCHOLOGY 2010. [DOI: 10.1080/08995601003638892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Johnson SK, Schmaling KB, Dmochowski J, Bernstein D. An investigation of victimization and the clinical course of chronic fatigue syndrome. J Health Psychol 2010; 15:351-61. [DOI: 10.1177/1359105309349453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Medically unexplained syndromes, including chronic fatigue syndrome (CFS), have been associated with victimization in childhood and adulthood. The purpose of this study was to examine the associations of victimization experiences in childhood and adulthood with functional status and illness severity in a sample of patients with CFS using longitudinal data. In the sample of 93 patients with CFS, childhood abuse and neglect had greater impact than adulthood victimization. Overall, victimization experiences in childhood demonstrated modest associations with clinical outcomes in CFS, although several victimization experiences were in the opposite direction of expectations. Victimization predicted worse outcomes, but not worsening outcomes over time.
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Ciccone DS, Weissman L, Natelson BH. Chronic Fatigue Syndrome in Male Gulf War Veterans and Civilians. J Health Psychol 2008; 13:529-36. [DOI: 10.1177/1359105308088525] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Different modes of fatigue onset in male Gulf War veterans versus male civilians raise the possibility that chronic fatigue syndrome (CFS) may not be a single disease entity. We addressed this issue by comparing 45 male veterans with CFS to 84 male civilians who satisfied identical case criteria. All were evaluated for fibromyalgia (FM), multiple chemical sensitivity and psychiatric comorbidity. CFS was more likely to present in a sudden flu-like manner in civilians than veterans ( p < .01) and comorbid FM was more prevalent in civilians ( p < .01). These findings question the assumption that all patients with CFS suffer from the same underlying disorder.
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Romans S, Cohen M. Unexplained and underpowered: the relationship between psychosomatic disorders and interpersonal abuse -- a critical review. Harv Rev Psychiatry 2008; 16:35-54. [PMID: 18306098 DOI: 10.1080/10673220801933788] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although it is commonly accepted that interpersonal violence (IntPV) leads to adverse health consequences, the available data are far from decisive. To test the hypothesized link, the authors devised an evidence-based strategy to determine the data quality in studies purporting to link IntPV and some medically unexplained disorders in women (irritable bowel syndrome, chronic pelvic pain, fibromyalgia/chronic fatigue, and other chronic pain syndromes). English language studies with control groups of unaffected women were assessed for the quality of their methodologies. The number of studies, together with the consistency of their findings in each domain, was collated to determine the overall weight of evidence regarding the link for each condition. The quantity and quality of research in each clinical area proved to be sparse. In general, most research was limited to small, convenience samples, with insufficient attention to the design of control groups and to sample size. The evidence currently available regarding irritable bowel syndrome, fibromyalgia/chronic fatigue, chronic pelvic pain, and other chronic pain syndromes does not allow for any firm conclusion regarding their link to IntPV. More research - paying particular regard to the methodological concerns identified here - is required in order to generate any definitive conclusions.
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Affiliation(s)
- Sarah Romans
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
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Lee B, Solowoniuk J, Fong M. ‘I was Independent since I was Born’: Pre‐Immigration Traumatic Experiences and Pathological Gambling in Four Chinese Canadians. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2007. [DOI: 10.1108/17479894200700011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Deary V, Chalder T, Sharpe M. The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clin Psychol Rev 2007; 27:781-97. [PMID: 17822818 DOI: 10.1016/j.cpr.2007.07.002] [Citation(s) in RCA: 292] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 06/21/2006] [Accepted: 07/13/2006] [Indexed: 10/23/2022]
Abstract
The article is a narrative review of the theoretical standing and empirical evidence for the cognitive behavioural model of medically unexplained symptoms (MUS) in general and for chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS) in particular. A literature search of Medline and Psychinfo from 1966 to the present day was conducted using MUS and related terms as search terms. All relevant articles were reviewed. The search was then limited in stages, by cognitive behavioural therapy (CBT), condition, treatment and type of trial. Evidence was found for genetic, neurological, psychophysiological, immunological, personality, attentional, attributional, affective, behavioural, social and inter-personal factors in the onset and maintenance of MUS. The evidence for the contribution of individual factors, and their autopoietic interaction in MUS (as hypothesised by the cognitive behavioural model) is examined. The evidence from the treatment trials of cognitive behavioural therapy for MUS, CFS and IBS is reviewed as an experimental test of the cognitive behavioural models. We conclude that a broadly conceptualized cognitive behavioural model of MUS suggests a novel and plausible mechanism of symptom generation and has heuristic value. We offer suggestions for further research.
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Affiliation(s)
- V Deary
- Institute of Health and Society, University of Newcastle, 21 Claremont Place, Newcastle Upon Tyne NE2 4AA, UK.
