Chronic fatigue syndrome (CFS) is characterized by severe and disabling fatigue in addition to other disturbances in concentration, short-term memory, sleep disruption, and musculoskeletal pain [
Little is known about the etiology of CFS [
There is considerable evidence to suggest that parental unemployment is associated with a wide range of negative educational, social, health behaviors, and mental health outcomes for children, adolescents, and adults [
Parental unemployment is also associated with lower levels of self-esteem and higher levels of anxiety and mental illness in children and adolescents [
A few panel studies have followed the children of unemployed and employed parents into later adolescence and adulthood to document the long-term social and educational outcomes of parental unemployment [
The literature examining the long-term outcomes of childhood parental unemployment on mental health and health is limited. Kaltiala-Heino and colleagues report that children who have experienced parental unemployment are more likely to experience depression in adulthood [
Although negative health behaviors such as smoking are associated with parental unemployment in childhood [
In this study we examine the association between parental unemployment and subsequent chronic fatigue syndrome, while controlling for a wide range of possible mediating factors including demographics, other childhood adversities, adult stressors and socioeconomic status, adult health behaviors and hypertension, and mental health.
Childhood parental unemployment often occurs with or exacerbates the presence of poverty, physical abuse, sexual abuse, parental mental illness, parental addictions, parental conflict, divorce, step-family situations, and single parent families. A number of adverse childhood experiences have been implicated in the development of chronic fatigue syndrome in adulthood [
Parental unemployment has been associated with adult health behaviors such as smoking [
As documented earlier, childhood experiences of parental unemployment influence adult education, lower household income, job status, daily stress, and divorce [
The long-term impacts of parental unemployment on mental health include but are not limited to depression, anxiety, and lower self-esteem [
It is important to understand the relationship between parental unemployment and CFS in the light of the present economic climate. There are few studies that have examined the long-term health outcomes of childhood parental unemployment. To our knowledge, no studies have examined the link between childhood parental unemployment and CFS. Using a large regionally representative community sample, this study seeks to examine the association between parental unemployment and CFS in adult women, while controlling for risk factors including demographics, other childhood adversities, adult health behaviors and hypertension, adult stressors and SES and mental health.
We conducted a secondary data analysis of female respondents from the Manitoba and Saskatchewan sample of the 2005 Canadian Community Health Survey (
Individuals were also asked to indicate whether they had “long-term conditions lasting six months or more” “that were diagnosed by a health professional.” Specifically they were asked “Do you have chronic fatigue syndrome?” (
We conducted six logistical regression analyses using chronic fatigue syndrome as the dependent variable. The decision about which variables to include was hypothesis driven, based on our review of the literature. In our first and all subsequent models, we controlled for age and race. In the second model we controlled for the number of other childhood adversities including childhood physical abuse, parental divorce, and parental addictions. The third model included adult health behaviours such as obesity, smoking, and alcohol use. In the fourth model we controlled for adult stress and socioeconomic status, which included factors such as self-reported stress, education, and income and marital status (a proxy for social support). The fifth model controlled for mental health conditions that were indicated through self-report of a medical diagnosis of (1) mood disorders and (2) anxiety disorders. Finally we adjusted for all of the above-mentioned risk factors in our last model.
Figure
Odds ratio and 95% confidence interval of chronic fatigue syndrome for women reporting parental unemployment during respondent’s childhood versus individuals reporting parents not unemployed. All data are adjusted for age and race. Sample sizes vary from
Respondents were asked if they had experienced the following stressors during childhood and adolescence: (1) “Were you ever physically abused by someone close to you?” (2) “Did your parents get a divorce?” (3) “Did either of your parents drink or use drugs so often that it caused problems for the family?” Respondents answers were summed to get the number of other childhood adversities. Response could range from 0 other adversities to 3 other adversities.
Body mass index (BMI) was divided into four categories (BMI < 25, overweight, obese, and missing data category). Smoking status was dichotomized as current or former smoker versus never smoked. Hypertension was based on the respondent’s self-report that they had been diagnosed with high blood pressure by a health professional.
Educational attainment, self-reported stress, marital status, and household income were examined under adult stressors. These stressors were categorized as following: educational attainment (<high school graduation, high school graduation, postsecondary graduation); daily stress (no stress to a bit of stress, quite a bit to extreme stress); marital status (not married, married); income (<$15,000, $15,000–$29,999, $30,000–$49,999; $50,000 or more, missing data category).
The two mental health conditions of interest in our study were depression and anxiety disorders. Depression was assessed by self-report of mood disorders to questions. Women were asked (1) “Do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia?” (2) “Do you have an anxiety disorder such as a phobia, obsessive compulsive disorder, or a panic disorder?”.
