Abstract
Purpose
There are no current psychiatric epidemiological studies examining prevalence estimates of neurasthenia across different racial and ethnic groups in the US. This study compares prevalence rates of International Classification of Diseases (ICD-10) lifetime and 12-month neurasthenia across racial/ethnic groups in the US (Asians, African Americans, Latinos, and non-Latino Whites) and by levels of acculturation. We examine comorbidity of neurasthenia with DSM-IV psychiatric disorders and the association between neurasthenia and impairment.
Methods
We used a pooled sample (N = 10, 118) from two nationally representative household surveys of adults ages 18 years and older: the National Comorbidity Survey-Replication (NCS-R) and the National Latino and Asian American Study (NLAAS).
Results
Among the total sample, the adjusted prevalence rates of lifetime and 12-month neurasthenia with exclusionary criteria were 2.22 and 1.19%. The adjusted prevalence rates for lifetime and 12-month neurasthenia without exclusionary criteria were 4.89 and 2.80%. There were significant racial/ethnic group differences in prevalence for both lifetime and past-year neurasthenia, with Asians reporting significantly lower prevalence of neurasthenia than their non-Latino White counterparts. Less acculturated individuals were at a decreased risk for lifetime and past-year neurasthenia. Lifetime neurasthenia was associated with increased odds of meeting lifetime criteria for any depressive, any anxiety, and any substance use disorder. Respondents with lifetime or past-year neurasthenia had significantly greater levels of impairment compared to those without neurasthenia.
Conclusion
Neurasthenia is a prevalent condition deserving further research attention given its comorbidity with other psychiatric disorders and its association with functional impairment.
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References
Harvey SB, Wessely S, Kuh D, Hotopf M (2009) The relationship between fatigue and psychiatric disorders: evidence for the concept of neurasthenia. J Psychosom Res 66:445–454
Kleinman A (1982) Neurasthenia and depression: a study of somatization and culture in China. Psychosom Med 6:846–849
Rin H, Huang MG (1989) Neurasthenia as nosological dilemma. Cult Med Psychiatry 13:215–226
Abbey SE, Garfinkel PE (1991) Neurasthenia and chronic fatigue syndrome: the role of culture in the making of a diagnosis. Am J Psychiatry 148(12):1638–1646
Bankier B, Aigner M, Bach M (2001) Clinical validity of ICD-10 Neurasthenia. Psychopathology 34:134–139
Merikangas K, Angst J (1994) Neurasthenia in a longitudinal cohort study of young adults. Psychol Med 24:1013–1024
Takeuchi DT, Chun CA, Gong F, Shen H (2002) Cultural expressions of distress. Health 6:221–236
Starcevic V (1999) Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome. Gen Hosp Psychiatry 21:249–255
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders 4th edn. American Psychiatric Association, Washington, DC
WHO (1992) The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. World Health Organization, Geneva
Shi-Fu X, Yan He-Qin, Linden M, Korten A, Sartorius N (1998) Recent developments in the study of prevalence and phenomenology of neurasthenia in general health care across cultures. Hong Kong J Psychiatry 8(1):24–29
Ormel J, VonKorff M, Ustun B, Pini S, Korten A, Oldehinkel T (1994) Common mental disorders and disability across cultures: Results from the WHO collaborative study on psychological problems in general health care. J Am Med Assoc 272(22):1741–1748
Hong W, Chan L, Zheng D, Wang C (1992) Neurasthenia in Chinese students at UCLA. Psychiatr Ann 22(4):199–201
Lee S, Wong KC (1995) Rethinking neurasthenia: The illness concepts of shenjing shuairuo among Chinese undergraduates in Hong Kong. Cult Med Psychiatry 19:91–111
Zheng Y, Lin K, Yamamoto J, Zheng D, Nakasaki G, Ferng H (1996) Neurasthenia in Chinese students and visiting scholars in the United States. Psychiatr Ann 22:194–198
Zheng Y, Lin K, Takeuchi D, Kurasaki KS, Wang Y, Cheung F (1997) An epidemiological study of neurasthenia in Chinese-Americans in Los Angeles. Compr Psychiatry 38(5):249–259
