Journal of Behavioral Medicine

, Volume 22, Issue 6, pp 549–573 | Cite as

Complaints of Fatigue: Related to Too Much as Well as Too Little External Stimulation?

  • Angelique E. de Rijk
  • Karlein M. G. Schreurs
  • Jozien M. Bensing
Article

Abstract

Fatigue has been acknowledged as a widespread problem associated with a variety of factors. In the present paper, we attempt to explain fatigue complaints on the basis of Pennebaker's (1982) “competition of cues” notion. Competition of cues suggests that both extremely low and extremely high levels of external stimulation in daily life may be related to relatively higher frequencies of complaint. The dimensional structure of external stimulation is first explored and then the shape of the relation between external stimulation (i.e., stimuli perceived in daily life) and fatigue was studied in a sample of 777 general-practice patients. Other risk factors for fatigue and moderating factors are also taken into consideration. Results show that quantity and quality of external stimulation can be distinguished. Both high quantity (high “experienced overload”) and low quality (low “attractiveness of external stimulation”) are related to higher fatigue frequencies. “Experienced overload” is a particularly strong predictor, in addition to “perceived health” of fatigue complaints. It is concluded that the “quality-quantity model for understanding fatigue” proposed here highlights psychological factors important for any theoretical framework of fatigue.

FATIGUE EXTERNAL STIMULATION COMPETITION OF CUES DEMANDS EXTERNAL INFORMATION 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. Abbey, S. E. (1993). Somatization, illness attribution and the sociocultural psychiatry of chronic fatigue syndrome. Ciba Found. Symp. 173: 238-261.Google Scholar
  2. Bensing, J., Hulsman, R., and Schreurs, K. (1996). Vermoeidheid: een chronisch probleem [Fatigue: Chronic problem]. Medisch Contact 4: 123-124 (in Dutch).Google Scholar
  3. Bensing, J., Hulsman, R., and Schreurs, K. (1999). Gender differences in fatigue: An empirical study into the biopsychosocial factors of fatigue in men and women. Med. Care (in press).Google Scholar
  4. Berkowitz, A. D., and Perkins, H. W. (1984). Stress among farm women: Work and family as interacting systems. J. Marriage Family 46(1): 161-166.Google Scholar
  5. Berkowitz, A. D., and Perkins, H. W. (1985). Correlates of psychosomatic stress symptoms among farm women: A research note on farm and family functioning. J. Hum. Stress 11(2): 76-81.Google Scholar
  6. Cathébras, P., Jacquin, L., le Gal, M., Fayol, C., Bouchouand, K., and Rousset, H. (1995). Correlates of somatic causal attributions in primary care patients with fatigue. Psychother. Psychosom. 63: 174-180.Google Scholar
  7. CBS (1998). Vademecum gezondheidsstatistiek Nederland 1997 [Referencebook Health Statistics The Netherlands 1997], CBS, Voorburg.Google Scholar
  8. David, A., Pelosi, A., McDonald, E., Stephens, D., Ledger, D., Rathbone, R., and Mann, A. (1990). Tired, weak or in need of a rest: Fatigue among general practice attenders. BMJ 301: 1199-1202.Google Scholar
  9. Davies, S. W., and Lipkin, D. (1996). Fatigue. In Weatherall, D. J., Ledigham, J. G. G., and Warrel, D. A. (eds.), Oxford Textbook of Medicine, Vol. II, 3rd ed., Oxford University Press, Oxford, pp. 2171-2173.Google Scholar
  10. Dinant, G. J., van Wijk, M. A. M., Janssens, H. J. E. M., Somford, R. G., de Jager, C. J., Beusmans, G. H. M. I., Dijkstra, R. H., and Wiersma, Tj. (1994). NHG-standaard Bloedonderzoek: Algemene principes en uitvoering in eigen beheer [Dutch Family Practitioners Association-standard for blood test: General principles and performance in own practice]. Huisarts & Wetenschap. 37: 202-211 (in Dutch).Google Scholar
  11. Finkelman, J. M. (1994). A large database study of the factors associated with work-induced fatigue. Hum. Factors 36: 232-243.Google Scholar
  12. Foets, M., and van der Velden, J. (1990). Een nationale studie van ziekten en verrichtingen in de huisartspraktijk. Basisrapport: meetinstrumenten en procedures [A national study of morbidity and intervention in general practice. Basic report: measures and procedures], Nivel, Utrecht.Google Scholar
  13. Frankenhaeuser, M. (1981). Coping with stress at work. Int. J. Health Serv. 11: 491-510.Google Scholar
  14. Frankenhaeuser, M. (1986). A psychobiological framework for research on human stress and coping. In Appley, M. H., and Trumbull, R. (eds.) Dynamics of Stress, Plenum, New York, pp. 101-106.Google Scholar
