and which I suspect are all caused from
BUTYL exposure
study of those with CFS diagnosis & depression/ suicidal tendencies
Conclusion
It is important for clinicians to assess depression and suicidal ideation among their patients with CFS, particularly among females, those reporting moderate to severe pain, low incomes and inadequate social support.
A Family Practice reprint 10-3-08
Introduction
Chronic fatigue syndrome (CFS) is a disorder diagnosed following at least 6 months of disabling, unexplained mental and physical fatigue accompanied by other physical and psychological symptoms.1,2 Common physical symptoms reported by patients include gastrointestinal problems, headaches, muscle and
joint pain; typical psychological symptoms include impaired memory or concentration,2,3 rendering clinical identification of CFS challenging for many GPs.4,5
Estimated prevalence rates for CFS among adults range from 0.23% to 2% of the total population.6-8 Average age at onset is between 29 and 35 years. Females account for at least 75% of CFS patients.2
In a random community sample, individuals with CFS were predominantly from lower socio-economic classes.3,9 Almost half of CFS patients were unemployed due to illness constraints, while many who remained employed had modified their work schedules since diagnosis.2,10 The symptoms of CFS often leave individuals disconnected from family, friends and personal interests.3,10. It has been hypothesized that the unpredictability of day-to-day energy levels may result in individuals with CFS intentionally restricting their scheduled social engagements to avoid disappointing friends and family.11
CFS patients have inordinately high rates of depression. Clinical samples indicate that between 35%12 and 46%13 suffer from depression. In Taylor et al.'s9 community sample, one in three individuals with CFS had a current mood disorder. Fatiguing illnesses, such as CFS, have been linked with reactive depression due to illness-imposed limitations.
Among a clinical sample of individuals with CFS, patients concurrently suffering from depression were found to have significantly worse outcomes, such as more severe symptoms and unemployment, than those without depression14; these individuals are also more likely to be female and poorer.9 Due to a lack of literature specifically focused on CFS and depression, we turned to studies of depression in individuals with other chronic illnesses [e.g. arthritis, inflammatory bowel disease, multiple sclerosis (MS) and systemic lupus erythematosus (SLE)].
Depressed individuals with other chronic illnesses were at a disadvantage to the non-depressed with these diseases with respect to poorer quality of life,15-17 lower levels of life satisfaction18 and
increased risk of suicide.17,19 Studies on other chronic health conditions also suggest that depression is associated with food insecurity,20 younger age,21,22 higher education20 and not being an immigrant.20 Lower levels of social support,10,22 in general, and being without a marital partner,20 in particular, have been associated with depression among those with chronic illnesses.
Studies involving clinical samples of individuals with MS,23 SLE24 and arthritis22 found that depression scores were higher among those reporting bodily pain. There appeared to be interaction effect between pain and self-esteem,25-27 as well as pain and social supports.20 Depression was also higher among individuals with chronic illnesses who reported limitations in their activities of daily living (ADL).22 Depression among those with chronic illnesses is associated with a greatly elevated risk of suicidal ideation.20
Among community samples of individuals with CFS, health-care usage is substantially higher than the general population.28,29 The single greatest cost of care for individuals with CFS stems from an average of 18 visits to GPs and specialists, in addition to 14 visits to non-physician practitioners28; an equivalent of $9.1 billion (US)30 per year.
Using a Canadian nationally representative sample of individuals reporting that they had been diagnosed with CFS by a health professional, we have investigated four research questions:
1. (i) What is the national prevalence of depression among those who report they have CFS?
2. (ii) What demographic (e.g. gender, age, education and income), intrapsychic (e.g. self-esteem and mastery), interpersonal (e.g. social support) and health-related characteristics (e.g. level of pain,self-reported health and number of other chronic conditions) are associated with depression among individuals with CFS?
3. (iii) What is the prevalence of use of family doctors, mental health services and antidepressants by depressed CFS patients?
4. (iv) What is the prevalence of suicidal ideation among depressed individuals with self-reported CFS?