Differences in Physical and Psychosocial Characteristics Between CFS and Fatigued Non-CFS Patients,a Case-Control Study

Purpose

The main research question is: “Do CFS patients differ from fatigued non-CFS patients with respect to physical, cognitive, behavioral, social, and emotional determinants?” In addition, group differences in relevant outcomes were explored.

Method

Patients who met the Centers for Disease Control (CDC) criteria for CFS were categorized as CFS; these patients were mainly recruited via a large Dutch patient organization. Primary care patients who were fatigued for at least 1 month and up to 2 years but did not meet the CDC criteria were classified as fatigued non-CFS patients. Both groups were matched by age and gender (N?=?192 for each group).

Results

CFS patients attributed their fatigue more frequently to external causes, reported a worse physical functioning, more medical visits, and a lower employment rate. The results of a multiple logistic regression analysis showed that patients who believe that their fatigue is associated with more severe consequences, that their fatigue will last longer and is responsible for more additional symptoms are more likely to be classified as CFS, while patients who are more physically active and have higher levels of “all or nothing behavior” are less likely to be classified as having CFS.

Conclusion

A longitudinal study should explore the predictive value of the above factors for the transition from medically unexplained fatigue to CFS in order to develop targeted interventions for primary care patients with short-term fatigue complaints.

     

Influence of Symptom Expectancies on Stair-Climbing Performance in Chronic Fatigue Syndrome: Effect of Study Context

Background

In patients with chronic fatigue syndrome (CFS), performance of physical activities may be affected by an anticipated increase in symptoms after these activities. Nijs et al. previously studied the influence of symptom expectancies and related psychological processes on the performance of an isolated physical activity [Nijs J, Meeus M, Heins M, Knoop H, Moorkens G, Bleijenberg G. Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study. Disabil Rehabil 2012. doi:10.3109/09638288.2011.641661.].

Purpose

We aimed to validate the previous findings in a larger group of patients in a different setting. We also extended the possible underlying psychological processes studied.

Method

In 49 CFS patients, we measured performance (duration and increase in heart rate) during self-paced climbing and descending of two floors of stairs. Before this task, patients rated experienced fatigue and anticipated fatigue after stair climbing. In addition, kinesiophobia, catastrophising and focusing on bodily symptoms were measured. Using correlational and regression analyses, we tested whether performance during stair climbing could be explained by experienced and anticipated fatigue and psychological factors.

Results

Longer duration of stair climbing correlated with higher anticipated fatigue, independently of sex, age, body mass index and fatigue before stair climbing. Focusing on bodily symptoms and fatigue-related catastrophising were related to anticipated fatigue.

Conclusion

Symptom expectations affect the performance of physical activity in CFS patients, possibly through focusing on bodily symptoms and catastrophising. These findings partially contradict the findings of the previous study, which stresses the importance of study context in conducting this type of experiments (i.e., patient characteristics, instructions).     

Organizational Justice and Psychological Distress Among Permanent and Non-permanent Employees in Japan: A Prospective Cohort Study

Background

Organizational justice has recently been introduced as a new concept as psychosocial determinants of employee health, and an increase in precarious employment is a challenging issue in occupational health. However, no study investigated the association of organizational justice with mental health among employees while taking into account employment contract.

Purpose

The purpose of the present study was to investigate the prospective association of organizational justice (procedural justice and interactional justice) with psychological distress by employment contract among Japanese employees.

Methods

A total of 373 males and 644 females from five branches of a manufacturing company in Japan were surveyed. At baseline (August 2009), self-administered questionnaires, including the Organizational Justice Questionnaire (OJQ), the K6 scale (psychological distress scale), the Eysenck Personality Questionnaire-Revised (EPQ-R), and other covariates, were used. After one-year follow-up (August 2010), the K6 scale was used again to assess psychological distress. Multiple logistic regression analyses were conducted by sex and employment contract.

Results

After adjusting for demographic characteristics, psychological distress, and neuroticism at baseline, low procedural justice was significantly associated with a higher risk of psychological distress at follow-up among non-permanent female employees, while no significant association of procedural justice or interactional justice with psychological distress at follow-up was observed among permanent male or female employees. The results of non-permanent male employees could not be calculated because of small sample size.

