Skip to main content
SpringerLink
Log in

Fatigue Severity, Attributions, Medical Utilization, and Symptoms in Persons with Chronic Fatigue

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

This study examined the roles of ethnicity, gender, and socioeconomic status (SES) in predicting fatigue severity, symptoms, medical utilization, and attributions among a sample of individuals with chronic fatigue. Using path analysis, a model was tested and revised. In the new model, gender predicted fatigue, ethnicity predicted attributions, fatigue predicted medical utilization and attributions, and attributions predicted medical utilization. Women reported more fatigue and were more likely to feel that stress and depression were causing their fatigue. Higher-SES participants were more likely to cite stress and overwork as causing their fatigue. Latinos reported more physical symptoms than African Americans and Whites. The implications of these results are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Andrykowski, M. A., Curran, S. L., and Lightner, R. (1998). Off-treatment fatigue in breast cancer survivors: A controlled comparison. J. Behav. Med. 21:1–18.

    Google Scholar 

  • Belgrave, F. Z., Molock, S. D., Kelley, K. S., and Nana-Sinham, P. (1991). Psychological factors influencing physical health in African American college students. J. Black Psychol. 18(1): 1–17. 112 Torres-Harding, Jason, and Taylor

    Google Scholar 

  • Browne, M.W. (1984). Asymptotically distribution-free methods for the analysis of covariance structures. Br. J. Math. Stat. Psychol. 37: 62–83.

    Google Scholar 

  • Buchwald, D., Manson, S. M., Pearlman, T., Umali, J., and Kith, P. (1996). Race and ethnicity in patients with chronic fatigue. J. Chron. Fatigue Syndr. 2(1): 53–67.

    Google Scholar 

  • Byrne, B. M. (1995). One application of structural equation modeling from two perspectives: Exploring the EQS and LISREL strategies. In Hoyle, R. H. (ed.), Structural Equation Modeling: Concepts, Issues, and Applications, Sage, Thousand Oaks, CA, pp. 138–157.

    Google Scholar 

  • Canino, I. A., Rubio-Stipec, M., Canino, G., and Escobar, J. (1992). Functional somatic symptoms: A cross-ethnic comparison. Am. J. Orthopsychiatry 62(4): 605–612.

    Google Scholar 

  • Cathebras, P. J., Robbins, J. M., Kirmayer, L. J., and Hayton, B. C. (1992). Fatigue in primary care: Prevalence, psychiatric comorbidity, illness behavior, and outcome. J. Gen. Intern. Med. 7: 276–286.

    Google Scholar 

  • Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., and Wallace, E. P. (1993). Development of a Fatigue Scale. J. Psychosom. Res. 37(2): 147–153.

    Google Scholar 

  • Cloninger, C. R., Sigvardsson, S., von Knorring, A. L., and Bohman, M. (1984). An adoption study of somatoform disorders. II. Identification of two discrete somatoform disorders. Arch. Gen. Psychiatry 41(9): 863–871.

    Google Scholar 

  • Cope, H., Mann, A., Pelosi, A., and David, A. (1996). Psychosocial risk factors for chronic fatigue and chronic fatigue syndrome following presumed viral illness: A case-control study. Psychol. Med. 26: 1197–1209.

    Google Scholar 

  • Crandell, D. L., and Dohrenwend, B. P. (1967). Some relations among psychiatric symptoms, organic illness, and social class. Am. J. Psychiatry 123(12): 1527–1538.

    Google Scholar 

  • Delaker, J., and Proctor, B. D. (2000). Poverty in the United States, 1999, U.S. Census Bureau, Current Population Reports, Series P60-210, U.S. Government Printing Office, Washington, DC.

    Google Scholar 

  • de Rijk, A. E., Schreurs, K. M. G., and Bensing, J. M. (1999). Complaints of fatigue: Related to too much as well as too little external stimulation? J. Behav. Med. 22(6): 549–573.