Ajdacic-Gross V, Horvath S, Canjuga M, Gamma A, Angst J, Rössler W, Eich D (2006) How ubiquitous are physical and psychological complaints in young and middle adulthood: a longitudinal perspective. Soc Psychiatry Psychiatr Epidemiol 41:881–888
Heun R, Müller HJ, Freyberger W, Maier W (1998) Reliability of interview information in a family study in the elderly. Soc Psychiatry Psychiatr Epidemiol 33:140–144
Hickie I, Davenport T, Issakidis C, Andrews G (2002) Neurasthenia: prevalence, disability and health care characteristics in the Australian community. Br J Psychiatry 181:56–61
Mundt AP, Fakhriddinov S, Fayzirahmanova M, Aichberger MC, Ivens S, Schouler-Ocak M, Grohmann R, Magzumova S, Heinz A, Sartorius N, Ströhle A (2011) Use of psychiatric inpatient capacities and diagnostic practice in Tashkent/Uzbekistan as compared to Berlin/Germany. Soc Psychiatry Psychiatr Epidemiol 46:1295–1302
Paralikar V, Sarmukaddam S, Agashe M, Weiss MG (2007) Diagnostic concordance of neurasthenia spectrum disorders in Pune, India. Soc Psychiatry Psychiatr Epidemiol 42:561–572
Starcevic V, Kelin K, Munjiza M (1996) Characteristics of neurasthenia: examination and cross-cultural applicability of ICD-10 diagnostic criteria for research. Eur J Psychiatry 11:289–297
Lee S, Kleinman A (2007) Are somatoform disorders changing with time? The case of neurasthenia. Psychosom Med 69:846–849
Lewis- Fernández R, Kleinman A (1994) Culture, personality, and psychopathology. J Abnorm Psychol 103(1):67–71
Koehn PH (2006) Globalization, migration health, and educational preparation for transnational medical encounters. Glob Health 2:2. doi:10.1186/1744-8603-2-2
Schwartz PY (2002) Why is neurasthenia important in Asian cultures? West J Med 176(4):257–258
Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E, Jin R, Pennell B, Walters EE, Zaslavsky A, Zheng H (2004) The US National Comorbidity Survey Replication (NCS-R): design and field procedures. Int J Methods Psychiatr Res 13(2):69–92
Alegría M, Takeuchi D, Canino G, Duan H, Shrout P, Meng X, Vega W, Zane N, Vila D, Woo M, Vera M, Guarnaccia P, Aguilar-Gaxiola S, Sue S, Escobar J, Lin K, Gong F (2004) Considering context, place and culture: The National Latino and Asian American Study. Int J Methods Psychiatr Res 13(4):208–220
Heeringa SG, Wagner J, Torres M, Duan N, Adams T, Berglund P (2004) Sample designs and sampling methods for the collaborative psychiatric epidemiology studies. Int J Methods Psychiatr Res 13(4):221–240
Pennell B, Bowers A, Carr D, Chardoul S, Cheung G, Dinkelmann K, Gebler N, Hansen SE, Pennell S, Torres M (2004) The development and implementation of the National Comorbidity Survey Replication, the National Survey of American Life, and the National Latino and Asian American Survey. Int J Methods Psychiatr Res 13(4):241–269
Alegría M, Vila D, Woo M, Canino G, Takeuchi D, Vera M, Febo V, Guarnaccia P, Aguilar-Gaxiola S, Shrout P (2004) Cultural relevance and equivalence in the NLAAS instrument: integrating etic and emic in the development of cross-cultural measures for a psychiatric epidemiology and services study of Latinos. Int J Methods Psychiatr Res 13(4):270–288
Kessler RC, Üstün TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13(2):93–121
Sadock VA, Kaplan HI (2007) Kaplan and Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry, 10th edn edn. Lippincott Williams & Wilkins, Philadelphia, PA
Chisolm TH, Abrams HB, McArdle R, Wilson RH, Doyle PJ (2005) The WHO-DAS II: psychometric properties in the measurement of functional health status in adults with acquired hearing loss. Trends Amplification 9(3):111–126
StataCorp (2007) Stata Statistical Software: Release 10. StataCorp LP College Station, TX
Stubhaug B, Tveito TH, Eriksen HR, Ursin H (2005) Neurasthenia, subjective health complaints and sensitization. Psychoneuroendocrinology 30:1003–1009
Cao Y, Zhang Y, Chang DF, Wang G, Zhang X (2009) Psychosocial and immunological factors in neurasthenia. Psychosomatics 50(1):24–29
Lee S (1994) The vicissitudes of neurasthenia in Chinese societies: where will it go from the ICD-10? J Transcult Psychiatry 31:153–172
Lee S, Yu H, Wing Y, Chan C, Lee A, Lee D, Chen C, Lin K, Weiss MG (2000) Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong. Am J Psychitry 157(3):380–384