Conclusions

Low procedural justice may be an important predictor of psychological distress among non-permanent female employees.     

Cross-Cultural Study of Information Processing Biases in Chronic Fatigue Syndrome: Comparison of Dutch and UK Chronic Fatigue Patients

Purpose

This study aims to replicate a UK study, with a Dutch sample to explore whether attention and interpretation biases and general attentional control deficits in chronic fatigue syndrome (CFS) are similar across populations and cultures.

Method

Thirty eight Dutch CFS participants were compared to 52 CFS and 51 healthy participants recruited from the UK. Participants completed self-report measures of symptoms, functioning, and mood, as well as three experimental tasks (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) versus neutral words, (ii) interpretive bias task measuring positive versus somatic interpretations of ambiguous information, and (iii) the Attention Network Test measuring general attentional control.

Results

Compared to controls, Dutch and UK participants with CFS showed a significant attentional bias for illness-related words and were significantly more likely to interpret ambiguous information in a somatic way. These effects were not moderated by attentional control. There were no significant differences between the Dutch and UK CFS groups on attentional bias, interpretation bias, or attentional control scores.

Conclusion

This study replicated the main findings of the UK study, with a Dutch CFS population, indicating that across these two cultures, people with CFS demonstrate biases in how somatic information is attended to and interpreted. These illness-specific biases appear to be unrelated to general attentional control deficits.

     

Psychosocial and Clinical Correlates of Fatigue in Haemodialysis Patients: the Importance of Patients’ Illness Cognitions and Behaviours

Purpose

Fatigue is commonly experienced in end-stage kidney disease (ESKD) and is associated with poor outcomes. Currently, little research has examined the psychosocial correlates of fatigue severity and its impact on renal disease patients. We predicted that psychological factors (distress, cognitions and behaviours) would be associated with fatigue severity and impairment in ESKD patients even when controlling for clinical and disease factors.

Method

One hundred seventy-four haemodialysis patients completed the Chalder Fatigue Questionnaire (fatigue severity) and the Work and Social Adjustment Scale (fatigue-related impairment) in addition to measures evaluating distress, fatigue perceptions, symptom beliefs and behaviours. Demographic and clinical data were also collected.

Results

Fatigue severity was not related to haemoglobin levels, serum albumin or dialysis vintage. In hierarchical regression models, demographic and clinical factors explained 20 % of the variance in fatigue (ethnicity, body mass index, exercise, log C-reactive protein and multimorbidity). Psychological distress (beta?=?0.21, p?<?0.01), negative beliefs about fatigue (beta?=?0.10, p?=?0.01) and unhelpful behaviours (all-or-nothing behaviour [beta?=?0.28, p?<?0.01] and avoidance [beta?=?0.16, p?<?0.01]) explained an additional 36.4 % of the variance. Fatigue-related impairment was associated with psychological distress, perceptions that symptoms indicate damage, avoidance behaviour and the level of fatigue severity.

Conclusion

Patients’ mood, beliefs and behaviours are associated with fatigue in dialysis patients. Psychological interventions to alter these factors may reduce fatigue severity and fatigue-related disability in ESKD patients.

     

Chronic Fatigue Syndrome – A clinically empirical approach to its definition and study

Background

The lack of standardized criteria for defining chronic fatigue syndrome (CFS) has constrained research. The objective of this study was to apply the 1994 CFS criteria by standardized reproducible criteria.

Methods

This population-based case control study enrolled 227 adults identified from the population of Wichita with: (1) CFS (n = 58); (2) non-fatigued controls matched to CFS on sex, race, age and body mass index (n = 55); (3) persons with medically unexplained fatigue not CFS, which we term ISF (n = 59); (4) CFS accompanied by melancholic depression (n = 27); and (5) ISF plus melancholic depression (n = 28). Participants were admitted to a hospital for two days and underwent medical history and physical examination, the Diagnostic Interview Schedule, and laboratory testing to identify medical and psychiatric conditions exclusionary for CFS. Illness classification at the time of the clinical study utilized two algorithms: (1) the same criteria as in the surveillance study; (2) a standardized clinically empirical algorithm based on quantitative assessment of the major domains of CFS (impairment, fatigue, and accompanying symptoms).

