Psychosocial Profiles of Adolescents with Chronic Fatigue Syndrome: Correlations with Fatigue Severity and FITNET Treatment Outcome

Abstract

Objectives: To further improve the treatment and prognosis of adolescent chronic fatigue syndrome (CFS), it is essential to consider the heterogeneity of the patient population and identify factors that contribute to treatment effectiveness or are associated with non-recovery. Although Fatigue In Teenagers on the interNET (FITNET) is considered an effective treatment for adolescent CFS, still one-third of the patient population does not recover. Profiles of co-occurring psychosocial factors may suggest potential targets for the treatment of CFS. The aim of this study was 1) to identify these psychosocial profiles in patients with CFS, 2) to assess the associated levels of fatigue before treatment initiation and 3) to examine whether the outcome of FITNET can be predicted using the psychosocial profiles. Methods: Participants were 120 adolescent patients with CFS who underwent FITNET treatment in the Wilhelmina Children’s Hospital (mean age 15.8 years old, 81.7% female). Baseline measurements included a broad set of adolescent and parental psychosocial variables, quantified by (subscales of) validated questionnaires, and adolescent activity levels measured using an actometer. Fatigue score and psychiatric comorbidities were assessed before inclusion. Treatment efficacy was determined by examination of fatigue severity, physical functioning, school presence and self-rated improvement. Exploratory factor analysis and cluster analysis were conducted to identify the psychosocial profiles. Results: Principal factor analysis (oblimin rotation) yielded four factors: Maternal Psychopathology, Paternal Psychopathology, Rearing Behaviour and Child Psychopathology. Cluster analysis based on these four factors identified four profiles: no psychopathology within system (n=57), deviant rearing behaviour (n=24), maternal psychopathology (n=21) and paternal psychopathology (n=18). Among the profiles subgroups, differences were found with respect to depression scores [p=.003] and anxiety scores [p=.002] before therapy, type of disease onset [p=.016] and duration of the symptoms before treatment initiation [p=.014]. High child psychopathology factor scores were related with elevated baseline fatigue scores [p=.048]. High factor scores on Maternal Psychopathology were related with recovery from CFS [p=.040] in subjects that completed all FITNET modules (n=78). The four identified profiles subgroups were neither found to be predicting for fatigue severity before treatment nor for effectiveness of the FITNET intervention. Conclusions: Heterogeneity of CFS among adolescents was indicated by four clinically distinguishable profiles comprised of four factors. However, most included variables were not found to be distinctly predictive for fatigue severity or treatment outcome. Our study did not find an indication to develop personalized treatment forms for the adolescent with CFS, thus application of evidence-based therapy, such as FITNET, remains the preferred decision.