Population based study of fatigue and psychological distress.

Abstract

Objectives--To determine the prevalence of fatigue in the general population and the factors associated with fatigue.

Design--Postal survey.

Setting--Six general practices in southern England.

Subjects--31 651 men and women aged 18-45 years registered with the practices.

Main outcome measures--Responses to the 12 item general health questionnaire and a fatigue questionnaire which included self reported measures of duration, severity, and causes of fatigue.

Results--15 283 valid questionnaires were returned, giving a response rate of 48.3%, (64% after adjustment for inaccuracies in the practice registers). 2798 (18.3%) of respondents reported substantial fatigue lasting six months or longer. Fatigue and psychological morbidity were moderately correlated (r=0.62). Women were more likely to complain of fatigue than men, even after adjustment for psychological distress. The commonest cited reasons for fatigue were psychosocial (40% of patients). Of 2798 patients with excessive tiredness, only 38 (1.4%) attributed this to the chronic fatigue syndrome.

Conclusion--Fatigue is distributed as a continuous variable in the community and is closely associated with psychologicalmorbidity.

Introduction

Community surveys have shown that fatigue is common in developed countries. A British survey of those attending general practice found that 10.2% of men and 10.6% of women had had substantial fatigue for over a month.[1] Despite its prevalence, however, surprisingly few data exist on the demographic and social associations of fatigue.[2]

In recent years fatigue has attracted renewed attention, largely because of the prominence given to the chronic fatigue syndrome, also known as postviral fatigue or myalgic encephalomyelitis. However, controversy exists concerning not only the relative contributions of infective and psychological risk factors but the classification of the syndrome itself. These disputes cannot be resolved without sound community studies.[3]

Nearly all studies of chronic fatigue syndrome have been conducted in tertiary referral settings, where the typical patient is a young adult, usually a woman, with a professional job. Most patients trace their illness to an infective trigger but also fulfil criteria for a psychiatric disorder.[4-7] The infective and psychiatric characteristics may, however, be the result of referral patterns and illness behaviour and not intrinsically related to the chronic fatigue syndrome.

We conducted a large community survey to determine the level of fatigue and psychiatric morbidity in a population, to explore the association between fatigue and psychological distress, and to identify what fatigue is commonly attributed to.

Subjects and methods

We sent questionnaires to all patients aged 18 to 45 years registered with selected practices. We recruited six …