Results

One hundred and sixty-four participants had no exclusionary conditions at the time of this study. Clinically empirical classification identified 43 subjects as CFS, 57 as ISF, and 64 as not ill. There was minimal association between the empirical classification and classification by the surveillance criteria. Subjects empirically classified as CFS had significantly worse impairment (evaluated by the SF-36), more severe fatigue (documented by the multidimensional fatigue inventory), more frequent and severe accompanying symptoms than those with ISF, who in turn had significantly worse scores than the not ill; this was not true for classification by the surveillance algorithm.

Conclusion

The empirical definition includes all aspects of CFS specified in the 1994 case definition and identifies persons with CFS in a precise manner that can be readily reproduced by both investigators and clinicians.     

Specificity May Count: Not Every Aspect of Coping Self-Efficacy is Beneficial to Quality of Life Among Chinese Cancer Survivors in China

Background

General self-efficacy has been shown to be a protective factor of cancer survivors’ quality of life (QoL). Coping self-efficacy includes multiple aspects, such as maintaining positive attitudes, regulating emotion, seeking social support, and seeking medical information. How these various aspects are related to multiple domains of QoL is unclear.

Purpose

This study examined the associations between different aspects of coping self-efficacy and QoL among Chinese cancer survivors.

Methods

A sample of 238 Chinese cancer survivors (mean age?=?55.7, 74.4 % female) in Beijing, China participated in the survey. Coping self-efficacy and QoL were measured by the Cancer Behavior Inventory and Quality of Life—Cancer Survivor Instrument.

Results

After controlling for demographic and disease-related variables, hierarchical regression analyses showed that coping self-efficacy in accepting cancer/maintaining a positive attitude was positively associated with physical, psychological, and spiritual QoL. Self-efficacy in affective regulation was positively associated with psychological and social QoL, but negatively associated with spiritual well-being. Self-efficacy in seeking support was positively associated with spiritual well-being, but negatively associated with physical QoL. Self-efficacy in seeking and understanding medical information was negatively associated with psychological and social QoL.

Conclusions

Our findings imply the specificity of coping self-efficacy in predicting QOL. Our findings could be helpful for designing future interventions. Increasing cancer survivors’ self-efficacies in accepting cancer/maintaining a positive attitude, affective regulation, and seeking support may improve cancer survivors’ QoL depending on the specific domains.     

Normalization as a Strategy for Maintaining Quality of Life While Coping with Infertility in a Pronatalist Culture

Purpose

Infertility could be highly stressful, particularly in a pronatalist culture. We aimed to develop the concept and a measure of normalization (maintaining normal life routines and feeling “normal”) as a strategy that could enable women with infertility maintain their quality of life (QoL) while coping with this condition. We tested its associations with women’s well-being, distress and QoL in Israel, where being childless is socially unacceptable and highly stigmatized.

Methods

One-hundred and eighty Israeli women undergoing infertility treatment at a fertility community clinic filled in questionnaires assessing normalization-related coping strategies, QoL, and psychological adjustment (distress, wellbeing). Eight months later, 55 women conceived; 55 women who had not conceived completed a second questionnaire.

Results

At baseline, normalization was related to higher QoL and better adjustment. Structural equation modeling showed that QoL was impaired mainly among women who felt different than others, compared, and blamed themselves. Over time, normalization was overall unrelated to conception or to changes in adjustment yet was protective against decrease in well-being among women who already had a child.

Conclusions

Infertility is highly stressful in a pronatalist culture like Israel. It requires treatment yet is not disabling. Patients who manage to maintain normal routines and not feel different than other people their age may experience better QoL and psychological adjustment.

     

Dimensions of pure chronic fatigue: psychophysical,cognitive and biological correlates in the chronic fatigue syndrome

Objectives

To investigate associated dimensions of fatigue regarding cognitive impairment, psychomotor performances, muscular effort power and circulating cytokine levels and their relations to symptom intensity in a sample of pure chronic fatigue syndrome (CFS) patients without overlapping objective sleepiness or sleep disorders.

Methods

16 CFS patients were compared to 14 matched controls. We assessed structured symptom-scales, polysomnography, multiple sleep latency tests, attention (Zazzo-Cancellation ZCT, digit-symbol-substitution DSST), psychomotor vigilance and speed (PVT, finger tapping test, FTT), dynamometer handgrip force (tonic and phasic trials) and circulating cytokines (IFN-γ, IL-1b, IL-6, IL-8, IL-10, TNF-α).

