ENERGISE
Research type
Research Study
Full title
ENERGISE: A qualitative study exploring depression and fatigue in adolescents
IRAS ID
302262
Contact name
Nina Higson-Sweeney
Contact email
Sponsor organisation
University of Bath
Duration of Study in the UK
1 years, 2 months, 31 days
Research summary
Research Summary
Feeling fatigued or tired is a common experience in adolescence and is often related to changes that happen during puberty. However, for some adolescents, this feeling of fatigue can be prolonged and last for months or years. This prolonged fatigue is associate with poor outcomes, like high rates school absence and reduced quality of life.Fatigue is also one of the main symptoms of depression, which can often start during adolescence. Previous research suggests fatigue is a common symptom in adolescent depression that is linked with greater depression severity, which may affect an adolescent’s ability to engage in treatment. However, little is known about fatigue from an adolescent’s perspective, and whether fatigue as part of depression is an important symptom to address. The current study therefore aims to explore adolescent’s experiences of fatigue within depression.
NHS clinicians working in Oxford Health CAMHS will identify adolescents within their service who meet the study criteria and will share the study advert. If the patient would like to know more, the clinician will share their contact details with the researcher, who will reach out with more information. If the adolescent would like to proceed, they will complete two short questionnaires to assess eligibility, which will ask questions about their mood, feelings and potential fatigue. A community sample of adolescents will also be recruited through social media and charities.
Once an adolescent has been identified as eligible and agreed to participate (along with their parent if they are under 16 years old), they will take part in an interview with the researcher. Interviews will either be over the telephone or online. The interviews will follow a general structure to explore adolescent’s experiences and knowledge of depression and fatigue and will try to gain an understanding of the impact fatigue may have for depressed adolescents.
Summary of Results
Adolescent depression is a serious public health concern. This is because it is common, associated with many adverse short- and long-term outcomes, and negatively impacts adolescents' quality of life. While current treatments are available, like Cognitive Behavioural Therapy (CBT) and antidepressants, these are only moderately effective at best. This could be because our understanding of adolescent depression is based on adult depression - but we know that there are differences between the two, and it is important to hear directly from adolescents about how they experience depression and the different symptoms.One common symptom of adolescent depression is fatigue (an extreme state of physical and/or mental exhaustion following normal activities). Previous research suggests it is highly disabling and has the potential to interfere with psychological treatments for depression, like CBT. Despite this, fatigue is often not assessed or specifically targeted within Child and Adolescent Mental Health Services (CAMHS) in the UK.
In order to improve the effectiveness of treatments for adolescent depression, it is important that we have a better understanding of how adolescents experience and understand fatigue as a symptom. The current study interviewed 19 adolescents (aged 14-18 years, 58% female) recruited from social media and CAMHS about their experiences of fatigue in depression. The recorded data was transcribed and then analysed using reflexive thematic analysis. Three themes were generated.
Theme 1 (‘Fatigue’ is a complex concept) explored how adolescents make sense of fatigue in the context of depression, and found that while they understood what ‘fatigue’ meant, they would use other terms in day-to-day life, like ‘tired’, ‘drained’, and ‘exhausted’. Adolescents recognised that some tiredness was normal, but that the fatigue they experienced was abnormal, and changed on an hourly, daily, or weekly basis. They also distinguished between two different types of fatigue: physical fatigue, which was easier to identify and could be resolved through activities like resting or napping; and mental fatigue, which was harder to identify, harder to treat, and more closely linked to depression.
Theme 2 (Trapped in a cycle of fatigue) described how adolescents felt trapped in a never-ending cycle, with fatigue at the centre. Many different emotions, activities, and depressive symptoms could make adolescents feel fatigued; in turn, feeling fatigue also made other depressive symptoms, like low mood or irritability, worse. This made it hard for adolescents to disentangle the symptom of fatigue from other depressive symptoms – they were all interconnected.
Adolescents described how this lack of energy prevented them from engaging in everyday activities, like paying attention in school or hanging out with friends. As they didn’t have enough energy to do everything they wanted to do, adolescents felt forced to pick and choose what they did and did not do, and this led to feelings of isolation, guilt, and missing out. They did identify some coping strategies that helped to improve their fatigue, however. These included low-effort activities, like listening to music, and making sure they stayed healthy by eating well and exercising.
Theme 3 (Stigma as a barrier to help-seeking) discussed how, despite the significant impact of fatigue, adolescents were reluctant to seek help for it. This was partially because adolescents seemed to blame themselves for their fatigue, and described feeling like they should be able to push through their tiredness. This reluctance was also because of a lack of understanding from others; because nothing was physically wrong, they shared how their family and friends just thought they were being lazy. Because their fatigue wasn’t taken seriously, adolescents believed that it wasn’t serious enough to take to a healthcare professional, and that they would be wasting the healthcare professional’s time if they did seek support.
Overall, the findings from the study suggest that adolescents experience fatigue in depression as common, complex, and hard to manage, but do not feel able to seek support. The findings have implications for how we can better identify and address fatigue within this population, and hopefully improve the overall effectiveness of treatments for depression.
REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
21/LO/0676
Date of REC Opinion
8 Oct 2021
REC opinion
Favourable Opinion