This systematic review reports on moderating and mediating variables in the relationship between childhood adversity and affective disorders. Embase, MEDLINE & PsycINFO were searched from inception ...to October 2017, for English articles published in peer-reviewed journals investigating at least one moderating, mediating or otherwise associated variable in the relationship between childhood adversity and major depressive disorders, post-traumatic stress disorder, generalized anxiety disorder or social anxiety disorder. Overall, 214 studies were included. The review revealed that biological (i.e. heightened amygdala responses and structural neurological changes), psychological (i.e. emotional dysregulation, attachment anxiety, maladaptive cognitive style, emotion-focused coping, attentional biases, psychoform dissociation, maladaptive personality types, anxious arousal, lack of resilience, low self esteem and trauma-related guilt), and social (i.e. retraumatizations, chronic interpersonal stress, low social support and friendship) variables served as mediators between childhood adversity and affective disorders in adulthood. Furthermore, biological (i.e. genetic polymorphisms in the 5-HTT, BDNF, FKBP5, CRHR1, NR3C2, OXTR, ADCYAP1R1 genes, and alterations in the connectivity of the emotion processing circuitry), and psychological (i.e. romantic attachment avoidance and low self esteem) variables served as moderators in this relationship. A transdiagnostic moderation and mediation model is proposed, limitations are discussed and suggestions for future empirical studies are presented.
•The relationship between childhood adversity and affective disorders seems to be moderated and mediated biopsychosocially•More research is needed to clarify whether a given moderator/mediator acts disorder-specific or transdiagnostically•Overall, the quality of studies in this line of research is moderate according to the proposed quality criteria•It is recommended to include transdiagnostic and biopsychosocial conceptualizations in future research
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Objective Beliefs about the unacceptability of experiencing or expressing negative emotions have been noted in individuals with a range of problems, including chronic fatigue syndrome (CFS), ...irritable bowel syndrome, somatization disorder, depression, eating disorders, social phobia, posttraumatic stress disorder, and borderline personality disorder. These beliefs are likely to have implications for emotion regulation and processing, and are addressed explicitly or implicitly within many therapies including cognitive behavior therapy (CBT), mindfulness-based cognitive therapy (MBCT), and Acceptance and Commitment Therapy (ACT). This article describes the development, validation, and internal reliability of the Beliefs about Emotions Scale (BES), a self-report questionnaire to assess such beliefs. Methods The new scale was completed by people with CFS ( n =121) and healthy controls ( n =73). Twenty-two individuals with CFS completed the scale before and after CBT. Results People with CFS had significantly higher scores on this new questionnaire than healthy controls. Principal components analysis identified one factor, and the scale had high internal consistency (0.91). Scores on the BES were most highly correlated with a measure of negative perfectionism ( r =0.59) and also showed significant correlations with measures of dysfunctional attitudes, self-sacrifice, depression, anxiety, and fatigue. When completed before and after CBT for CFS, the questionnaire was sufficiently sensitive to detect a significant reduction in endorsement of unhelpful beliefs about emotions. Conclusion The new Beliefs about Emotions Scale showed good internal reliability, validity and sensitivity to change.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Little is known about the prevalence and natural trajectory of post-COVID symptoms in young people, despite very high numbers of young people having acute COVID. To date, there has been no ...prospective follow-up to establish the pattern of symptoms over a 6-month time period.
A non-hospitalised, national sample of 3,395 (1,737 SARS-COV-2 Negative;1,658 SARS-COV-2 Positive at baseline) children and young people (CYP) aged 11-17 completed questionnaires 3 and 6 months after PCR-confirmed SARS-CoV-2 infection between January and March 2021 and were compared with age, sex and geographically-matched test-negative CYP.
Three months after a positive SARS-CoV-2 PCR test, 11 of the 21 most common symptoms reported by >10% of CYP had reduced. There was a further decline at 6 months. By 3 and 6 months the prevalence of chills, fever, myalgia, cough and sore throat of CYP who tested positive for SARS-CoV-2 reduced from 10-25% at testing to <3%. The prevalence of loss of smell declined from 21% to 5% at 3 months and 4% at 6 months. Prevalence of shortness of breath and tiredness also declined, but at a lower rate. Among test-negatives, the same common symptoms and trends were observed at lower prevalence's. Importantly, in some instances (shortness of breath, tiredness) the overall prevalence of specific individual symptoms at 3 and 6 months was higher than at PCR-testing because these symptoms were reported in new cohorts of CYP who had not reported the specific individual symptom previously.
