Abstract
Literature reviewAnxiety and depression are thought to be common in Chronic Fatigue Syndrome, although the reported prevalence of these difficulties varies between studies. These comorbidities are known to have implications for patient wellbeing and health, and there is some evidence that they might have implications for outcomes to treatment for Chronic Fatigue. The current review aimed to examine the prevalence of anxiety and depression, and to investigate whether these difficulties affect fatigue and physical function outcomes in available randomised controlled trials of NICE endorsed evidence-based treatment.
A systematic review, meta-analysis and meta-regression were completed. Published and unpublished (a) randomised controlled trials of (b) CBT or GET for (c) adults with (d) CFS, in which (e) post-intervention fatigue and/or physical function scores were reported, and (f) anxiety and/or depression scores were reported at baseline, were identified, from searches of three databases (Pubmed, Embase, PsycINFO) and reference lists of included studies and relevant reviews. Searches took place on 10th April 2017. Risk of bias was assessed using the Cochrane Risk of Bias tool. Estimates of depression and anxiety were summarised with a narrative review. Meta-regression models were used to explore whether anxiety and depression are associated with outcomes to treatment.
Nine papers were identified and included in the review. The analysis indicated that reported rates of anxiety and depression were heterogeneous between studies, but that up to 55% of participants experience comorbid depressive disorders, with 10-20% experiencing major depressive disorder, and that 10-48% of participants experience a comorbid anxiety disorder. Meta-regressions indicated that depressive symptoms were associated with less improvement in physical function following treatment (nine studies). Depression was not associated with fatigue outcomes; anxiety was not associated with either fatigue or physical function outcomes.
The findings have important implications for the support and treatment of patients with Chronic Fatigue Syndrome. For patients to receive the best possible care, it is imperative that clinicians and services address all presenting physical and psychological needs, to optimise treatment outcomes. Patients experiencing comorbid depression may benefit from essential interventions aimed at addressing depressive symptoms before or alongside treatment for Chronic Fatigue to increase treatment response.
Service Improvement Project
Mind-maps are a graphical communication technique that has been found to enhance therapeutic work in substance misuse services. Despite their value in these settings, they have not been so frequently utilised in general mental health provision. To address this gap, a mind-map booklet, the “My Wellbeing Toolkit” was recently developed and introduced in an NHS Recovery Service. The current service improvement project aimed to explore uptake of the booklet and make recommendations for improvements to the booklet.
A three-stage sequential explanatory mixed methods study was used to explore the evaluation questions: the initial stage involved collecting data on the number of care coordinators who had used the booklet, from existing logs, the second stage involved collection of questionnaire data on usage patterns of the booklet, the third involved collection of qualitative data on experiences of using the booklet. Quantitative data was explored using descriptive statistics; qualitative data was analysed using thematic analysis.
Care coordinators identified that the booklet was useful for themselves and for clients, however uptake of the booklet was low. A number of barriers were identified: practical barriers, lack of confidence and clarity when using the booklet and a lack of client engagement. A series of recommendations were made to address these barriers and to improve the content of the booklet.
The project suggests that mind-map booklets have considerable value for mental health provision, however support needs to be provided to clinicians to facilitate their use. Future directions for research include exploring client experiences of mind-map based booklets.
Main Research Project
Cervical cancer patients are at particular risk of experiencing psychological distress and mental health difficulties. The current study investigated whether this is associated with knowledge of the sexually-transmitted nature of HPV, exploring HPV-related shame, anxiety and low mood in women with cervical cancer.
110 women with cervical cancer completed a repeated measures study, during which they read information that HPV is (1) considered to be a sexually-transmitted virus and (2) very common. Participants completed measures of shame, mood and anxiety after each level of information.
The results indicated that information that HPV is sexually-transmitted is associated with experiences of shame. Increased shame was associated with depression, low mood, anxiety and poor wellbeing. Women with a history of depression and anxiety were at particular risk for experiencing high levels of shame.
The results indicate that women with cervical cancer experience high levels of shame related to HPV information. This has implications for how to support patients who are at risk of experiencing high levels of shame, particularly around HPV-information provision, identifying at-risk patients, and the psychological support of patients.
| Date of Award | 17 Sept 2018 |
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| Original language | English |
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| Supervisor | Jo Daniels (Supervisor), Cara Davis (Supervisor), Megan Wilkinson-Tough (Supervisor) & Emma Griffith (Supervisor) |
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