What treatments work for anxiety and depression in children and adolescents with Chronic Fatigue Syndrome? An updated systematic review

Philippa Clery; Alexander  Royston; Katie Driver; Jasmine Bailey; Esther Crawley; Maria Loades

doi:10.1136/bmjopen-2021-051358

What treatments work for anxiety and depression in children and adolescents with Chronic Fatigue Syndrome? An updated systematic review

Philippa Clery, Alexander Royston , Katie Driver, Jasmine Bailey, Esther Crawley, Maria Loades

Department of Psychology

University of Bristol

Research output: Contribution to journal › Review article › peer-review

2 Citations (SciVal)

99 Downloads (Pure)

Abstract

Objectives Children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings. Design A systematic review. We searched Cochrane library, Medline, Embase and PsycINFO databases from 2015 to 2020. We combined the updated results with our previous reviews in a narrative synthesis. Participants Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centers for Disease Control and Prevention, National Institute for Health and Care Excellence or Oxford criteria); validated measures of depression and/or anxiety. Interventions Observational studies or randomised controlled trials. Comparison Any or none. Outcomes Studies with outcome measures of anxiety, depression or fatigue. Results The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared with specialist care alone. Previous studies evaluated cognitive-behavioural therapy (CBT); pharmacological interventions and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated. Conclusion Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME. PROSPERO registration numbers CRD42016043488 and CRD42015016813.

Original language	English
Article number	e051358
Journal	BMJ Open
Volume	12
Issue number	1
Early online date	31 Jan 2022
DOIs	https://doi.org/10.1136/bmjopen-2021-051358
Publication status	Published - 31 Jan 2022

Bibliographical note

Funding Information:
Funding ML is funded by the National Institute for Health Research (NIHR Doctoral Research Fellowship, DRF-2016-09-021). This report is independent research.

Funding Information:
Acknowledgements We would like to acknowledge the support from the CFS/ME teams at the Centre for Academic Child Health at the University of Bristol and the CFS/ME service at the Royal United Hospitals Bath NHS Foundation Trust.

Publisher Copyright:
©

Keywords

Anxiety disorders
Child & adolescent psychiatry
Depression & mood disorders
Mental health
Paediatrics

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjopen-2021-051358Licence: CC BY

Manuscript_Accepted_3.12.21.PDFAccepted author manuscript, 608 KBLicence: CC BY

Cite this

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title = "What treatments work for anxiety and depression in children and adolescents with Chronic Fatigue Syndrome? An updated systematic review",

abstract = "Objectives Children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings. Design A systematic review. We searched Cochrane library, Medline, Embase and PsycINFO databases from 2015 to 2020. We combined the updated results with our previous reviews in a narrative synthesis. Participants Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centers for Disease Control and Prevention, National Institute for Health and Care Excellence or Oxford criteria); validated measures of depression and/or anxiety. Interventions Observational studies or randomised controlled trials. Comparison Any or none. Outcomes Studies with outcome measures of anxiety, depression or fatigue. Results The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared with specialist care alone. Previous studies evaluated cognitive-behavioural therapy (CBT); pharmacological interventions and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated. Conclusion Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME. PROSPERO registration numbers CRD42016043488 and CRD42015016813.",

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author = "Philippa Clery and Alexander Royston and Katie Driver and Jasmine Bailey and Esther Crawley and Maria Loades",

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AU - Driver, Katie

AU - Bailey, Jasmine

AU - Crawley, Esther

AU - Loades, Maria

N1 - Funding Information: Funding ML is funded by the National Institute for Health Research (NIHR Doctoral Research Fellowship, DRF-2016-09-021). This report is independent research. Funding Information: Acknowledgements We would like to acknowledge the support from the CFS/ME teams at the Centre for Academic Child Health at the University of Bristol and the CFS/ME service at the Royal United Hospitals Bath NHS Foundation Trust. Publisher Copyright: ©

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Y1 - 2022/1/31

N2 - Objectives Children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings. Design A systematic review. We searched Cochrane library, Medline, Embase and PsycINFO databases from 2015 to 2020. We combined the updated results with our previous reviews in a narrative synthesis. Participants Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centers for Disease Control and Prevention, National Institute for Health and Care Excellence or Oxford criteria); validated measures of depression and/or anxiety. Interventions Observational studies or randomised controlled trials. Comparison Any or none. Outcomes Studies with outcome measures of anxiety, depression or fatigue. Results The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared with specialist care alone. Previous studies evaluated cognitive-behavioural therapy (CBT); pharmacological interventions and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated. Conclusion Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME. PROSPERO registration numbers CRD42016043488 and CRD42015016813.

AB - Objectives Children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience a higher prevalence of depression and anxiety compared with age-matched controls. Our previous systematic reviews in 2015/16 found little evidence for effective treatment for children with CFS/ME with comorbid depression and/or anxiety. This review updates these findings. Design A systematic review. We searched Cochrane library, Medline, Embase and PsycINFO databases from 2015 to 2020. We combined the updated results with our previous reviews in a narrative synthesis. Participants Inclusion criteria: <18 years old; diagnosed with CFS/ME (using Centers for Disease Control and Prevention, National Institute for Health and Care Excellence or Oxford criteria); validated measures of depression and/or anxiety. Interventions Observational studies or randomised controlled trials. Comparison Any or none. Outcomes Studies with outcome measures of anxiety, depression or fatigue. Results The updated review identified two studies. This brings the total number of paediatric CFS/ME studies with a measure of anxiety and/or depression since 1991 to 16. None of the studies specifically targeted depression, nor anxiety. One new study showed the Lightning Process (in addition to specialist care) was more effective at reducing depressive and anxiety symptoms compared with specialist care alone. Previous studies evaluated cognitive-behavioural therapy (CBT); pharmacological interventions and behavioural approaches. CBT-type interventions had most evidence for improving comorbid anxiety and/or depressive symptoms but varied in delivery and modality. Other interventions showed promise but studies were small and have not been replicated. Conclusion Very few paediatric CFS/ME intervention studies have been conducted. This review update does not significantly add to what is known from previous reviews. The evidence is of poor quality and insufficient to conclude which interventions are effective at treating comorbid anxiety and/or depression in paediatric CFS/ME. PROSPERO registration numbers CRD42016043488 and CRD42015016813.

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KW - Child & adolescent psychiatry

KW - Depression & mood disorders

KW - Mental health

KW - Paediatrics

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DO - 10.1136/bmjopen-2021-051358

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SN - 2044-6055

VL - 12

JO - BMJ Open

JF - BMJ Open

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ER -

What treatments work for anxiety and depression in children and adolescents with Chronic Fatigue Syndrome? An updated systematic review

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Doctoral Research Fellowship: Depression in Paediatric Chronic Fatigue Syndrome (CFS/ME)

Cite this

What treatments work for anxiety and depression in children and adolescents with Chronic Fatigue Syndrome? An updated systematic review

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Projects

Doctoral Research Fellowship: Depression in Paediatric Chronic Fatigue Syndrome (CFS/ME)

Cite this