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The temporal stability & co-morbidity of prolonged fatigue: a longitudinal study in primary care

  [ 544 votes ]   [ Discuss This Article ] • July 10, 1999

BACKGROUND: Depression, anxiety and fatigue are among the most
common symptoms presented in primary care. Whether such
symptoms indicate discrete psychological syndromes or whether
they result from a common vulnerability is not clear. This
study examined longitudinally the patterns of co-morbidity
between prolonged fatigue and other forms of psychological
distress in patients attending general practitioners.

Adults attending primary care completed questionnaires
designed to detect cases of prolonged fatigue and
psychological distress at presentation and 12 months later.

RESULTS: Of 652 patients, the prevalence rates of 'prolonged
fatigue' alone, 'psychological distress' alone, 'prolonged
fatigue + psychological distress' and 'no disorder' were 7%,
19%, 15% and 59% respectively at initial assessment. Of those
patients with any prolonged fatigue syndrome initially, 58%
still reported fatigue 12 months later (representing 13% of
the total sample). Most importantly, the risk of developing
prolonged fatigue was not increased in patients who initially
had psychological distress (OR = 0.95; 95% CI 0.2-3.6),
neither was the risk of developing psychological distress
increased in patients who initially had prolonged fatigue (OR
= 1.4; 95% CI 0.6-3.4).

CONCLUSIONS: This study indicates that
prolonged fatigue is a persistent diagnosis over time. The
longitudinal patterns of co-morbidity with psychological
distress do not support an aetiological model that proposes a
common vulnerability factor for these disorders. Psychiatric
classification systems may be better served by treating
prolonged fatigue and psychological distress as independent

Hickie I, Koschera A, Hadzi-Pavlovic D, Bennett B, Lloyd A

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