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Igreja V, Kleijn W, Richters A. When the war was over, little changed: women's posttraumatic suffering after the war in Mozambique. J Nerv Ment Dis 2006; 194:502-9. [PMID: 16840846 DOI: 10.1097/01.nmd.0000228505.36302.a3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article explores the psychosocial effects of women's prolonged exposure to civil war in the center of Mozambique. Using a combination of quantitative and qualitative methods, 91 women were assessed for posttraumatic stress symptoms and psychosocial indicators of ill health. The results indicate that for the majority of the women in this study, traumatic experiences are sequential processes. Their ill health ranges from symptoms of posttraumatic stress to episodes of spirit possession (gamba), affecting women's capacities to conceive and raise children, and marginalizing their social position. A careful analysis of the specific problems and needs of women in postwar contexts is recommended, along with a systematic examination of the effectiveness of the available resources that may play a role in boosting trauma recovery in this group of women.
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Affiliation(s)
- Victor Igreja
- Research School of Asian, African, and Amerindian Studies (CNWS), Leiden, The Netherlands
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Brown RF, Schutte NS. Direct and indirect relationships between emotional intelligence and subjective fatigue in university students. J Psychosom Res 2006; 60:585-93. [PMID: 16731233 DOI: 10.1016/j.jpsychores.2006.05.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Rhonda F Brown
- Department of Psychology, University of New England, ARMIDALE NSW 2351, Australia.
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25
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Curtis CE, Jason LA, Olson BD, Ferrari JR. Disordered eating, trauma, and sense of community: examining women in substance abuse recovery homes. Women Health 2005; 41:87-100. [PMID: 16260415 DOI: 10.1300/j013v41n04_05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Women with substance-related disorders are likely to suffer from disordered eating and past traumatic experience, issues that might inhibit the recovery process. The present study determined the prevalence of co-morbidity of disordered eating, trauma, and substance-related disorders among 60 women living in one of 15 mutual help substance abuse recovery homes that establish new social networks for residents. Psychological sense of community was also examined to determine whether residents were able to obtain support that may have previously been absent. Results indicated that women with co-existing disordered eating and substance-related disorders, as well as women who have experienced trauma benefit from democratic, independent-living environments. Implications for treatment and future research are discussed.
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Affiliation(s)
- Carmen E Curtis
- Center for Community Research, DePaul University, Chicago, IL 60614, USA.
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Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C. Chronic fatigue syndrome: the need for subtypes. Neuropsychol Rev 2005; 15:29-58. [PMID: 15929497 DOI: 10.1007/s11065-005-3588-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS' characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.
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Heim C, Bierl C, Nisenbaum R, Wagner D, Reeves WC. Regional prevalence of fatiguing illnesses in the United States before and after the terrorist attacks of September 11, 2001. Psychosom Med 2004; 66:672-8. [PMID: 15385690 DOI: 10.1097/01.psy.0000138116.12495.a2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stress or emotional traumas are considered risk factors for unexplained fatiguing illnesses. From July to December 2001, the Centers for Disease Control and Prevention conducted a multigeographical pilot study to test the feasibility of a survey to estimate the prevalence of fatiguing illnesses in the United States. We used data obtained during this survey to estimate the effect of the coincidentally occurring terrorist attacks of September 11, 2001, on the regional prevalence of fatiguing illnesses. METHODS Identified by random-digit dialing, 2,728 households in eight regional strata were interviewed, and 7,317 respondents were screened for severe fatigue of at least 1 month duration. Identified fatigued people of age 18 to 69 years (N = 440) and a sample of nonfatigued people of the same age range (N = 444) were interviewed in detail concerning fatigue, other symptoms, and medical and psychiatric histories. RESULTS Weighted prevalence estimates based on interviews performed after the attacks were significantly lower compared with estimates based on interviews performed before the attacks (prolonged fatigue: 5,450 vs. 1,530/100,000, p =.010; chronic fatigue: 18,510 vs. 10,070/100,000, p =.002; chronic fatigue syndrome-like illness: 2,510 vs. 960/100,000, p =.014). CONCLUSION Our findings suggest decreased regional prevalence of fatiguing illnesses in the aftermath of the terrorist attacks. The causes of this effect are unknown but might involve acute psychological and physiological adaptations that modify the perception or manifestation of fatigue. Future studies should be specifically designed to scrutinize the relationship between stress and fatiguing illnesses and the mediating mechanisms of such a relationship.
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Affiliation(s)
- Christine Heim
- Division of Viral and Rickettsial Diseases, Viral Exanthems and Herpesvirus Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Hulme PA. Retrospective measurement of childhood sexual abuse: a review of instruments. CHILD MALTREATMENT 2004; 9:201-217. [PMID: 15104889 DOI: 10.1177/1077559504264264] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this comprehensive review of retrospective childhood sexual abuse (CSA) instruments, instruments from studies published between 1986 and 2001 are examined according to administration method, number and specificity of questions, CSA operational definitions, psychometric properties, and the use of scales. It was found that both self-administered and interview instruments range from the vagueness of a single question to the preciseness of multiple, specific questions. Furthermore, the review demonstrated that CSA instruments generally lack standardization. Many are developed for one-time use and others modified when reused. Descriptive CSA instruments have been preferred by researchers and primarily used to measure CSA dichotomously. However, little consensus exists as to how to operationally define CSA. One positive trend is the development of scales that measure CSA as an interval-level variable, allowing for more extensive psychometric data to be collected.
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Affiliation(s)
- Polly A Hulme
- College of Nursing, University of Nebraska Medical Center, Nebraska, USA
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