In CYP, the prevalence of specific symptoms reported at time of PCR-testing declined with time. Similar patterns were observed among test-positives and test-negatives and new symptoms were reported six months post-test for both groups suggesting that symptoms are unlikely to exclusively be a specific consequence of SARS-COV-2 infection. Many CYP experienced unwanted symptoms that warrant investigation and potential intervention.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
The study of mediation of treatment effects, or how treatments work, is important to understanding and improving psychological and behavioral treatments, but applications often focus on ...mediators and outcomes measured at a single time point. Such cross-sectional analyses do not respect the implied temporal ordering that mediation suggests. Clinical trials of treatments often provide repeated measures of outcomes and, increasingly, of mediators as well. Repeated measurements allow the application of various types of longitudinal structural equation mediation models. These provide flexibility in modeling, including the ability to incorporate some types of measurement error and unmeasured confounding that can strengthen the robustness of findings. The usual approach is to identify the most theoretically plausible model and apply that model. In the absence of clear theory, we put forward the option of fitting a few theoretically plausible models, providing a type of sensitivity analysis for the mediation hypothesis. In this tutorial, we outline how to fit several longitudinal mediation models, including simplex, latent growth and latent change models. This will allow readers to learn about one type of model that is of interest, or about several alternative models, so that they can take this sensitivity approach. We use the Pacing, Graded Activity, and Cognitive Behavioral Therapy: A Randomized Evaluation (PACE) trial of rehabilitative treatments for chronic fatigue syndrome (ISRCTN 54285094) as a motivating example and describe how to fit and interpret various longitudinal mediation models using simulated data similar to those in the PACE trial. The simulated data set and Mplus code and output are provided.
Translational Abstract
Studying how treatments work is important to understanding and improving them. We can do this using mediation analysis. This sort of analysis studies a chain of events in which a treatment affects one variable, which then affects another variable in turn. To date, investigators have tended to measure these variables at the same point. Instead, several measurements should be taken so that we can better understand the relationships between the variables over time. Nowadays, studies often measure variables of interest several times during treatment and follow-up. When this is done, more flexible and realistic models of change can be used, giving a more holistic picture of how the treatment worked (the treatment mechanism). This manuscript takes a tutorial format, showing readers how to use several different statistical models. For a treatment theory with stronger evidence behind it, readers can learn about the statistical model that best aligns with this theory. When readers are less clear about how the treatment process works, they can take the approach of trying alternative models that are reasonable given the treatment theory, examining whether they lead to similar conclusions about the treatment mechanism. We use the Pacing, Graded Activity, and Cognitive Behavioral Therapy: A Randomized Evaluation (PACE) trial of rehabilitative treatments for chronic fatigue syndrome (ISRCTN 54285094) as an example. To help readers use these models, we have provided a simulated data set similar to the data from the PACE trial and software code for the models described in the article.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Objective
To test the feasibility of a telephone delivered intervention, informed by cognitive behavioural principles, for post-stroke fatigue, and estimated its effect on fatigue and other outcomes.
...Design
Randomised controlled parallel group trial.
Setting
Three Scottish stroke services.
Subjects
Stroke survivors with fatigue three months to two years post-stroke onset.
Interventions
Seven telephone calls (fortnightly then a ‘booster session’ at 16 weeks) of a manualised intervention, plus information about fatigue, versus information only.
Main measures
Feasibility of trial methods, and collected outcome measures (fatigue, mood, anxiety, social participation, quality of life, return to work) just before randomisation, at the end of treatment (four months after randomisation) and at six months after randomisation.
Results
Between October 2018 and January 2020, we invited 886 stroke survivors to participate in postal screening: 188/886 (21%) returned questionnaires and consented, of whom 76/188 (40%) were eligible and returned baseline forms; 64/76 (84%) returned six month follow-up questionnaires. Of the 39 allocated the intervention, 23 (59%) attended at least four sessions. At six months, there were no significant differences between the groups (adjusted mean differences in Fatigue Assessment Scale −0.619 (95% CI −4.9631, 3.694; p = 0.768), the Generalised Anxiety Disorder 7 −0.178 (95% CI −3.823, 3.467, p = 0.92), and the Patient Health Questionnaire −0.247 (95% CI −2.935, 2.442, p = 0.851). There were no between-group differences in quality of life, social participation or return to work.
Conclusion
Patients can be recruited to a trial of this design. These data will inform the design of further trials in post-stroke fatigue.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Chronic Fatigue Syndrome (CFS) is a condition characterised by severe mental and physical fatigue coupled with profound disability. The purpose of this review was to investigate psychological, social ...and physiological factors associated with fatigue and disability in CFS in children and adolescents. The review aimed to gain an overview of the strength of evidence for the relationship between these different factors and CFS in young people. Seventy-nine studies met the inclusion criteria and were included in the review. A narrative synthesis of these studies was conducted. The strongest and most consistent finding was that rates of psychiatric co-morbidity, predominantly anxiety and depressive disorders, were higher in young people with CFS compared to healthy controls or illness control groups. Studies suggested that many children and adolescents with CFS reported that their illness began with an infection and there was some objective and prospective evidence to support this. Preliminary evidence suggested a link between CFS and a family history of CFS, high expectations from both the parent and child, personality traits such as conscientiousness and physical illness attributions. The evidence was limited by methodological problems. Few studies were prospective in nature and future research should address this. Clinical implications of the findings are discussed and a hypothesised model of the factors associated with CFS in children and adolescents is presented.
