Rethinking childhood adversity in chronic fatigue syndrome.
Rethinking childhood adversity in chronic fatigue syndrome.
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重新思考慢性疲劳综合征的童年逆境。
DOI：
10.1080/21641846.2018.1384095
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Watson S
中科院分区：
文献类型：
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作者：
Clark JE;Davidson SL;Maclachlan L;Newton JL;Watson S
背景：以往的研究一致表明慢性疲劳综合征（CFS）的儿童期逆境发生率增加。然而，这种CFS的病原学研究可能会因合并症和误诊而混淆，特别是与抑郁症混淆。目的：我们使用两种互补的方法(1)无抑郁史的CFS患者样本和(2)建模方法来检验童年逆境发生率之间的关系。方法：对52名慢性疲劳综合征患者和19名不符合精神障碍标准（使用DSM-IV的结构化临床访谈确认）的对照组进行儿童创伤问卷调查（CTQ）。随后，采用中介分析（贝叶斯规则）来确定儿童期逆境对慢性疲劳综合症伴抑郁和不伴抑郁的风险。结果：在一个全面排除抑郁症的CFS患者队列中，CTQ评分明显低于所有先前的研究，与这些先前的研究相比，与健康对照组相比，CTQ评分没有增加。事后分析显示，CTQ得分与一生中最糟糕的情绪低落时期抑郁症状的数量相关。儿童期有创伤史的人患慢性疲劳综合症的概率为4%，是普通人群的两倍。然而，这种风险很大程度上是由伴随发展的重度抑郁症介导的。结论：先前的研究表明童年逆境与CFS之间的关系可能归因于共病或误诊的抑郁症的混杂效应。缩写：CFS：慢性疲劳综合征；CTQ：儿童创伤问卷；重度抑郁障碍；CA：童年的逆境；P:概率
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