BMJ 2003;327:654-655 (20 September)
|
|||||||||||
|
|
Paper
Epidemiology of chronic
fatigue syndrome and self reported myalgic encephalomyelitis in 5-15 year olds:
cross sectional study
T
Chalder, reader1, R Goodman, professor2,
S Wessely, professor1, M
Hotopf, reader in psychological medicine1, H
Meltzer, principal survey officer3
1 Department of
Psychological Medicine, Guy's, King's, and St Thomas's School of Medicine,
London SE5 8AZ, 2 Department of Child and Adolescent Psychiatry,
Institute of Psychiatry, London SE5 8AF, 3 Office for National
Statistics, London SW1V 2QQ
Correspondence to: T Chalder sphatrc@iop.kcl.ac.uk
|
|
Introduction |
|
|
Chronic fatigue syndrome is characterised by severe physical and
mental fatigue associated with disability, which by definition markedly
affects people's lives. At one end of the spectrum, newspaper
headlines imply that chronic fatigue syndrome or myalgic encephalomyelitis
in children is of epidemic proportions, whereas at the other end the
existence of the disorder is refuted. Attempts have been made to
assess the size of the problem in the community, general practice,
schools, and secondary care.w1-w5 Methodological problems,
however, such as selection biases and poor response rates make it
difficult to draw conclusions from these studies. We are unaware of
any population studies in the United Kingdom that examine the
prevalence of and factors associated with chronic fatigue syndrome
in children. We determined the prevalence of chronic fatigue,
chronic fatigue syndrome, and reported myalgic encephalomyelitis in
5-15 year olds and examined demographic and psychiatric
associations.
|
|
Methods and results |
|
|
This study was part of a larger study, carried out in 1999 by the
social survey division of the Office for National Statistics to find
out the prevalence of mental disorders in children aged 5-15. A
total of 14 250 families were contacted, 931 (6.5%) opted out, and
790 (5.5%) of addresses were ineligible. Families living in private
households in England, Scotland, and Wales were sampled.1
Altogether 10 438 of 12 529
mothers were asked whether the index child had myalgic
encephalomyelitis or chronic fatigue syndrome and completed the 12
item general health questionnaire.2 The sample for the interview study
consisted of 4240 11-15 year old children identified from this
sample, and they were asked whether they had been feeling more tired
and worn out than usual. If they answered affirmatively the
interviewer asked supplementary questions relating to duration,
effect of fatigue on different aspects of their life, and number and
severity of symptoms. We used the development and wellbeing
assessment to assess psychiatric disorder.3
|
Chronic fatigue was defined
as severe fatigue of at least six months' duration, for which rest
did not help and which led to functional impairment of the child. Chronic
fatigue syndrome was defined according to the criteria of the US
Centers for Disease Control and Prevention (CDC).4
We used logistic regression
to examine associations in terms of odds ratios between independent
and dependent variables. We conducted interviews with 10 438 of 12
529 eligible children. Failed interviews were due to either
non-contact (n = 317) or refusal (n = 1774). The table shows risk
factors for each of the three main outcomes. The risk factors for
chronic fatigue and CDC criteria for chronic fatigue syndrome were
older age and anxiety disorders. Parental report of myalgic
encephalomyelitis or chronic fatigue syndrome was associated with
maternal distress on the general health questionnaire. Female sex
was not a risk factor for any outcomes.
|
|
Comment |
|
|
Symptomatic fatigue in children is common, but chronic fatigue and
chronic fatigue syndrome are relatively rare. The rates of the
syndrome that we report are lower than those found in equivalent
surveys in adults. Cases where children are labelled as having
myalgic encephalomyelitis or chronic fatigue syndrome are even less
common. Given the small numbers, the results obtained in the
subsequent analysis cannot be precise. We found no concordance between
parental labelling that a child had myalgic encephalomyelitis and
operationally defined chronic fatigue syndrome. We found a strong
association between psychiatric disorder and these outcomes, which
is a consistent finding among adults with chronic fatigue syndrome. Maternal
psychological distress was associated with parental report of
myalgic encephalomyelitis or chronic fatigue syndrome, but given the
cross sectional nature of the data it is impossible to determine the
direction of causality.
Additional references w1-w5 appear on bmj.com
We thank all
the families who agreed to take part.
Contributors:
TC did the analysis, wrote the paper, and is the guarantor. RG and
HM designed the study and, with SW and MH, contributed to the
write-up.
Funding:
Department of Health.
Competing
interests: None declared.
Ethical
approval: Ethics committee of the Institute of Psychiatry, King's
College London.
|
|
References |
|
|
- Meltzer H, Gatward R, Goodman
R, Ford T. Mental health of children and adolescents in Great Britain.
London: Stationery Office, 2000.
- Goldberg D. The detection of
psychiatric illness by questionnaire. London:
Oxford University Press, 1972.
