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Abstract
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.
- chronic fatigue syndrome
- CFS/ME
- anxiety
- paediatric
- child and adolescent psychiatry
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Footnotes
Contributors ML conceived the study and designed the study protocol. SS, ML, NL, VR and AB did the data search and data synthesis. EC resolved conflicts. SS drafted the manuscript and ML and EC reviewed and edited the manuscript. All authors reviewed the paper before submission.
Funding EC was funded by the NIHR (Senior Research Fellowship, SRFA2013A06A013). Dr Loades is funded by the NIHR (Doctoral Research Fellowship, DRFA2016A09A021). This report is independent research. The views expressed in this publication are those of the authors(s) and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health.
Competing interests EC is a medical advisor for the Sussex & Kent ME/CFS Society. There are no other conflicts of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available. This systematic review is based on published research only. There was no new data collected in this research.