  15. Frankenhaeuser, M. (1989). A biopsychological approach to work life issues. Int. J. Health Serv. 19: 747-758.Google Scholar
  16. Fuhrer, R., and Wessely, S. (1995). The epidemiology of fatigue and depression: A French primarycare study. Psychol. Med. 25: 895-905.Google Scholar
  17. Giesen, C. W. M. (1991). Werkverhoudingen en stress op het boerenbedriff [Work relations and stress on farms], Doctoral dissertation, Amsterdam (in Dutch).Google Scholar
  18. Gijsbers van Wijk, C. M. T., and Kolk, A. M. M. (1995). Psychometric evaluation of symptom perception related measures. Pers. Indiv. Diff. 22: 55-70.Google Scholar
  19. Gijsbers van Wijk, C. M. T., and Kolk, A. M. M. (1997a). Sekseverschillen in gezondheidsbeleving [Sex differences in perceived health]. Ned. Tijdschr. Geneeskd. 141(6): 283-287 (in Dutch; English abstract).Google Scholar
  20. Gijsbers van Wijk, C. M. T., and Kolk, A. M. M. (1997b). Sex differences in physical symptoms: The contribution of symptom perception theory. Soc. Sci. Med. 45(2): 231-246.Google Scholar
  21. Groenendijk, H. (1998). Werken en zorgen: de moeite waard [Working and caring: The effort worth combining], Doctoral dissertation, Erasmus University Rotterdam, Rotterdam (in Dutch).Google Scholar
  22. Hennen, B. K. (1987). Fatigue. In Shires, D. B., Hennen, B. K., and Rice, D. I. (eds.), Family Medicine: A Guidebook for Practitioners of the Art, 2nd ed., McGraw-Hill, New York, pp. 172-179.Google Scholar
  23. Jackson, T., Iezzi, A., and Lafreniere, K. (1997). The impact of psychosocial features of employment status on emotional distress in chronic pain and healthy comparison samples. J. Behav. Med. 20: 241-256.Google Scholar
  24. Kirk, J., Douglas, R., Nelson, E., Jaffe, J., Lopez, A., Ohler, J., Blanchard, C., Chapman, R., McHugo, G., and Stone, K. (1990). Chief complaint of fatigue: A prospective study. J. Family Pract. 30: 33-41.Google Scholar
  25. Knottnerus, J. A., Knipschild, P. G., van Wersch, J. W. J., and Sijstermans, A. H. J. (1986). Unexplained fatigue and hemoglobin: A primary care study. Can. Family Phys. 32: 1601-1604.Google Scholar
  26. Kroenke, K., Wood, D. R., Mangelsdorff, A. D., Meier, N. J., and Powel, J. B. (1988). Chronic fatigue in primary care: Prevalence, patient characteristics, and outcome. JAMA 7: 929-934.Google Scholar
  27. Lewis, G., and Wessely, S. (1992). The epidemiology of fatigue: More questions than answers. J. Epid. Commun. Health 46: 92-97.Google Scholar
  28. McPhee, S. J., and Schroeda, S. A. (1996). General approach to the patient; Health maintenance & disease prevention; & common symptoms. In Tierney, L. M., McPhee, S. J., and Papadakis, M. A. (eds.), Current Medical Diagnosis & Treatment 1996, 35th ed., Prentice Hall, London, pp. 23-25.Google Scholar
  29. McWhinney, J. (1989). Textbook of Family Medicine, Oxford University Press, Oxford, pp. 260-277.Google Scholar
  30. Meijman, T. F. (1991). Over vermoeidheid [On fatigue], Doctoral dissertation, Study Center for Work and Health/ Coronel Laboratorium, Groningen /Amsterdam (in Dutch).Google Scholar
  31. Meijman, T., and Schaufeli, W. (1996). Psychische vermoeidheid en arbeid [Psychological fatigue and work]. De Psycholoog. 6: 236-241 (in Dutch; English abstract).Google Scholar
  32. Morrison, J. D. (1980). Fatigue as a presenting complaint in family practice. J. Family Pract. 10: 795-801.Google Scholar
  33. Murtagh, J. (1994). Tiredness. In Murtagh, J. (ed.), General Practice, McGraw-Hill, Sydney, pp. 613-621.Google Scholar
  34. Pawlikowska, T., Chalder, T., Hirsch, S. R., Wright, D. J. M., and Wessely, S. C. (1994). Population based study of fatigue and psychological distress. BMJ 308: 763-766.Google Scholar
  35. Pennebaker, J. W. (1982). The Psychology of Physical Symptoms, Springer-Verlag, New York.Google Scholar
  36. Pennebaker, J. W., and Brittingham, G. L. (1982). Environmen tal and sensory cues affecting the perception of physical symptoms. In Baum, A., and Singer, J. E. (eds.), Advances in Environmental Psychology: Environmental Health, Erlbaum, Hillsdale, NJ.Google Scholar
  37. RCPPGP, Report of Joint Working Group of the Royal College of Physicians, Psychiatrists and General Practitioners (1997). Chronic Fatigue Syndrome CR 54, London, pp. 5-59.Google Scholar
  38. Ridsdale, L., Evans, A., Jerrett, W., Mandalia, S., Osler, K., and Vora, H. (1993). Patients with fatigue in general practice: A prospective study. BMJ 307: 103-106.Google Scholar