Results

In addition to fatigue, CFS patients presented with higher affective symptom intensity and worse perceived sleep quality. Polysomnography showed more slow-wave sleep and microarousals in CFS but similar sleep time, efficiency and light-sleep durations than controls. Patients presented with impaired attention (DSST, ZCT), slower reaction times (PVT) but not with lower hit rates (FTT). Notwithstanding lower grip strength during tonic and phasic trials, CFS also presented with higher fatigability during phasic trials. Cytokine levels were increased for IL-1b, IL-8, IL-10 and TNF-α and fatigue intensity was correlated to grip strength and IL-8.

Conclusions

In contrast to sleepiness, chronic fatigue is a more complex phenomenon that cannot be reduced to one single measured dimension (i.e., sleep propensity). Showing its relations to different measurements, our study reflects this multidimensionality, in a psychosomatic disorder such as CFS. To obtain objective information, routine assessments of fatigue should rule out sleepiness, combine aspects of mental and physical fatigue and focus on fatigability.     

Prevalence of DSM-IV Personality Disorders in Patients with Chronic Fatigue Syndrome: A Controlled Study

Background

It is not yet clear whether chronic fatigue syndrome (CFS) is associated with elevated levels of personality disorders.

Purpose

This study aims to determine the prevalence of DSM-IV axis II personality disorders among patients with CFS.

Methods

We examined the prevalence of personality disorders in a sample of 92 female CFS patients and in two well-matched control groups, i.e., normal community individuals (N?=?92) and psychiatric patients (N?=?92). Participants completed the assessment of DSM-IV personality disorders questionnaire (ADP-IV), which yields a categorical and dimensional evaluation of personality disorder features.

Results

The prevalence of personality disorders in CFS patients (16.3 %) was significantly lower than in psychiatric patients (58.7 %) and was similar to that in the community sample (16.3 %). Similar results were found for dimensional and pseudodimensional scores, except for the Depressive (DE) and Obsessive–Compulsive Personality Disorder (O-C) subscales. Patients with CFS had significantly higher levels of DE features compared to normal controls and similar dimensional scores on the O-C scale compared to psychiatric controls.

Conclusions

Although the CFS sample was characterized by depressive and obsessive–compulsive personality features, this study provides no evidence for the assumption that these patients generally show a higher prevalence of axis II pathology. Given the conflicting findings in this area, future studies using multiple measures to assess personality disorders in CFS are needed to substantiate these findings.     

Multiple Somatic Symptoms Predict Impaired Health Status in Functional Somatic Syndromes

Background

The relationship between functional somatic syndromes and multiple somatic symptoms is unclear.

Purpose

We assessed whether the number of somatic symptoms is a predictor of health status in three functional somatic syndromes (FSS).

Methods

In a population-based study of 990 UK adults we assessed chronic widespread pain (CWP), chronic fatigue (CF) and irritable bowel syndrome (IBS) by questionnaire and medical record data. We assessed health status (Short Form 12 and EQ-5D), number of somatic symptoms (Somatic Symptom Inventory) and anxiety/depression (Hospital Anxiety and Depression Scale) both at baseline and at follow-up 1 year later.

Results

The proportion of people with an FSS who also have multiple somatic symptoms (52–55 %) was similar in the three functional syndromes. The presence of multiple somatic symptoms was associated with more impaired health status both at baseline and at follow-up. This finding was not explained by severity of FSS. In the absence of multiple somatic symptoms, the health status of the FSS was fair or good. In multiple regression analysis, the number of somatic symptoms, the presence of a functional syndrome (CWP or CF) and anxiety/depression were predictors of EQ-5D thermometer at follow-up after adjustment for confounders.

Conclusions

Multiple somatic symptoms in people with an FSS are associated with impaired health status and this cannot be explained by more severe functional syndrome or the presence of anxiety and depression.     

An Exploratory Analysis of Fear of Recurrence among African-American Breast Cancer Survivors

Background

Fear of recurrence (FOR) is a psychological concern that has been studied extensively in cancer survivors but has not been adequately examined in African-American breast cancer survivors.

