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What treatments work for anxiety in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)?
Sarah Victoria Ellen Stoll1, Esther Crawley1, Victoria Richards1
1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Insights
Anxiety is common in pediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This review found no definitive treatments for children with both conditions, highlighting the need for further research into effective anxiety management strategies.
Area of Science:
- Pediatric Health
- Mental Health
- Chronic Illness Management
Background:
- Anxiety is more prevalent in children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) compared to the general population.
- Effective treatment strategies for comorbid anxiety in pediatric CFS/ME are not well-established.
Purpose of the Study:
- To systematically review and identify effective treatment methods for children diagnosed with CFS/ME and anxiety.
- To synthesize evidence on interventions targeting anxiety in pediatric CFS/ME patients.
Main Methods:
- A systematic review was conducted using multiple databases (Cochrane Library, Medline, Embase, psychINFO).
- Included studies involved participants under 18 with CFS/ME and anxiety, encompassing observational studies and randomized controlled trials.
- Outcomes focused on changes in anxiety status or severity from pre- to post-treatment.
Main Results:
- Nine papers from eight studies met the inclusion criteria.
- No studies specifically targeted anxiety; six measured it as a secondary outcome.
- Four studies using cognitive behavioral therapy (CBT)-type approaches, one behavioral approach, and one gammaglobulin trial reported improvements in anxiety. However, data stratification was insufficient to determine treatment efficacy for comorbid anxiety.
Conclusions:
- Current evidence is insufficient to recommend specific treatments for children experiencing both anxiety and CFS/ME.
- Further research is critically needed to identify and validate effective interventions for this population.
Objectives:
Anxiety is more prevalent in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) than in the general population. A systematic review was carried out to identify which treatment methods are most effective for children with CFS and anxiety.
Design:
Systematic review using search terms entered into the Cochrane library and Ovid to search the databases Medline, Embase and psychINFO.
Participants:
Studies were selected if participants were <18 years old, diagnosed with CFS/ME (using US Centers for Disease Control and Prevention, the National Institute for Health and Care Excellence or Oxford criteria) and had a valid assessment of anxiety.
Interventions:
We included observational studies and randomised controlled trials.
Comparison:
Any or none.
Outcomes:
Change in anxiety diagnostic status and/or change in anxiety severity on a validated measure of anxiety from pretreatment to post-treatment.
Results:
The review identified nine papers from eight studies that met the inclusion criteria. None of the studies specifically targeted anxiety but six studies tested an intervention and measured anxiety as a secondary outcome. Of these studies, four used a cognitive behavioural therapy (CBT)-type approach to treat CFS/ME, one used a behavioural approach and one compared a drug treatment, gammaglobulin with a placebo. Three of the CBT-type studies described an improvement in anxiety as did the trial of gammaglobulin. As none of the studies stratified outcomes according to anxiety diagnostic status or severity, we were unable to determine whether anxiety changed prognosis or whether treatments were equally effective in those with comorbid anxiety compared with those without.
Conclusion:
We do not know what treatment should be offered for children with both anxiety and CFS/ME. Further research is therefore required to answer this question.
Trial Registration Number:
This review was registered on Prospective Register of Systematic Review Protocols (PROSPERO) and the protocol is available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016043488.
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