Article

The relationship between prior psychiatric disorder and chronic fatigue: Evidence from a national birth cohort study

Department of Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK.
Psychological Medicine (Impact Factor: 5.43). 08/2008; 38(7):933-40. DOI: 10.1017/S0033291707001900
Source: PubMed

ABSTRACT Increased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms.
A total of 5,362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years.
Thirty-four (1.1%) of the 3,035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26-5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose-response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME.
This temporal, dose-response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.

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    • "It is usually associated with middle age, being female, and having lower education and occupation attainment [4]. Fatigue is common in psychiatric conditions such as anxiety and depression (25–36%) [5] [6] [7] and in chronic medical conditions such as cancer, Parkinson's disease, multiple sclerosis, diabetes, and viral infection [8] [9] [10] [11] [12]. Fatigue worsens with increasing physical disease severity [10] and is independent of medication suggesting that medication itself is not responsible for fatigue. "
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    • "Weitere Risikofaktoren sind frühkindliche Belastungen (Heim et al. 2006), Somatisierungsneigung (Addington et al. 2001) wie auch psychische Störungen im Erwachsenenalter, insbesondere Angst und depressive Störungen (Harvey et al. 2008; Goodwin et al. 2011). Da das CFS bei Frauen deutlich häufiger auftritt als bei Männern (Harvey et al. 2008), ohne dass die Gründe hierfür klar sind, kann schlussendlich auch das weibliche Geschlecht als Risikofaktor gewertet werden. "
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    • "Kato et al. [34] used the registry to examine childhood risks for CFS and found that perceived stress and " emotional instability " are risks for later CFS. This is consistent with birth cohort studies of people who later develop CFS, which show that premorbid psychiatric disorder, particularly depressive and anxiety disorders, are more likely in those who later develop CFS than in those who do not [35]. Furthermore, Heim et al. [36] [37] have replicated their original finding that childhood abuse of any kind is more likely to be reported retrospectively by those with CFS compared to those without. "
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