Purpose

This exploratory study describes the extent and nature of FOR in African-American breast cancer survivors. FOR is examined in relation to socio-demographic characteristics, treatment-related characteristics, psychological distress, and quality of life (QOL).

Methods

Participants completed questionnaires assessing FOR, psychological distress, QOL, and demographic and treatment characteristics. Pearson r correlations, t tests, and ANOVAs were used to determine the association between FOR and demographic and treatment-related characteristics. Hierarchical multiple regression models were performed to investigate the degree to which FOR dimensions account for the variance in QOL and psychological distress.

Results

Fifty-one African-American breast cancer survivors participated in this study. The mean age of participants was 64.24 (SD?=?12.3). Overall fears as well as concerns about death and health were rated as low to moderate. Role worries and womanhood worries were very low. Inverse relationships were observed between age and FOR dimensions. FOR was positively correlated with measures of psychological distress and negatively correlated with QOL. FOR significantly accounted for a portion of the variance in QOL and distress after controlling for other variables.

Conclusions

This study suggests that African-American women in this sample demonstrated some degree of FOR. Results indicate that FOR among African-American breast cancer survivors decreases with age and time since diagnosis and co-occurs with psychological distress as well as diminished quality of life.     

Somatic Symptoms and Holistic Thinking as Major Dimensions Behind Modern Health Worries

Background

Modern health worries (MHWs) were related to somatic symptoms and to preference of holistic healing methods in previous studies.

Purpose

The study aimed to investigate the contribution of symptom-related and holism-related factors to MHWs.

Methods

Participants (visitors of an Internet news portal; N?=?16152; 64.1 % males) completed a questionnaire assessing MHWs, somatosensory amplification, somatic symptoms, positive and negative affect, spirituality, holistic health beliefs, and various aspects of health care utilization (both conventional and alternative).

Results

Exploratory factor analysis with oblique rotation revealed two independent dimensions (“Somatic symptom distress” and “Holism”) MHWs were involved with factor loadings of 0.294 and 0.417, respectively. The existence of two factors was supported by the results of confirmatory factor analysis. No practically significant interaction between the two factors was found in binary logistic regression analysis. Positive and negative affect, somatosensory amplification, spirituality, and holistic health beliefs were positively connected, while self-rated health status was negatively connected to MHWs even after controlling for socio-demographic and treatment-related variables.

Conclusions

Holistic thinking and symptom-related behavioral and psychological factors are independently associated with MHWs. Modern health worries can be conceptualized as symptom-related by-products of a holistic–spiritual worldview.     

Self-Efficacy as a Psychological Moderator of Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue and a variety of somatic symptoms. Few studies have examined psychological aspects of CFS. In the present study, self-efficacy is shown to be a significant predictor of CFS symptoms beyond the variance accounted for by demographic variables and distress. Further psychological CFS research is encouraged by (1)identifying dimensions that are salient in the experience and study of CFS, (2) providing preliminary psychometric data for measures of those dimensions, and (3)identifying psychological variables that serve as moderators of the experience of CFS.     

Classifying Fibromyalgia Syndrome as a Mental Disorder?—An Ambulatory Assessment Study

Purpose

Fibromyalgia syndrome (FMS) is associated with psychological distress. The recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) raises the question of whether FMS is classifiable as “somatic symptom disorder” (SSD) and consequently as a mental disorder. To address this, the present ambulatory assessment study focuses on the everyday life occurrence of SSD symptoms in FMS and their predictive value concerning severity indicators of widespread pain.

Method

Ambulatory data were assessed six times daily on 14 consecutive days via iPod. Twenty-eight women suffering from FMS indicated symptoms associated with SSD (somatic illness beliefs, health anxiety, time/energy devoted to pain, or health concerns) and momentary pain levels. Questionnaires regarding potential covariates (such as somatization, depression, health status) were completed at two additional sessions in the research laboratory.

Results

On average, SSD symptoms occurred three to four times daily and were mild to moderate in severity. Furthermore, these symptoms were both concurrently and prospectively associated with momentary pain intensity and subjective impairment by pain. Twenty percent of the variance in pain intensity and 28 % of the variance in subjective impairment were explained by momentary variables (SSD symptoms and intake of pain medication). Eighty-two percent of persons with FMS fulfilled the psychological SSD criterion when considering everyday occurring symptoms with at least mild severity.