•The strongest evidence for the aetiology of CFS in adolescents is that the EBV is associated with an increased risk of CFS.•Rates of psychiatric co-morbidity, predominantly anxiety and depressive disorders were higher in adolescents with CFS.•Treatment should be tailored to specific personality types, and should address certain individual characteristics.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract: Objectives: This review sought to determine what is currently known about the focus, form, and efficacy of web-based interventions that aim to support the well-being of workers and enable ...them to manage their work-related stress. Method: A scoping review of the literature as this relates to web-based interventions for the management of work-related stress and supporting the psychological well-being of workers was conducted. Results: Forty-eight web-based interventions were identified and reviewed, the majority of which (n=37) were "individual" -focused and utilized cognitive-behavioral techniques, relaxation exercises, mindfulness, or cognitive behavior therapy. Most interventions identified were provided via a website (n=34) and were atheoretical in nature. Conclusions: There is some low-to-moderate quality evidence that "individual" -focused interventions are effective for supporting employee well-being and managing their work-related stress. There are few web-based interventions that target "organizational" or "individual/organization" interface factors, and there is limited support for their efficacy. A clear gap appears to exist between work-stress theory and its application in the design and development of web-based interventions for the management of work-related stress.
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CEKLJ, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The COVID-19 pandemic and consequent lockdowns had a substantial impact on mental health. Distress and fatigue are highly correlated. However, little is known about the determinants of fatigue in the ...general population during the pandemic. This study aimed to examine the prevalence and predictors of fatigue during the COVID-19 pandemic in the UK population. Online surveys were completed by a UK community cohort in April 2020 (wave 1), July-September 2020 (wave 2) and November-December 2020 (wave 3). In total, 3097 participants completed the wave 1 survey, and 1385 and 1087 participants (85.4% women) completed wave 2 and 3 surveys respectively. Fatigue was assessed using the Chalder Fatigue Scale at waves 2 and 3. Hair samples were provided by 827 participants (90.6% women) at wave 1 and wave 2, which were analyzed to indicate HairE (stress hormone). The mean total fatigue score during wave 2 was 14.7 (SD = 4.7), significantly higher than pre-pandemic levels observed in the community (mean difference 0.50,
= .003). At wave 2, 614 (44.3%) participants met the case definition for fatigue, only 15.6% of whom indicated that fatigue lasted for more than 6 months (suggesting it had started prior to the pandemic). Predictors of fatigue at wave 3 included being in a risk group, depression and belief in having COVID-19, which explained 23.8% of the variability in fatigue scores. Depression at wave 1 was the only significant predictor of remaining a fatigue case at wave 3. Fatigue was highly prevalent in the UK community during the COVID-19 pandemic and limited people's daily function. Depression and sociodemographic variables were significant predictors of fatigue.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Cognitive behaviour therapy (CBT) added to specialist medical care (SMC), or graded exercise therapy (GET) added to SMC, are more effective in reducing fatigue and improving physical function than ...both adaptive pacing therapy (APT) plus SMC and SMC alone for chronic fatigue syndrome. We investigate putative treatment mechanisms.
We did a planned secondary mediation analysis of the PACE trial comparing SMC alone or SMC plus APT with SMC plus CBT and SMC plus GET for patients with chronic fatigue syndrome. 641 participants were recruited from six specialist chronic fatigue syndrome clinics in the UK National Health Service between March 18, 2005, and Nov 28, 2008. We assessed mediation using the product of coefficients method with the 12 week measure of the mediators and the 52 week measure of the outcomes. The primary outcomes were fatigue measured by the Chalder fatigue scale and physical function measured by the physical function subscale of the SF-36. We included confounder covariates and used treatment by mediator interaction terms to examine differences in mediator-outcome relations by treatment group.
The largest mediated effect for both CBT and GET and both primary outcomes was through fear avoidance beliefs with an effect of larger magnitude for GET (standardised effects ×10, CBT vs APT, fatigue -1.22, 95% CI -0.52 to -1.97, physical function 1.54, 0.86 to 2.31; GET vs APT, fatigue -1.86, -0.80 to -2.89, physical function 2.35, 1.35 to 3.39). Increase in exercise tolerance (6 min walk distance) was a potent mediator of the effect of GET (vs APT, fatigue -1.37, 95% CI -0.76 to -2.21, physical function 1.90, 1.10 to 2.91), but not CBT.
Our main finding was that fear avoidance beliefs were the strongest mediator for both CBT and GET. Changes in both beliefs and behaviour mediated the effects of both CBT and GET, but more so for GET. The results support a treatment model in which both beliefs and behaviour play a part in perpetuating fatigue and disability in chronic fatigue syndrome.
UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions, National Institute for Health Research (NIHR), NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, Psychology, and Neuroscience, King's College London.
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