Jasso G, Massey DS, Rosenzweig MR, Smith JP (2004) Immigrant health: selectivity and acculturation. In: RAND The Institute for Fiscal Studies. California
Kalibatseva Z, Leong FTL (2011) Depression among Asian Americans: review and recommendations. Depress Res Treat doi:10.1155/2011/320902
Parker G, Chan B, Hadzi-Pavlovic D (2007) Lower rates of depression in westernized Chinese in the US. J Affect Disorders 104:175–178
Takeuchi DT, Zane N, Hong S, Chae DH, Gong F, Gee GC, Walton E, Sue S, Alegría M (2007) Immigration-related factors and mental disorders among Asian Americans. Am J Public Health 97:84–90
Guarnaccia PJ, Lewis- Fernández R, Pincay IM, Shrout P, Guo J, Torres M, Canino G, Alegría M (2009) Ataque de nervios as a marker of social and psychiatric vulnerability: results from the NLAAS. Int J Soc Psychatr 56(3):298–309
Alegría M, Woo M, Takeuchi D, Jackson J (2009) Ethnic and racial-group specific considerations. In: Ruiz P, Primm AB (eds) Disparities in psychiatric care: clinical and cross-cultural perspectives. Lippincott Williams & Wilkins, Maryland, pp 306–318
Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G (2007) Prevalence of psychiatric disorders across Latino subgroups in the United States. Am J Public Health 97:68–75
Canino G, Alegría M (2008) Psychiatric diagnosis-is it universal or relative to culture? J Child Psychol Psychiatry 49(3):237–250
Zhang W, Lee L-C, Connor KM, Chang C-M, Lai T-J, Davidson JRT (2007) Symptoms of neurasthenia following earthquake trauma: re-examination of a discarded syndrome. Psychiatry Res 153(2):171–177
Alegría M (2009) The challenge of acculturation measures: What are we missing? A commentary on Thomson & Hoffman-Goetz. Soc Sci Med 69(7):996–998
Kawanishi Y (1992) Somatization of Asians: an artifact of Western medicalization? J Transcult Psychiatry 29:5–36
Lee S (2002) Socio-cultural and global health perspectives for the development of future psychiatric diagnostic systems. Psychopathology 35:152–157
Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C (2005) Chronic fatigue syndrome: the need for subtypes. Neuropsychol Rev 15(1):29–58
Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR, McCready W, Huang C-F, Plioplys S (1999) A community-based study of chronic fatigue syndrome. Arch Intern Med 159:2129–2137
Hanel G, Henningsen P, Herzog W, Sauer N, Schaefert R, Szecsenyi J, Lowe B (2009) Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res 67:189–197
Kroenke K, Spitzer RL, deGruy III FV, Hahn SR, Linzer M, Williams JBW, Brody D, Davies M (1997) Multisomatoform disorder: an alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry 54(4):352–358
Lieb R, Meinlschmidt G, Araya R (2007) Epidemiology of the association between somatoform disorders and anxiety and depressive disorders: an update. Psychosom Med 69:860–863
Escobar JI, Gureje O (2007) Influence of cultural and social factors on the epidemiology of idiopathic somatic complaints and syndromes. Psychosom Med 69:841–845
Regier DA (2007) Somatic presentations of mental disorders: refining the research agenda for DSM-V. Psychosom Med 69:827–828
Acknowledgments
This study was supported by NIH Research grant no. 1P50 MHO 73469 funded by the National Institute of Mental Health and no. P60 MD0 02261 (NCMHD), funded by the National Institute on Minority Health and Health Disparities. Work for this article was done in part while the first author was a predoctoral fellow at the Center for Multicultural Mental Health Research. The first author was partially supported by a National Science Foundation Graduate Fellowship and by a postdoctoral fellowship through a Kirstein-NRSA Training Grant #T32HL007426 from the National Heart, Lung and Blood Institute.
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Molina, K.M., Chen, CN., Alegría, M. et al. Prevalence of neurasthenia, comorbidity, and association with impairment among a nationally representative sample of US adults. Soc Psychiatry Psychiatr Epidemiol 47, 1733–1744 (2012). https://doi.org/10.1007/s00127-012-0489-6
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DOI: https://doi.org/10.1007/s00127-012-0489-6