Findings from Taylor & Jason (2001) study

Taylor, R.R. & Jason, L.A. (2001). Sexual abuse, physical abuse, chronic fatigue, and chronic fatigue syndrome: A community-based study. Journal of Nervous and Mental Disease, 189, 709-715.

Objectives of Our Study In a random community sample unbiased by

help-seeking behavior or self-selection…

• Do rates of abuse vary among individuals with different conditions involving chronic fatigue and healthy controls?

• Do individuals with CFS demonstrate an increased likelihood to report histories of childhood sexual, physical, and death threat abuse?

Methods

• A random community sample of 18,675 adults was screened for CFS symptoms.

• A subset of participants with chronic fatigue and healthy controls underwent full psychiatric and medical evaluation, which included a structured interview assessing childhood and adulthood history of sexual abuse, physical abuse, and death threat.

Diagnoses from Physician Review Panel

• 32 chronic fatigue syndrome (CFS)

• 45 idiopathic chronic fatigue (ICF)

• 56 psychiatrically explained chronic fatigue (CF-Explained-Psychiatric)

• 33 medically explained chronic fatigue

(CF-Explained-Medical)

• 47 controls

Methods

Question 1

Do rates of abuse vary among healthy controls and medically diagnosed fatigue groups?

• Multinomial logistic regression was used to examine the relationship between abuse history and chronic fatigue group outcomes while controlling for the effects of sociodemographic variables.

Results

Childhood Sexual Abuse significantly predicted diagnoses of:

• idiopathic chronic fatigue • chronic fatigue explained - psychiatric• chronic fatigue explained - medical

None of the abuse history types significantly predicted a diagnosis of chronic fatigue syndrome.

Results

Childhood Sexual Abuse

CFS ICF CF-Psych CF-Med Control

16.1% 34.1%** 28.8%* 21.2%* 2.2%

Do individuals with CFS demonstrate an increased likelihood to report histories of childhood abuse?

• A one-way Chi-square test was performed within the CFS group comparing presence versus absence of childhood sexual, physical, and death threat abuse.

Question 2

CFS Group Results

Present Absent X2

Sexual Abuse 16.1% 83.9% 14.23**

Physical Abuse 29.0% 71.0% 5.45*

Death Threat 6.5% 93.5% 23.52**

• Taken together, findings from medical samples (Doyle et al., 1999; Tiersky et al., 1998) and this random epidemiological sample indicate that histories of childhood sexual, physical, or death threat abuse are not implicated in the etiology of chronic fatigue syndrome.

• Other risk factors may be involved in the etiology of CFS, and further research is necessary to explore alternative hypotheses.

Conclusions

Impairment • The ADA definition of impairment is:

1. A major physical or mental impairment that substantially limits one or more major life activities.

2. Having a record of such impairment, such as educational, medical, or employment records.

3. Being “regarded” as having such an impairment.

What does “substantially limits a major life activity” mean?

• Being unable to perform one of the following major life activities:

• breathing, walking, sitting, standing, lifting, reaching, performing manual tasks, caring for oneself, learning, working, etc.

CFS Physical and Mental Impairments

• A person with CFS may have a physical impairment because CFS substantially limits her ability to stand, walk, lift, care for herself, or breathe.

• A person with CFS may have a mental impairment because CFS substantially limits her ability to learn, concentrate, and retain new information.

Social Security Administration

• In April, 1999, SSA issued new regulations defining medically determinable impairment requirements for CFS.

Outcomes of a Consumer-

Driven Rehabilitation Program for Individuals with CFS: A Randomized Clinical Trial

U.S. Department of Education (H133G000097)

CFS Empowerment Project

Study Design and Assessment Intervals

4 MonthsPost Baseline

12 MonthsPost Baseline

16 MonthsPost Baseline

24 MonthsPost Baseline

Recruitment Screening Baseline Assessment

Follow-upAssessment 4

Post 1:1Assessment 3

Post-GroupAssessment 2

Treatment

Post-GroupAssessment 4

BaselineAssessment 3

BaselineAssessment 2

Control

Randomization

Follow -upAssessm ent 5

Post 1:1Assessm ent 5

Goal Setting

Peer Counseling: Group Phase

Peer Counseling: One-on-One Phase

Focus on Empowerment

Independent Living Philosophy

Project Goals

Interdisciplinary Collaboration

Professional Resources

CommunityResources

Project Physician

Biostatistician

Center forIndependent

Living

Local CFSSelf Help Grp

UniversityResearchers

Program Evaluation

Findings from the Taylor (in press) study

Taylor, R.R.. (in press). Quality of Life and Symptom Severity for Individuals with Chronic Fatigue Syndrome: Findings from a Randomized Clinical Trial. American Journal of Occupational Therapy.

Characteristics of the Sample (N = 7)

Characteristics of the Sample

Assessments

• Baseline: CFS screening interview, SCID• Repeated outcome measures:• Quality of Life Index, Craig Handicap

Assessment & Reporting Technique, Chalder Scale, CFS Symptom Rating Form, Illness Management Questionnaire, Service Utilization Checklist, Conservation of Resources Scale

Measures Used

• Quality of Life Index (Ferrans & Powers, 1992)

• CFS Symptom Rating Form (Jason et al., 1997)

• Conservation of Resources Scale (Hobfoll, 1998)

Overall Quality of Life

Overall Quality of Life

Overall Quality of Life

12

13

14

15

16

1 2 3

Assessment

Over

all Q

ualit

y of

Life

Program participants

Controls

Symptom Severity

Symptom Severity

Symptom Severity

12

13

14

15

16

1 2 3

Assessment

Sym

pto

m S

ever

ity

Program Participants

Controls

Evaluating CIL Integration