Lauren Jones, Emma Anderson, Maria Loades, Rebecca Barnes, Esther Crawley

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Comorbid depression is common in adolescents with chronic illness. We aimed to design and test a linguistic coding scheme for identifying depression in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), by exploring features of e-consultations within online cognitive behavioural therapy treatment. E-consultations of 16 adolescents (aged 11–17) receiving FITNET-NHS (Fatigue in teenagers on the interNET in the National Health Service) treatment in a national randomized controlled trial were examined. A theoretically driven linguistic coding scheme was developed and used to categorize comorbid depression in e-consultations using computerized content analysis. Linguistic coding scheme categorization was subsequently compared with classification of depression using the Revised Children's Anxiety and Depression Scale published cut-offs (t-scores ≥65, ≥70). Extra linguistic elements identified deductively and inductively were compared with self-reported depressive symptoms after unblinding. The linguistic coding scheme categorized three (19%) of our sample consistently with self-report assessment. Of all 12 identified linguistic features, differences in language use by categorization of self-report assessment were found for “past focus” words (mean rank frequencies: 1.50 for no depression, 5.50 for possible depression, and 10.70 for probable depression; p <.05) and “discrepancy” words (mean rank frequencies: 16.00 for no depression, 11.20 for possible depression, and 6.40 for probable depression; p <.05). The linguistic coding profile developed as a potential tool to support clinicians in identifying comorbid depression in e-consultations showed poor value in this sample of adolescents with CFS/ME. Some promising linguistic features were identified, warranting further research with larger samples.

Original languageEnglish
JournalClinical Psychology & Psychotherapy
Early online date15 Dec 2019
Publication statusPublished - 2019

Bibliographical note

Funding Information:
The authors would like to thank Dr Kate Chapple and Dr Rosanna Chapman for their useful input to the coding scheme and Daisy Gaunt who provided valuable advice regarding the analysis. Prof Crawley was funded by the NIHR (Senior Research Fellowship, SRF‐2013‐06‐013) during this study. Dr Loades is funded by the NIHR (Doctoral Research Fellowship, DRF‐2016‐09‐021). This report is independent research. The views expressed in this publication are those of the authors(s) and not necessarily those of the NHS, The National Institute for Health Research, or the Department of Health.

Publisher Copyright:
© 2019 John Wiley & Sons, Ltd.


  • chronic fatigue syndrome
  • cognitive behavioural therapy
  • depressive symptoms
  • e-consultations
  • linguistic analysis
  • paediatric

ASJC Scopus subject areas

  • Clinical Psychology


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