Conclusion

FMS might be diagnosed as a mental disorder according to DSM-5 in many cases. SSD symptoms proved to have predictive value for FMS severity and may thus have clinical relevance for diagnostic, prognostic, and intervention purposes.

     

Trajectories of Perceived Emotional and Physical Distress in Patients with an Implantable Cardioverter Defibrillator

Background

Little is known about the course of emotional and physical distress in patients with an implantable cardioverter defibrillator (ICD).

Purpose

We examined (1) trajectories of emotional and physical distress in the first 18 months postimplantation and (2) predictors of these trajectories, including demographical, clinical, and personality factors.

Methods

Dutch patients with an ICD (N?=?645) completed measures on anxiety, depression, somatic symptoms, and perceived disability at the time of implantation, and 2, 12, and 18 months postimplantation. Measures on Type D personality (tendency to inhibit the expression of negative emotions) and anxiety sensitivity (tendency to fear anxiety-related sensations) were also completed at baseline.

Results

Latent class analysis (LatentGOLD) identified six to seven distinct trajectories, varying largely in overall levels of distress, and remaining relatively stable after a small initial decline. Multinomial regression showed that Type D personality and anxiety sensitivity were the most prominent predictors, particularly of trajectories that reflected higher distress levels. Cardiac resynchronization therapy and coronary artery disease also increased the risk for distress, whereas ICD indication and shocks did not.

Conclusions

The course of emotional and physical distress may be relatively stable after ICD implantation. In clinical practice, identification of patients with high risk of higher levels of emotional and physical distress may be warranted; as such, patients with high levels of anxiety sensitivity or a Type D personality should be identified and offered behavioral support.     

Self-regulatory Fatigue in Hematologic Malignancies: Impact on Quality of Life, Coping, and Adherence to Medical Recommendations

Background

Hematopoietic stem cell transplantation (HSCT) is an intensive cancer therapy entailing numerous physical, emotional, cognitive, and practical challenges. Patients’ ability to adjust and cope with such challenges may depend on their ability to exert control over cognitive, emotional, and behavioral processes, that is, ability to self-regulate. Self-regulatory capacity is a limited resource that can be depleted or fatigued (i.e., “self-regulatory fatigue”), particularly in the context of stressful life events such as cancer diagnosis and treatment.

Purpose

This is one of the first studies to examine self-regulatory fatigue in a cancer population. The current study aimed to (1) extract items for a specific scale of self-regulatory capacity and (2) examine the impact of such capacity on adaptation in patients with hematologic malignancies preparing for HSCT.

Methods

Factor analysis of four existing scales gauging psychological adjustment and well-being in 314 patients preparing for HSCT (63% male and 89% Caucasian) identified 23 items (α?=?0.85) related to self-regulatory control or fatigue. This measure was then examined using existing clinical data obtained from 178 patients (57% male and 91% Caucasian) undergoing treatment for hematologic malignancies in relationship to quality of life, coping, and self-reported adherence to physicians’ recommendations.

Results

Controlling for pain severity, physical fatigue, and depression, self-regulatory fatigue scores were incrementally associated with decreased quality of life, use of avoidance coping strategies, and decreased adherence to physicians’ recommendations.

Conclusion

These results emphasize the potential role of self-regulatory capacity in coping with and adjusting to hematologic cancers and future research is warranted.     

The Distinction Between “Medically Unexplained” and “Medically Explained” in the Context of Somatoform Disorders

Purpose

Medically unexplained symptoms (MUS) currently constitute the main diagnostic criterion of somatoform disorders. It has been proposed that the required dichotomization of somatic complaints into MUS and medically explained symptoms (MES) should be abandoned in DSM-V. The present study investigated complaints in the general population in order to evaluate the relevance of a distinction between MUS and MES.

Methods

Three hundred twenty-one participants from a population-based sample were interviewed by telephone to assess symptoms present during the previous 12 months. Complaints were examined in terms of health care use, diagnoses made by the physician and degree of impairment. At the 1-year follow-up, 244 subjects were re-interviewed in order to explore the stability of symptoms.

