Tired all the time: Fatigue in adolescents with depression

Abstract

Little is known about fatigue in adolescent depression, but preliminary research indicates that it is frequently reported and highly disabling. Yet, it is not necessarily a priority for intervention in routine mental health services. Research in adults with depression has linked fatigue with detrimental outcomes, like reduced quality of life and psychosocial functioning, and has also found that fatigue is a common residual symptom following psychological treatments for depression. However, it is inappropriate to assume that research conducted in adults can be directly applied to other populations, like adolescents. The lack of focused attention on fatigue as a symptom of adolescent depression therefore presents a major gap in our knowledge. This is particularly concerning given that depression often has an onset in adolescence. I therefore aimed to further our understanding of fatigue in adolescent depression by conducting research from a bottom-up perspective. In this thesis, I report on three empirical studies which were conducted in parallel and are presented in order of publication. My first study (Chapter 2) was a systematic review that sought to synthesise the existing evidence regarding nonpharmacological interventions for adolescent fatigue, alongside the behaviour change techniques utilised. Sixteen trials were identified, five of which were classified as likely promising. These interventions often involved psychoeducation, Cognitive Behavioural Therapy, and physical activity, and incorporated numerous behaviour change techniques. However, the quality of the included studies was mixed, indicating that improvements are needed in trial design and reporting. In my second study (Chapter 3), I used qualitative methods to explore adolescents’ experiences of fatigue as a symptom of depression. Three themes were generated, highlighting that adolescentsunderstand fatigue as a complex, multifaceted symptom that has them trapped in a viciouscycle. This cycle drains their energy and impacts their ability to engage in everyday activities; yet adolescents are reluctant to seek help for their fatigue due to the perception that it is not serious enough. My final study (Chapter 4) adopted a quantitative approach and used secondary data available from a large-scale randomised controlled trial to examine the prevalence and associated characteristics of fatigue in depressed adolescents, alongside the effectiveness of three psychological treatments for reducing levels of fatigue. I found that73% of the sample reported clinically significant fatigue and that fatigue was consistently associated with older age and increased depression severity. Interestingly, all three psychological treatments demonstrated reductions in levels of fatigue, and the presence of fatigue did not interfere with improvements in depression severity and psychosocial functioning. Combined, my research contributes to our limited understanding of fatigue within adolescent depression, providing insight into adolescents’ conceptualisations of fatigue in depression, indicators that may aid early identification, and promising nonpharmacological interventions for reducing levels of fatigue in adolescents, both from a transdiagnostic perspective and in the specific context of depression. Clinical implications alongside future directions for research are also considered.

Date of Award	11 Sept 2024
Original language	English
Awarding Institution	University of Bath
Sponsors	Economic and Social Research Council
Supervisor	Maria Loades (Supervisor), Barney Dunn (Supervisor) & Kate Cooper (Supervisor)