    Google Scholar 

  • Ethington, C. A. (1987). The robustness of LISREL estimates in structural equation models with categorical variables. J. Exp. Educ. 55: 80–88.

    Google Scholar 

  • Findley, J. C., Kerns, R., Weinberg, L. D., and Rosenberg, R. (1998). Self-efficacy as a psychological moderator of chronic fatigue syndrome. J. Behav. Med. 21: 351–362.

    Google Scholar 

  • Fukuda, K., Straus, S., Hickie, I., Sharpe, M. C., Dobbins, J. G., Komaroff, A., and the International Chronic Fatigue Syndrome Study Group (1994). The chronic fatigue syndrome: A comprehensive approach to its definition and study. Ann. Intern. Med. 121: 953–959.

    Google Scholar 

  • Hall, D. G., Sanders, S. D., and Replogle, W. H. (1994). Fatigue: A new approach to an old problem. J. Miss. State Med. Assoc. 35: 155–160.

    Google Scholar 

  • Jason, L. A., Ropacki, M. T., Santoro, N. B., Richman, J. A., Heatherly, W., Taylor, R., Ferrari, J. R., Haney-Davis, T. M., Rademaker, A., Dupuis, J., Golding J., Plioplys, A. V., and Plioplys, S. (1997). A screening instrument for chronic fatigue syndrome: Reliability and validity. J. Chron. Fatigue Syndr. 3: 39–59.

    Google Scholar 

  • Jason, L. A., Richman, J. A., Rademaker, A. W., Jordan, K. M., Plioplys, A. V., Taylor, R. R., McCready, W., Huang, C., and Plioplys, S. (1999). A community-based study of chronic fatigue syndrome. Arch. Intern. Med. 159: 2129–2137.

    Google Scholar 

  • Jöreskog, K. G., and Sörbom, D. (1999a). PRELIS 2.30, Scientific Software International, Chicago.

    Google Scholar 

  • Jöreskog, K. G., and Sörbom, D. (1999b). LISREL 8.30, Scientific Software International, Chicago.

    Google Scholar 

  • Kirmayer, L. J. (1984). Culture, affect, and somatization. 1. Transcultural. Psychiatr. Res. Rev. 21: 159–188.

    Google Scholar 

  • Kirmayer, L. J., Robbins, J. M., Dworkind, M., and Yaffe, M. J. (1993). Somatization and the recognition of depression and anxiety in primary care. Am. J. Psychiatry 150: 734–741.

    Google Scholar 

  • Kirmayer, L. J., Young, A., and Robbins, J.M. (1994). Symptom attribution in cultural perspective. Can. J. Psychiatry 39: 584–594.

    Google Scholar 

  • Klonoff, E. A., and Landrine, H. (1994). Culture and gender diversity in commonsense beliefs about the causes of six illnesses. J. Behav. Med. 17: 407–418. Fatigue Severity 113

    Google Scholar 

  • Koss, J. D. (1990). Somatization and somatic complaint syndromes among Hispanics: Overview and ethnopsychological perspectives. Transcult. Psychiatr. Res. Rev. 27(1): 5–29.

    Google Scholar 

  • Lawrie, S. M., Manders, D. N., Geddes, J. R., and Pelosi, A. J. (1997). A population-based incidence study of chronic fatigue. Psychol. Med. 27: 343–353.

    Google Scholar 

  • Loge, J. H., Ekeberg, O., and Kaasa, S. (1998). Fatigue in the general Norwegian population: Normative data and associations. J. Psychosom. Res. 45(1): 53–65.

    Google Scholar 

  • Maduro, R. (1983). Curanderismo and Latino views of disease and curing. West. J. Med. 139: 868–874.

    Google Scholar 

  • McDonald, E., David, A. S., Pelosi, A. J., and Mann, A. H. (1993). Chronic fatigue in primary care attenders. Psychol. Med. 23(4): 987–998.

