title: Maternal and childhood psychological factors predict chronic disabling fatigue at age 13 years.
abstract: OBJECTIVE
  To investigate whether premorbid maternal and childhood psychological problems are risk factors for chronic disabling fatigue at age 13 years among children in the Avon Longitudinal Study of Parents and Children birth cohort.
  
  
  METHODS
  Chronic disabling fatigue was defined as fatigue of at least 3-month, and up to 5-year, duration that prevented school attendance or hobbies/sport/leisure activities, and for which other causes were not identified. Maternal psychological factors were symptoms of anxiety and depression assessed up to eight times between pregnancy and age 6 years. We investigated critical periods for maternal effects and effects of paternal depression at three time points. Child psychological factors included internalizing and externalizing problems and upsetting life events occurring at age 7-8 years.
  
  
  RESULTS
  Of 5,657 children, 110 (1.9%) had chronic disabling fatigue at age 13 years. Maternal anxiety (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.09-1.31 per episode), maternal depression (AOR, 1.24; CI, 1.11-1.39 per episode), child psychological problems (AOR, 1.19; CI, 1.00-1.41 per problem), and upsetting events (AOR, 1.22; CI, .99-1.58 per event) were associated with chronic disabling fatigue. Associations of child psychological problems and upsetting events were attenuated (AOR, 1.12; CI, .93-1.33 per problem; AOR, 1.19; CI, .94-1.52 per event) after further adjusting for maternal anxiety and depression.
  
  
  CONCLUSIONS
  Pediatricians need to be aware that children whose mothers experience anxiety and/or depression between pregnancy and child's age 6 years have an increased risk of developing chronic disabling fatigue in early adolescence. Conversely, clinicians need to be alert to fatigue in children whose mothers have longstanding anxiety and depression. These findings suggest the importance of family-based approaches to treatment.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom. Electronic address: simon.collin@bristol.ac.uk.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Collin
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Tilling
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom.
authors.forename: Carol
authors.initials: C
authors.lastname: Joinson
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Rimes
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Pearson
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Hughes
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom.
authors.forename: Esther
authors.initials: E
authors.lastname: Crawley
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000150:complications* / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications* / Q000453:epidemiology; D015673:Fatigue Syndrome, Chronic / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000523:psychology*; D012307:Risk Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Childhood adversity; Chronic fatigue syndrome; Maternal depression; Pediatric fatigue