title: 'It's personal to me': A qualitative study of depression in young people with CFS/ME.
abstract: BACKGROUND
  Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has a prevalence of 0.4-2.4% and is defined as 'generalised disabling fatigue persisting after routine tests and investigations have failed to identify an obvious underlying cause'. One-third of young people with CFS/ME have probable depression. Little is known about why depression develops, the relationship between depression and CFS/ME, or what treatment might be helpful.
  
  
  METHODS
  We conducted nine semi-structured interviews with young people with CFS/ME (aged 13-17 years, 8/9 female) and probable depression, covering perceived causes of depression, the relationship between CFS/ME and depression, and treatment strategies.
  
  
  RESULTS
  Most thought CFS/ME caused depression. Many discussed a cyclical relationship: low mood made CFS/ME worse. A sense of loss was common. CFS/ME restricted activities participants valued and changed systemic structures, causing depression. There was no single helpful treatment approach. Individualised approaches using combinations of cognitive behavioural therapy (CBT), medication, activity management and other strategies were described.
  
  
  CONCLUSIONS
  This study suggests that depression may be secondary to CFS/ME in young people because of the impact of CFS/ME on quality of life. Clinicians treating young people with CFS/ME need to consider strategies to prevent development of depression, and research is needed into approaches that are effective in treating CFS/ME with co-morbid depression.
authors.affiliation: 1 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Taylor
authors.affiliation: 2 Department of Psychology, University of Bath, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Loades
authors.affiliation: 1 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Amberly Lc
authors.initials: AL
authors.lastname: Brigden
authors.affiliation: 1 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Collin
authors.affiliation: 1 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK.
authors.forename: Esther
authors.initials: E
authors.lastname: Crawley
mesh_terms: D000293:Adolescent; D003863:Depression / Q000209:etiology* / Q000523:psychology; D015673:Fatigue Syndrome, Chronic / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*
keywords: CFS/ME; Chronic fatigue syndrome; adolescents; depression; young people