Objective: To study the prevalence of fatigue in the general population and its association with psychiatric disorders, somatization, and medical utilization.
Setting: The public-use data tape from the 1984 National Institute of Mental Health Epidemiologic Catchment Area Study.
Participants: Household sample of 18,571 subjects.
Interventions: Structured psychiatric interviews were reviewed to study the prevalences of complaints of current and lifetime fatigue and their relationship to selected psychiatric disorders.
Results: Fatigue has high current (6.7%) and lifetime (24.4%) prevalences in the general population. Medically unexplained fatigue also has high current (6.0%) and lifetime (15.5%) prevalences. When compared with those reporting no current fatigue, subjects who reported current (one-month) fatigue were significantly more likely to have experienced current and lifetime episodes of major depression, dysthymic disorder, panic disorder, and somatization disorder. They also had significantly higher mean numbers of lifetime and current DSM-HI psychiatric diagnoses, medically unexplained physical symptoms (not just fatigue-related symptoms), and visits to health care providers than did patients without current episodes of fatigue.
Conclusions: The high prevalence of fatigue in the general population appears to be significantly associated with increased lifetime and current risk for affective, anxiety, and somatoform disorders, as well as increased utilization of medical services. These data suggest that assessment of both medical and psychological health may be essential for the proper care of patients with fatigue.
fatigue chronic fatigue syndrome psychiatric diagnoses somatization health care utilization
Buchwald D, Sullivan JL, Komaroff A. Frequency of “chronic active Epstein-Barr virus infection” in a general medical practice. JAMA. 1987;257:2303–8.PubMedCrossRefGoogle Scholar
The Health and Lifestyle Survey [British government study]. London: Health Promotion Research Trust, 1987.Google Scholar
Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989;86:262–6.PubMedCrossRefGoogle Scholar
Katon WJ, Buchwald DS, Simon GE, Russo JE, Mease PJ. Psychiatric illness in patients with chronic fatigue and those with rheumatoid arthritis. J Gen Intern Med. 1991;6:277–85.PubMedCrossRefGoogle Scholar
Taerk GS, Toner BB, Salit IE, Garfinkel PE, Ozersky S. Depression in patients with neuromyasthenia (benign myalgic encephalomyelitis). Int J Psychiatry Med. 1987;17:49–56.PubMedCrossRefGoogle Scholar
Wessely S, Powell R. Fatigue syndromes: a comparison of chronic “postviral” fatigue with neuromuscular and affective disorders. 1989;52:940–8.Google Scholar
Kruesi MJP, Dale J, Straus SE. Psychiatric diagnoses in patients who have chronic fatigue syndrome. J Clin Psychiatry. 1989;50:53–6.PubMedGoogle Scholar
Manu P, Lane TJ, Matthews DA. The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue. Ann Intern Med. 1988;109:554–6.PubMedGoogle Scholar
Gold D, Bowden R, Sixbey J, et al. Chronic fatigue. A prospective clinical and virologic study. JAMA. 1990;264:48–53.PubMedCrossRefGoogle Scholar
Wood GC, Bentall RP, Göpfert, Edwards RHT. A comparative psychiatric assessment of patients with chronic fatigue syndrome and muscle disease. Psychol Med. 1991;21:619–28.PubMedGoogle Scholar
Hickie I, Lloyd A, Wakefield D, Parker G. The psychiatric status of patients with the chronic fatigue syndrome. Br J Psychiatry. 1990;156:534–40.PubMedCrossRefGoogle Scholar
Cathebras PJ, Robbins JM, Kirmayer LJ, Hayton BC: Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome. J Gen Intern Med. 1992;7:276–86.PubMedCrossRefGoogle Scholar
Holmes GP, Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988;103:387–9.Google Scholar
Regier DA, Myers JK, Kramer M, et al. The NIMH Epidemiologic Catchment Area program. Arch Gen Psychiatry. 1984;41:934–41.PubMedGoogle Scholar
Robins LN, Helzer JE, Croughan J, et al. National Institute of Health Diagnostic Interview Schedule. Arch Gen Psychiatry. 1981;38:381–9.PubMedGoogle Scholar
George LK, Holzer CE, Skinner EA, Works J, Timbers DM, Munson ML. Data preparation. In: Eaton WW, Kessler LG (eds). Epidemiologic Field Methods in Psychiatry. Orlando, FL: Academic Press, 1985;104.Google Scholar
Escobar JI, Burnham MA, Karno M, et al. Somatization in the community. Arch Gen Psychiatry. 1987;44:713–8.PubMedGoogle Scholar
Hannay D. Symptom prevalence in the community. J R Coll Gen Pract. 1978;28:492–9.PubMedGoogle Scholar
Cheng T. Symptomatology of minor psychiatric morbidity: a cross-cultural comparison. Psychol Med. 1989;19:697–708.PubMedCrossRefGoogle Scholar
Hammond E. Some preliminary findings on physical complaints from a prospective survey of 1,064,004 men and women. Am J Public Health. 1964;54:11–23.CrossRefGoogle Scholar
Smith GR. Somatization disorder in the medical setting. National Institute of Mental Health, 1990. Washington, DC: DHHS Pub. No. (ADM) 90-1631.Google Scholar
Katon WJ, Russo J. Chronic fatigue syndrome criteria: a critique of the requirement for multiple physical complaints. Arch Intern Med. 1992;152:1604–9.PubMedCrossRefGoogle Scholar
Katon WJ, Walker EA. The relationship of chronic fatigue to psychiatric illness in community, primary care and tertiary care samples. Presented at CIBA Foundation Symposium on Chronic Fatigue Syndrome, London, May 1992.Google Scholar