Results

The complaints frequently prompted participants to seek medical health care (several pain and pseudoneurological symptoms led to a doctors' visit in >80 % of cases), although etiological findings rarely suggested a medical pathology (occasionally <30 %). MUS and MES proved, to an equal degree, to impair individuals and prompt a change in lifestyle. Pain caused the worst impairment compared with other symptoms. The most prevalent MUS and MES were characterized by a transient course (approximately 60 % remitted, 55 % newly emerged to follow-up), although various unexplained pain complaints tended to be persistent (e.g., back pain 67 %). Remarkably, the appraised etiology as explained or unexplained changed from baseline to follow-up in many persisting symptoms (20 % MUS → MES, 50 % MES → MUS).

Conclusions

In principal, MUS and MES resulted in comparable impairment and stability. Due to conceptual and methodological difficulties, classification criteria for somatoform disorders should not be restricted to somatic aspects of the symptomatology.     

Psychosomatic Conditions of the Children and Adolescents Exposed to 5.12 Wenchuan Earthquake

Background

A devastating earthquake registering 8.0 on the Richter Scale struck Wenchuan County in Northwest Sichuan Province in China on May 12, 2008, claiming over 69,200 lives, seriously wounding more than 374,600 people, and rendering more than 18,400 people missing. The epicenter was close to Yingxiu Township in Wenchuan County.

Purpose

This study aimed to investigate the psychosomatic conditions of the children and adolescents exposed to the devastating earthquake and explore the risk factors for psychosomatic symptoms.

Method

A total of 1,828 participants aged 6 to 16 years, of whom 842 from the affected area and 986 from non-affected area, were administered a Psychosomatic Conditions Scale.

Results

Each factor score, total somatic score, total psychological score, and total psychosomatic score of the experimental group were significantly higher than those of the control group (P?<?0.001). Positive correlation was found between the psychological state and somatic symptoms in the experimental group(r?=?0.157?~?0.489, P?<?0.01). Respiratory system, cardiovascular system, nervous system, digestive system, urogenital system, emotion, behavior, and language, combined as a panel, were significantly differentiated between the two groups, accounting for 73.4 % of the total difference. In the experimental group, the factor scores of anxiety, behavior, total psychological score, and total psychosomatic score of the girls were obviously higher than those of the boys (P?<?0.01?~?0.05); most somatic factors and psychological factors, total somatic score, total psychological score, and total psychosomatic score of the elder adolescents were significantly higher than those of the younger children (P?<?0.01?~?0.05).

Conclusion

The children and adolescents exposed to 5.12 earthquake greatly suffered from terrible psychosomatic conditions, among whom the elder girls had more severe symptoms, particularly in terms of anxiety and behavior.     

In Vivo β-Adrenergic Receptor Responsiveness: Ethnic Differences in the Relationship with Symptoms of Depression and Fatigue

Background

Depressive symptoms and fatigue frequently overlap in clinical samples and the general population. The link of depressive symptoms and fatigue with increased risk of cardiovascular disease has been partly explained by shared biological mechanisms including sympathetic overactivity. Prolonged sympathetic overactivity downregulates the responsiveness of the β-adrenergic receptor (β-AR), a receptor that mediates several end-organ sympathetic responses.

Purpose

The authors studied whether depression and fatigue are related to reduced β-AR responsiveness within the human body (in vivo) in an ethnically diverse sample of African and Caucasian Americans.

Methods

The chronotropic₂₅ dose (CD₂₅) was used to determine in vivo β-AR responsiveness in 93 healthy participants. Psychometric measures included the Center of Epidemiological Studies-Depression Scale and the Multidimensional Fatigue Symptom Inventory.

Results

Hierarchical regression analyses (adjusted for age, gender, body mass index, blood pressure, smoking, and ethnicity) revealed that mental fatigue was significantly related to reduced β-AR responsiveness (i.e., higher CD₂₅ values) in the whole sample. Moderation analyses indicated significant ethnicity × depression/fatigue interactions. Depressive symptoms, total fatigue, emotional fatigue, mental fatigue, and physical fatigue were related to reduced β-AR responsiveness in Caucasian American but not in African Americans.

Conclusions

Our findings suggest that symptoms of depression and fatigue are related to decreased in vivo β-AR responsiveness in Caucasian Americans. The lack of this association in African Americans highlights the importance for considering ethnicity as a potential moderator in research focusing on associations between psychological variables and cardiovascular function.