  39. Saultz, J. (1993). Fatigue. In Taylor, R. B., Johnson, T. A., Philips, D. M., and Scherger, J. E. (eds.), Family Medicine: Principles and Practice, 4th ed., Springer Verlag, New York, pp. 419-423.Google Scholar
  40. Schut, H. A. W. (1992). Omgaan met de dood van de partner: Effecten op gezondheid en effecten van rouwbegeleiding [Coping with the death of the spouse: Effects on health and effects of grief counseling], Doctoral dissertation, Amsterdam (in Dutch).Google Scholar
  41. Selye, H. (1975). Stress Without Distress, New American Library, New York.Google Scholar
  42. Shahar, E., and Lederer, J. (1990). Asthenic symptoms in a rural family practice: Epidemiologic characteristics and a proposed classification. J. Family Pract. 31: 257-262.Google Scholar
  43. Siegrist, J., Peter, R., Junge, A., Cremer, P., and Seidel, D. (1990). Low status control, high effort at work and ischemaic heart disease: Prospective evidence from blue-collar men. Soc. Sci. Med. 31: 1127-1134.Google Scholar
  44. Smets, E. M. A., Garssen, B., Bonke, B., and de Haes, J. C. J. M. (1995). The Multidimensional Fatigue Inventory (MFI): Psychometric qualities of an instrument to assess fatigue. J. Psychosom. Res. 39: 315-325.Google Scholar
  45. Smets, E. M. A., Visser, M. R. M., Garssen, B., Willems, A. F. M. N., Frijda, N. H., Oosterveld and de Haes, J. C. J. M. (1998). Understanding the level of fatigue in cancer patients. J. Psychosom. Res. 45(3): 277-295.Google Scholar
  46. Strelau, J. (1995). Temperament and stress: Temperament as a moderator of stressors, emotional states, coping, and costs. In Spielberger, C. D., and Sarason, I. G. (eds.), Stress & Emotion; Anxiety, Anger, and Curiosity, Taylor & Francis, London, pp. 215-254.Google Scholar
  47. Sugarman, J. R., and Berg, A. O. (1984). Evaluation of fatigue in a family practice. J. Fam. Pract. 19(5): 643-647.Google Scholar
  48. Tijhuis, M. A. R. (1994). Social Networks and Health, Doctoral dissertation, Nivel, Utrecht.Google Scholar
  49. Tijhuis, M. A. R., Flap, H. D., Foets, M., and Groenewegen, P. P. (1995). Social support and stressful events in two dimensions: Life events and illness as an event. Soc. Sci. Med. 40(11): 1513-1526.Google Scholar
  50. Van de Lisdonk, E. H. (1985). Ervaren en aangeboden morbiditeit in de huisartspraktijk [Experienced and offered morbidity in general practice], Doctoral dissertation, University Nijmegen, Nijmegen, The Netherlands (in Dutch).Google Scholar
  51. Van der Meer, J. W. M. (1997). Chronische-vermoeidheidsyndroom [Chronic fatigue syndrome]. Ned. Tijdschr. Geneeskd. 141: 1507-1509 (in Dutch; English abstract).Google Scholar
  52. Van der Velden, J., de Bakker, D. H.; Claessens, A. A. M. C., and Schellevis, F. G. (1992). Morbidity in General Practice, Nivel, Utrecht.Google Scholar
  53. Van Mens-Verhulst, J., and Bensing, J. (1997). Sex differences in persistent fatigue. Women Health 26: 51-70.Google Scholar
  54. Van Vliet, K. P., Everaerd, W. T. A. M., van Zuuren, F. J., Lammes, F. B., Briët, M., Kleiverda, G., and Schutte (1994). Symptom perception: Psychological correlates of symptom reporting and illness behavior of women with medically unexplained gynecological symptoms. J. Psychosom. Obstet. Gynaecol. 15: 171-181.Google Scholar
  55. Verhaak, P. F. M., and Tijhuis, M. A. R. (1994). The somatizing patient in general practice. Int. J. Psychiat. Med. 24; 157-177.Google Scholar
  56. Ware, N. C. (1993). Society, mind and body in chronic fatigue: An anthropological view. Ciba Found. Symp. 173: 62-73.Google Scholar
  57. Wessely, S. (1990). Old wine in new bottles: Neurasthenia and `ME.' Psychol. Med. 20: 35-53.Google Scholar
  58. Wohlfarth, T. (1997). Socioeconomic inequality and psychopathology: Are socioeconomic status and social class interchangeable? Soc. Sci. Med. 3: 399-410.Google Scholar
  59. Zaat, J. O. M., Schellevis, F. G., Kluijt, I., van Eijk, J. Th. M., and van der Velden, J. (1991). Laboratoriumonderzoe k bij klachten over moeheid [Laboratory research in case of fatigue complaints]. In Zaat, J. O. M. (ed.), De macht der gewoonte: over de huisarts en zijn laboratoriumonderzoek [The power of habits: On general practitioners and their laboratory research], Doctoral dissertation, Free University Amsterdam, Amsterdam, pp. 133-151.Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Angelique E. de Rijk
  • Karlein M. G. Schreurs
  • Jozien M. Bensing

There are no affiliations available

Personalised recommendations