Prevalence and Correlates of Prolonged Fatigue in a U.S. Sample of Adolescents

Lamers, Femke; Hickie, Ian B.; Merikangas, Kathleen R.

doi:10.1176/appi.ajp.2012.12040454

Cited by 45 publications

(34 citation statements)

References 32 publications

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“…Tension type headaches and chronic daily headaches in our study are also more common than the 10– 25 % and 3.5 % reported in adolescents [24, 25]. The prevalence of fatigue in our cohort is similar to that reported in ALL survivors and more than that reported in healthy adolescents [26, 27]. We found neuropathy to be less prevalent than that reported by Ramchandren et al but they had only 37 ALL survivors in their cohort [28].…”

Section: Resultssupporting

confidence: 85%

Neurologic morbidity and quality of life in survivors of childhood acute lymphoblastic leukemia: a prospective cross-sectional study

et al. 2014

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Purpose Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs and neurologic complications in long-term survivors are inadequately studied. This study investigated neurologic morbidity and its effect on quality of life in long-term survivors of childhood ALL. Methods Prospective, single institution, cross-sectional, institutional review board-approved study of long-term ALL survivors. Participants were recruited from institutional clinics. Participants answered an investigator-administered questionnaire followed by evaluation by a neurologist. Quality of life (QOL) was also assessed. Results Of the 162 participants recruited over a 3-year period, 83.3 % reported at least one neurologic symptom of interest, 16.7 % had single symptom, 11.1 % had two symptoms, and 55.6 % had three or more symptoms. Symptoms were mild and disability was low in the majority of participants with neurologic symptoms. Median age at ALL diagnosis was 3.9 years (0.4–18.6), median age at study enrollment was 15.7 years (6.9–28.9), and median time from completion of ALL therapy was 7.4 years (1.9–20.3). On multivariable analyses, female sex correlated with presence of dizziness, urinary incontinence, constipation, and neuropathy; use of≥10 doses of triple intrathecal chemotherapy correlated with uri-nary incontinence, back pain, and neuropathy; cranial radiation with ataxia; history of ALL relapse with fatigue; and CNS leukemia at diagnosis with seizures. Decline in mental QOL was associated with migraine and tension type headaches, while physical QOL was impaired by presence of dizziness and falls. Overall, good QOL and physical function was maintained by a majority of participants. Conclusions Neurologic symptoms were present in 83 % long-term ALL survivors. Symptoms related morbidity and QOL impairment is low in majority of survivors. Female sex, ≥10 doses of intrathecal chemotherapy, and history of ALL relapse predispose to impaired QOL. Implications for Cancer Survivors This study will educate survivors and their care providers regarding cancer or treatment-related neurologic symptoms and morbidity. This study will help them understand factors contributing to impaired QOL when present.

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Section: Resultssupporting

confidence: 85%

Neurologic morbidity and quality of life in survivors of childhood acute lymphoblastic leukemia: a prospective cross-sectional study

et al. 2014

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“…Fatigue has also been associated with lower cortisol responses to stress in non-depressed adults (Lennartsson et al, 2015). Understanding the mechanisms linking fatigue and blunted cortisol reactivity is critical given that depressed adolescents with prolonged fatigue exhibited greater disability and health service use than adolescents with either prolonged fatigue or depression alone (Lamers et al, 2013). The relative impact of insomnia versus hypersomnia and increased versus decreased appetite on cortisol responses could not be addressed because all symptoms were included in the neurovegetative composite.…”

Section: Discussionmentioning

confidence: 99%

Depressive symptom composites associated with cortisol stress reactivity in adolescents

Morris

Kouros

Mielock

et al. 2017

Journal of Affective Disorders

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Background Altered hypothalamic-pituitary-adrenal (HPA) function is common in youth with major depressive disorder (MDD) but variability in the strength and direction of HPA alterations has prompted a search for symptom-based subtypes with unique neuroendocrine signatures. This study investigated the extent to which depressive symptom composites were differentially associated with cortisol responses to psychosocial stress. Methods This study examined salivary cortisol responses to the Trier Social Stress Test (TSST) in 145 adolescents who varied in their risk for MDD: 38 had current MDD; 35 were healthy but at high risk for MDD based on having one or both parents with unipolar MDD; and 72 were healthy youth with no personal or family history of a psychiatric disorder. Multilevel models examined within-person change in cortisol levels during a 2-hour resting phase prior to the TSST and both linear and quadratic changes in cortisol levels following the TSST. Results Anticipatory cortisol reactivity was lower in MDD youth compared to low-risk youth, and in youth with higher compared to lower depressive symptom severity. Whereas affective symptoms were associated with increased anticipatory cortisol reactivity and more rapid recovery to the TSST, neurovegetative symptoms were associated with decreased anticipatory cortisol reactivity and slower recovery. Limitations The cross-sectional design does not permit inferences regarding temporal relations between cortisol responses and depressive symptom composites. Conclusions The present findings suggest that heterogeneity among studies examining HPA reactivity in depressed youth may be driven, in part, by differences in depressive symptom composites across samples.

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“…7 Chronic fatigue of at least 3 months' duration affects 2% to 3% of children and young people aged 8 to 18 years. [8][9][10] Population-based studies in the United Kingdom and the United States have reported a prevalence of 1.3% for fatigue of ≥6 months' duration. 8,9,11 Although clinician-verified CFS seems to be less prevalent (0.1%-0.5%), [12][13][14] this discrepancy is almost certainly a consequence of referral pathways and barriers to accessing clinical services.…”

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confidence: 99%