Findings from Taylor

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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.

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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?

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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.

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Methods

• 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

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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.

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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.

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Results

• Childhood Sexual Abuse
• CFS ICF CF-Psych CF-Med Control
• 16.1 34.1 28.8 21.2 2.2

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Question 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.

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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

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Conclusions

• 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.

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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.

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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.

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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.

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Social Security Administration

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

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Outcomes of a Consumer-Driven Rehabilitation
Program for Individuals with CFS A Randomized
Clinical Trial U.S. Department of Education
(H133G000097)
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CFS Empowerment Project

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Study Design and Assessment Intervals
Baseline Assessment
Recruitment
Screening
Randomization

Control
Treatment
4 Months
Baseline
Post-Group
Post Baseline
Assessment 2
Assessment 2
12 Months
Post 11
Baseline
Post Baseline
Assessment 3
Assessment 3
16 Months
Follow-up
Post-Group
Post Baseline
Assessment 4
Assessment 4
24 Months
Post Baseline
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Goal Setting

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Peer Counseling Group Phase

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Peer Counseling One-on-One Phase

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Focus on Empowerment
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Independent Living Philosophy
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Project Goals
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Interdisciplinary Collaboration
Center for Independent Living
Professional Resources
Community Resources
University Researchers
Project Physician
Biostatistician
Local CFS Self Help Grp
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Program Evaluation
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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.

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Characteristics of the Sample (N 7)

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Characteristics of the Sample

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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

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Measures Used

• Quality of Life Index
  (Ferrans Powers, 1992)
• CFS Symptom Rating Form (Jason
  et al., 1997)
• Conservation of Resources Scale (Hobfoll, 1998)

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Overall Quality of Life

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Overall Quality of Life

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Symptom Severity

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Symptom Severity

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Evaluating CIL Integration