We found a strong and significant association between long-term parental unemployment in childhood and chronic fatigue syndrome in women (see Figure
Table
Age-race adjusted logistic regression of chronic fatigue syndrome (
Age-race adjusted |
Lower 95% confidence interval | Upper 95% confidence interval | Fully adjusted |
Lower 95% confidence interval | Upper 95% confidence interval | |
---|---|---|---|---|---|---|
Parental unemployment | ||||||
Yes unemployment |
|
2.598 | 6.518 |
|
1.807 | 5.139 |
No unemployment | 1.00 | Reference | Reference | 1.00 | Reference | Reference |
| ||||||
Age by decade | ||||||
12–19 | 1.00 | Reference | Reference | 1.00 | Reference | Reference |
20–29 | 8.436 | 0.584 | 121.778 | 9.206 | 0.625 | 135.687 |
30–39 | 7.401 | 0.507 | 108.045 | 10.261 | 0.679 | 154.970 |
40–49 | 8.092 | 0.561 | 116.664 | 11.934 | 0.795 | 179.210 |
50–59 | 7.992 | 0.551 | 115.954 | 10.154 | 0.667 | 154.491 |
60–69 | 9.608 | 0.651 | 141.844 | 12.884 | 0.825 | 201.224 |
70–79 | 8.109 | 0.538 | 122.152 | 8.891 | 0.594 | 142.607 |
80+ years | 5.614 | 0.342 | 92.087 | 6.987 | 0.407 | 120.004 |
Race (self-report) | ||||||
White |
|
1.695 | 14.136 |
|
1.820 | 16.140 |
Non-White | 1.00 | Reference | Reference | 1.00 | Reference | Reference |
| ||||||
Number of other childhood adversities | 1.289 | 0.990 | 1.677 | |||
| ||||||
Body mass index | ||||||
Underweight or normal (bmi < 25) | 1.00 | Reference | Reference | |||
Overweight | 0.724 | 0.420 | 1.247 | |||
Obese | 1.298 | 0.760 | 2.216 | |||
Missing | 0.312 | 0.069 | 1.408 | |||
High blood pressure | ||||||
Yes | 1.422 | 0.843 | 2.398 | |||
No | 1.00 | Reference | Reference | |||
Smoking status | ||||||
Current or former | 1.035 | 0.648 | 1.655 | |||
Never smoked | 1.00 | Reference | Reference | |||
| ||||||
Education | ||||||
<High school graduate | 1.00 | Reference | Reference | |||
High school grad or some |
|
1.119 | 4.149 | |||
Postsecondary graduation | 1.184 | 0.608 | 2.309 | |||
Household income | ||||||
No or <$15,000 |
|
1.810 | 8.102 | |||
$15,000–$29,999 | 1.378 | 0.634 | 2.992 | |||
$30,000–$49,999 |
|
1.095 | 3.750 | |||
$50,000 or more | 1.00 | Reference | Reference | |||
Missing data |
|
1.591 | 5.722 | |||
Stress level (self-report) | ||||||
Quite a bit to extremely stressed |
|
1.965 | 4.754 | |||
No stress to a bit of stress | 1.00 | Reference | Reference | |||
Marital status | 0.744 | 0.456 | 1.217 | |||
Married | ||||||
Not married | 1.00 | Reference | Reference | |||
| ||||||
Mood disorder | ||||||
Yes | 1.298 | 0.702 | 2.400 | |||
No | 1.00 | Reference | Reference | |||
Anxiety disorder | ||||||
Yes |
|
1.685 | 5.491 | |||
No | 1.00 | Reference | Reference |
This study examined the association between long-term parental unemployment and chronic fatigue syndrome when controlling for other childhood adversities, adult health behaviors, adult stressors, adult socioeconomic status, and adult mental health. We found a strong and significant association between parental unemployment and CFS after adjusting for these factors. Our analysis suggests that adjusting for number of other childhood adversities substantially reduced the parental unemployment-CFS relationship although parental unemployment was still significantly associated with CFS. In the literature, one childhood stressor in particular, physical abuse, has been implicated as an important risk factor for CFS [
Adult health behaviors and hypertension do not appear to affect the relationship between parental unemployment and CFS. Felitti and colleagues suggested that health behaviors were the major pathways that mediated the relationship between adverse childhood experiences such as parental unemployment and adult health conditions [
Including adult stressors resulted in a slight decrease in the relationship between parental unemployment and chronic fatigue syndrome. We anticipated that parental unemployment would lead to lower socioeconomic status and greater distress in adulthood, which in turn would influence CFS. Christoffersen hypothesized that the relationship between parental unemployment and a child’s eventual career trajectory may be mediated through self-esteem and self-image, thus impacting social and economic well-being in adulthood [
Mental health conditions such as mood and anxiety disorders have been strongly linked to both CFS and parental unemployment [
To our knowledge this was the first study to examine the association between parental unemployment and CFS in a large population-based study of women. Even after controlling for the number of other childhood adversities, adult health behaviors and hypertension, adult stressors, socioeconomic status, and adult mental health, there remains a strong relationship between parental unemployment and CFS.
Future research would benefit from examination of the potential role that the hypothalamic-pituitary-adrenal (HPA) axis plays in the relationship between parental unemployment and CFS [
There are a number of limitations to this study. The CCHS survey is a cross-sectional study and therefore does not permit causal analysis of the data. Retrospective data was used to assess childhood parental unemployment; prospective studies would minimize the likelihood of differential recall among participants. Chronic fatigue syndrome status was based on the respondents’ report of a diagnosis by a health professional. The chances of underreporting are high as research suggests that fewer than 20% of individuals with CFS have been diagnosed.
Childhood parental unemployment remained an independent risk factor for chronic fatigue syndrome even after adjustment for most of the known risk factors for CFS. It may therefore be useful for clinicians and researchers to assess patients exhibiting symptoms of CFS for childhood experiences of parental unemployment and other adverse childhood experiences. Future research should also examine the role of other potential risk factors in mediating the relationship between parental unemployment and CFS. The risk factors we examined in this study vary in their importance; however, childhood physical abuse appears to play an important role in development of CFS and should be examined further.
This study provides additional support to the emerging literature on the long-term mental and physical health consequences of parental unemployment. In conjunction with the substantial literature suggesting short-term negative outcomes for the well-being and mental and physical health of the children and adolescents of unemployed parents, the study underlines the urgency of adopting policies and programs to decrease unemployment levels and to provide an expanded social safety net for those who are out of work. The intergenerational transfer of the negative consequences of unemployment makes it imperative that as a nation we move quickly to improve employment opportunities.
This research was conducted, in part, thanks to the first author’s support from the Sandra Rotman Chair Endowment.