- Goodman R, Ford T, Richards H, Garward R,
Meltzer H. The development and well-being assessment: description and
initial validation of an integrated assessment of child and adolescent
psychopathology. J Child Psychol Psychiatry 2000;41: 645-55.[CrossRef][ISI][Medline]
- Fukuda K, Straus S, Hickie I, Sharpe M,
Dobbins J, Komaroff A. The chronic fatigue syndrome: a comprehensive
approach to its definition and study. Ann
Intern Med 1994;121: 953-9.
[Abstract/Free Full Text]
(Accepted July 15, 2003)
This
article has been cited by other articles:
|
|
|
|
|
|
|
|
|
|||||
Rapid Responses:
Read all Rapid Responses
Impact
of CFS in Children
Chris Clark
bmj.com, 19 Sep 2003 [Full text]
Another
shockingly uncontroversial Wessley publication: something must be done!
John F Morgan
bmj.com, 19 Sep 2003 [Full text]
Re:
Another shockingly uncontroversial Wessley publication: something must be done!
Ellen Goudsmit
bmj.com, 20 Sep 2003 [Full text]
Another
shockingly pointless Wessley publication: something must be done!
N Portman, et al.
bmj.com, 20 Sep 2003 [Full text]
A
waste of funding
Gurli Bagnall
bmj.com, 20 Sep 2003 [Full text]
Young
People need a voice of their own.
MaryJane Willows
bmj.com, 21 Sep 2003 [Full text]
Endocrinologists,
too, should review manuscrips on chronic fatigue syndrome
Riccardo Baschetti
bmj.com, 21 Sep 2003 [Full text]
Some
very questionable conclusions and results about ME/CFS in children and
adolescents
Charles B Shepherd
bmj.com, 22 Sep 2003 [Full text]
Chalder
et al's worrying unawareness
Jane C Colby
bmj.com, 22 Sep 2003 [Full text]
'first
do no harm'
Paul Lynch
bmj.com, 22 Sep 2003 [Full text]
Please
help our children
Jane Bryant
bmj.com, 23 Sep 2003 [Full text]
Interests
Douglas T Fraser
bmj.com, 23 Sep 2003 [Full text]
What
Utter Bollocks!
Richard Simpson
bmj.com, 24 Sep 2003 [Full text]
Re:
Chalder et al's worrying unawareness
Suzy Chapman
bmj.com, 24 Sep 2003 [Full text]
A
Plea for Research Co-operation
Graham & Ann Robertson
bmj.com, 25 Sep 2003 [Full text]
Re:
A Plea for Research Co-operation
Paul Lynch
bmj.com, 25 Sep 2003 [Full text]
The
social myth of mind over matter
Angela P. Kennedy
bmj.com, 25 Sep 2003 [Full text]
The
Parent Must Not Close His or Her Mind to All Possible Factors In Regard To
Treatment
Dr P V Finn Cosgrove
bmj.com, 26 Sep 2003 [Full text]
Behind
the times?
Jane Bryant
bmj.com, 26 Sep 2003 [Full text]
The
Doctor must not close his or her mind to all possible factors in regard to
treatment
Angela P. Kennedy
bmj.com, 27 Sep 2003 [Full text]
Re:
The Parent Must Not Close His or Her Mind to All Possible Factors In Regard To
Treatment
Richard Simpson
bmj.com, 27 Sep 2003 [Full text]
Re:
The Parent Must Not Close His or Her Mind to All Possible Factors In Regard To
Treatment
Suzy Chapman
bmj.com, 28 Sep 2003 [Full text]
The
prevalence rate found wasn't that low compared to studies of adults
Tom P Kindlon
bmj.com, 28 Sep 2003 [Full text]
Re:
The Parent Must Not Close His or Her Mind to All Possible Factors In Regard To
Treatment
Ann Robertson
bmj.com, 29 Sep 2003 [Full text]
Re:
Re: The Parent Must Not Close His or Her Mind to All Possible Factors In Regard
To Treatment
James Taylor
bmj.com, 1 Oct 2003 [Full text]
Anxiety
Unrecognised, Untreated and Unrelieved
Dr P V Finn Cosgrove
bmj.com, 4 Oct 2003 [Full text]
Ever
tried this on cattle ?
Arthur J. Finnie
bmj.com, 4 Oct 2003 [Full text]
Recovery
from CFS/ME
Denis W Scadeng
bmj.com, 4 Oct 2003 [Full text]
Re:
Anxiety Unrecognised, Untreated and Unrelieved
Gerard T O' Brien
bmj.com, 5 Oct 2003 [Full text]
Re:
The prevalence rate found wasn't that low compared to studies of adults
Tom P Kindlon
bmj.com, 26 Oct 2003 [Full text]
|
||||||||||
|
|
