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Factors associated with acute fatigue in primary care

Published online by Cambridge University Press:  27 January 2010

T. Chalder ,
J. Neeleman ,
S. E. Reme ,
M. Power  and
S. Wessely
T. Chalder*
Affiliation:
Department of Psychological Medicine and Department of Primary Care, King's College Hospital, London, UK
J. Neeleman
Affiliation:
Department of Psychological Medicine and Department of Primary Care, King's College Hospital, London, UK
S. E. Reme
Affiliation:
Department of Psychological Medicine and Department of Primary Care, King's College Hospital, London, UK
M. Power
Affiliation:
Department of Psychological Medicine and Department of Primary Care, King's College Hospital, London, UK
S. Wessely
Affiliation:
Department of Psychological Medicine and Department of Primary Care, King's College Hospital, London, UK
*
*Address for correspondence: T. Chalder, Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine, 103 Denmark Hill, London SE5 8AZ, UK. (Email: trudie.chalder@kcl.ac.uk)
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Abstract

Background

To examine the role of psychological distress, negative life events, social support and lack of fitness (using breathlessness on exertion as a proxy) in the development of new onset fatigue in a primary care population.

Method

Adults between the ages of 18 and 45 years who were registered with five general practices in South East England were asked to complete a fatigue questionnaire and the 12-item General Health Questionnaire. Between 1 and 12 months later, subjects who visited the general practitioner (GP) with a suspected viral infection were recruited to the study and asked to complete measures of fatigue, psychological distress, life events, social support and allergies (stage 2). The next person to present to the GP with a complaint other than a viral illness was recruited as a control. Factors assessed at stage 2 that were associated with the development of fatigue were examined with stepwise logistic regression.

Results

Acute fatigue was not associated with a viral illness. Negative life events and breathlessness on exertion (interpreted as lack of fitness) were associated with incident cases of fatigue. However, when controlling for concurrent psychological distress, the independent association of negative life events disappeared.

Conclusions

Psychological distress was strongly associated with new onset fatigue and hence emphasizes the significance of psychological distress as a concomitant complaint in fatigue. Further, the salient association between breathlessness and fatigue may indicate the need to recommend exercise as a therapeutic strategy to improve physical fitness in the primary care setting.

Keywords

Fatiguelife eventsprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 8 , August 2010 , pp. 1289 - 1295
Copyright
Copyright © Cambridge University Press 2010