    Google Scholar 

  • McGoldrick, M., Giordano, J., et al. (1996). Ethnicity and Family Therapy, 2nd ed., Guilford Press, New York.

    Google Scholar 

  • Nelson, E., Kirk, J., McHugo, G., Douglass, R., Ohler, J., Wasson, J., and Zubkoff, M. (1987). Chief complaint fatigue: A longitudinal study from the patient's perspective. Fam. Pract. Res. J. 6(4): 175–188.

    Google Scholar 

  • Nisenbaum, R., Reyes, M., Mawle, A. C., and Reeves, W. (1998). Factor analysis of unexplained severe fatigue and interrelated symptoms. Am. J. Epidemiol. 148(1): 72–77.

    Google Scholar 

  • Pawlikowska, T., Chalder, T., Hirsch, S. R., Wallace, P., Wright, D. J. M., and Wessely, S. C. (1994). Population based study of fatigue and psychological distress. BMJ 308: 763–766.

    Google Scholar 

  • Ray, C., Weir, R. C., Cullen, S., and Phillips, S. (1992). Illness perception and symptom components in chronic fatigue syndrome. J. Psychosom. Res. 36(3): 243–256.

    Google Scholar 

  • Rencher, A. C. (1995). Methods of Multivariate Analysis, JohnWiley & Sons, New York.

    Google Scholar 

  • Robbins, J. M., Kirmayer, L. J., and Hemami, S. (1997). Latent variable models of functional somatic distress. J. Nerv. Ment. Dis. 185(10): 606–615.

    Google Scholar 

  • Ruiz, P. (1995). Assessing, diagnosing and treating culturally diverse individuals: A Hispanic perspective. Psychiatr. Q. 66: 329–341.

    Google Scholar 

  • Song, S., Jason, L. A., and Taylor, R. R. (1999). The relationship between ethnicity and fatigue in a community-based sample. J. Gender Cult. Health 4(4): 255–268.

    Google Scholar 

  • Taylor, J., Henderson, D., and Jackson, B. B. (1991). A holistic model for understanding and practicing depressive symptoms in African American women. J. Commun. Psychol. 19: 306–320.

    Google Scholar 

  • Thomas, S. (1992). The health of the Black community in the twenty-first century: A futuristic perspective. In Braithwaite, R. L., and Taylor, S. E., (eds.), Health Issues in the Black Community, Jossey-Bass, San Francisco, pp. 121–131.

    Google Scholar 

  • Tseng, W. S. (1975). The development of psychiatric concepts in traditional Chinese medicine. Arch. Gen. Psychiatry 29: 158–161.

    Google Scholar 

  • Walden, C. (1994.) The health status of African-American college students: A literature review. J. Am. College Health 42: 199–205.

    Google Scholar 

  • Ware, N. C., and Kleinman, A. (1992). Culture and somatic experience: The social course of illness in neurasthenia and chronic fatigue syndrome. Psychosom. Med. 54: 546–560.

    Google Scholar 

  • Wasser, T. E. (1991). Statistical correction of Hollingshead's four factor index of social status. Paper presented at the annual meeting of the American Psychological Association, San Francisco, Aug.

  • Wessely, S. (1998). The epidemiology of chronic fatigue syndrome. Epidemiol. Psychiatria Soc. 7(1): 10–24.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. DePaul University, Chicago, Illinois

    Susan R. Torres-Harding, Leonard A. Jason & Renee R. Taylor

Authors
  1. Susan R. Torres-Harding
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonard A. Jason
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Renee R. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan R. Torres-Harding.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Torres-Harding, S.R., Jason, L.A. & Taylor, R.R. Fatigue Severity, Attributions, Medical Utilization, and Symptoms in Persons with Chronic Fatigue. J Behav Med 25, 99–113 (2002). https://doi.org/10.1023/A:1014850819995

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1014850819995

Search

Navigation