Arch Dis Child doi:10.1136/archdischild-2012-303396
  • Original article

Depression in paediatric chronic fatigue syndrome

  1. Esther Crawley1
  1. 1School of Social and Community Medicine, University of Bristol, Bristol, UK
  2. 2Institute of Psychiatry, King's College London, London, UK
  1. Correspondence to Dr Esther Crawley, Centre for Child and Adolescent Health, School for Social and Community Medicine, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK; esther.crawley{at}
  • Received 14 November 2012
  • Revised 3 March 2013
  • Accepted 24 March 2013
  • Published Online First 25 April 2013


Objective To describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability, pain and school attendance.

Design Cross-sectional survey data using the Hospital Anxiety and Depression Scale (HADS) collected at assessment.

Setting Specialist paediatric CFS/ME service in the South West.

Patients Children aged 12–18 years with CFS/ME.

Main outcome measure Depression was defined as scoring >9 on the HADS depression scale.

Results 542 subjects had complete data for the HADS and 29% (156/542) (95% CI 25% to 33%) had depression. In a univariable analysis, female sex, poorer school attendance, and higher levels of fatigue, disability, pain, and anxiety were associated with higher odds of depression. Age of child and duration of illness were not associated with depression. In a multivariable analysis, the factors most strongly associated with depression were disability, with higher scores on the physical function subscale of the 36 item Short Form (SF-36).

Conclusions Depression is commonly comorbid with CFS/ME, much more common than in the general population, and is associated with markers of disease severity. It is important to screen for, identify and treat depression in this population.

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