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References

Berelowitz, GJ, Burgess, AP, Thanabalasingham, T, Murray-Lyon, IM, Wright, DJ (1995). Post-hepatitis syndrome revisited. Journal of Viral Hepatitis 2, 133–138.CrossRefGoogle ScholarPubMed
Buchwald, DS, Rea, TD, Katon, WJ, Russo, JE, Ashley, RL (2000). Acute infectious mononucleosis: characteristics of patients who report failure to recover. American Journal of Medicine 109, 531–537.CrossRefGoogle ScholarPubMed
Cairns, R, Hotopf, M (2005). A systematic review describing the prognosis of chronic fatigue syndrome. Occupational Medicine 55, 20–31.CrossRefGoogle ScholarPubMed
Chalder, T, Berelowitz, G, Pawlikowska, T, Watts, L, Wessely, S, Wright, D, Wallace, EP (1993). Development of a fatigue scale. Journal of Psychosomatic Research 37, 147–153.CrossRefGoogle ScholarPubMed
Chalder, T, Power, MJ, Wessely, S (1996). Chronic fatigue in the community: ‘a question of attribution’. Psychological Medicine 26, 791–800.CrossRefGoogle ScholarPubMed
Cochrane, R, Robertson, A (1973). The life events inventory: a measure of the relative severity of psycho-social stressors. Journal of Psychosomatic Research 17, 135–140.CrossRefGoogle ScholarPubMed
Convertino, VA, Bloomfield, SA, Greenleaf, JE (1997). An overview of the issues: physiological effects of bed rest and restricted physical activity. Medicine and Science in Sports and Exercise 29, 187–190.CrossRefGoogle ScholarPubMed
Cope, H, David, A, Pelosi, A, Mann, A (1994). Predictors of chronic ‘postviral’ fatigue. Lancet 344, 864–868.CrossRefGoogle ScholarPubMed
Eriksen, HR, Svendsrød, R, Ursin, G, Ursin, H (1998). Prevalence of subjective health complaints in the Nordic European countries in 1993. European Journal of Public Health 8, 294–298.CrossRefGoogle Scholar
Goldberg, DP, Gater, R, Sartorius, N, Ustun, TB, Piccinelli, M, Gureje, O, Rutter, C (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27, 191–197.CrossRefGoogle ScholarPubMed
Greenleaf, JE, Kozlowski, S (1982). Physiological consequences of reduced physical activity during bed rest. Exercise and Sport Sciences Reviews 10, 84–119.CrossRefGoogle ScholarPubMed
Haines, RF (1974). Effect of bed rest and exercise on body balance. Journal of Applied Physiology 36, 323–327.CrossRefGoogle ScholarPubMed
Harvey, SB, Wadsworth, M, Wessely, S, Hotopf, M (2008). The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study. Psychological Medicine 38, 933–940.CrossRefGoogle ScholarPubMed
Hatcher, S, House, A (2003). Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case–control study. Psychological Medicine 33, 1185–1192.CrossRefGoogle ScholarPubMed
Heim, C, Wagner, D, Maloney, E, Papanicolaou, DA, Solomon, L, Jones, JF, Unger, ER, Reeves, WC (2006). Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study. Archives of General Psychiatry 63, 1258–1266.CrossRefGoogle ScholarPubMed
Hotopf, M, Noah, N, Wessely, S (1996). Chronic fatigue and minor psychiatric morbidity after viral meningitis: a controlled study. Journal of Neurology, Neurosurgery and Psychiatry 60, 504–509.CrossRefGoogle ScholarPubMed
Kato, K, Sullivan, PF, Evengard, B, Pedersen, NL (2006). Premorbid predictors of chronic fatigue. Archives of General Psychiatry 63, 1267–1272.CrossRefGoogle ScholarPubMed
Kroenke, K, Price, RK (1993). Symptoms in the community. Prevalence, classification, and psychiatric co-morbidity. Archives of Internal Medicine 153, 2474–2480.CrossRefGoogle Scholar
Kroenke, K, Wood, DR, Mangelsdorff, AD, Meier, NJ, Powell, JB (1988). Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome. Journal of the American Medical Association 260, 929–934.CrossRefGoogle Scholar
Lawrie, SM, Manders, DN, Geddes, JR, Pelosi, AJ (1997). A population-based incidence study of chronic fatigue. Psychological Medicine 27, 343–353.CrossRefGoogle ScholarPubMed
Lawrie, SM, Pelosi, AJ (1994). Chronic fatigue syndrome: prevalence and outcome. British Medical Journal 308, 732–733.CrossRefGoogle ScholarPubMed
Lewis, S, Cooper, CL, Bennett, D (1994). Psychosocial factors and chronic fatigue syndrome. Psychological Medicine 24, 661–671.CrossRefGoogle ScholarPubMed
Masuda, A, Nozoe, SI, Matsuyama, T, Tanaka, H (1994). Psychobehavioral and immunological characteristics of adult people with chronic fatigue and patients with chronic fatigue syndrome. Psychosomatic Medicine 56, 512–518.CrossRefGoogle ScholarPubMed
Pawlikowska, T, Chalder, T, Hirsch, SR, Wallace, P, Wright, DJ, Wessely, SC (1994). Population based study of fatigue and psychological distress. British Medical Journal 308, 763–766.CrossRefGoogle ScholarPubMed
Power, MJ, Champion, LA, Aris, SJ (1988). The development of a measure of social support: the Significant Others (SOS) Scale. British Journal of Clinical Psychology 27, 349–358.CrossRefGoogle ScholarPubMed
Puetz, TW (2006). Physical activity and feelings of energy and fatigue: epidemiological evidence. American Journal of Sports Medicine 36, 767–780.CrossRefGoogle ScholarPubMed
Ridsdale, L, Evans, A, Jerrett, W, Mandalia, S, Osler, K, Vora, H (1993). Patients with fatigue in general practice: a prospective study. British Medical Journal 307, 103–106.CrossRefGoogle ScholarPubMed
Russo, J, Katon, W, Clark, M, Kith, P, Sintay, M, Buchwald, D (1998). Longitudinal changes associated with improvement in chronic fatigue patients. Journal of Psychosomatic Research 45, 67–76.CrossRefGoogle ScholarPubMed
Sharpe, M, Hawton, K, Seagroatt, V, Pasvol, G (1992). Follow up of patients presenting with fatigue to an infectious diseases clinic. British Medical Journal 305, 147–152.CrossRefGoogle Scholar
Stricklin, A, Sewell, M, Austad, C (1990). Objective measurement of personality variables in epidemic neuromyasthenia patients. South African Medical Journal 77, 31–34.Google ScholarPubMed
Taylor, RR, Jason, LA, Curie, CJ (2002). Prognosis of chronic fatigue in a community-based sample. Psychosomatic Medicine 64, 319–327.CrossRefGoogle Scholar
Taylor, RR, Jason, LA, Jahn, SC (2003). Chronic fatigue and sociodemographic characteristics as predictors of psychiatric disorders in a community-based sample. Psychosomatic Medicine 65, 896–901.CrossRefGoogle Scholar
Theorell, T, Blomkvist, V, Lindh, G, Evengard, B (1999). Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis. Psychosomatic Medicine 61, 304–310.CrossRefGoogle ScholarPubMed
Van den Bergh, O, Winters, W, Devriese, S, van Diest, I, Vos, G, de Peuter, S (2004). Accuracy of respiratory symptom perception in persons with high and low negative affectivity. Psychology and Health 19, 9.CrossRefGoogle Scholar
Van't Leven, M, Zielhuis, GA, van der Meer, JW, Verbeek, AL, Bleijenberg, G (2009). Fatigue and chronic fatigue syndrome-like complaints in the general population. European Journal of Public Health. Published online: 18 August 2009. doi:10.1093/eurpub/ckp113.Google ScholarPubMed
Wessely, S, Chalder, T, Hirsch, S, Pawlikowska, T, Wallace, P, Wright, DJ (1995). Postinfectious fatigue: prospective cohort study in primary care. Lancet 345, 1333–1338.CrossRefGoogle ScholarPubMed
White, PD, Thomas, JM, Amess, J, Crawford, DH, Grover, SA, Kangro, HO, Clare, AW (1998). Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever. British Journal of Psychiatry 173, 475–481.CrossRefGoogle ScholarPubMed
White, PD, Thomas, JM, Kangro, HO, Bruce-Jones, WD, Amess, J, Crawford, DH, Grover, SA, Clare, AW (2001). Predictions and associations of fatigue syndromes and mood disorders that occur after infectious mononucleosis. Lancet 358, 1946–1954.CrossRefGoogle ScholarPubMed
Wilson, A, Hickie, I, Lloyd, A, Hadzi-Pavlovic, D, Boughton, C, Dwyer, J, Wakefield, D (1994). Longitudinal study of outcome of chronic fatigue syndrome. British Medical Journal 308, 756–759.CrossRefGoogle ScholarPubMed