OBJECTIVES: Disabling chronic fatigue that does not meet criteria
for chronic fatigue syndrome (CFS) or fibromyalgia (FM) is a
condition thought to be associated with substantial disability
and an apparently high use of health-care services. The
authors compare patients who have chronic fatigue, CFS, FM, or
CFS and FM together (CFS+FM) on employment status,
self-reported disability, number of medical care visits, type
of services obtained, and other diagnoses received.
The authors studied 402 patients from a university-based
chronic fatigue clinic. All patients underwent an initial
structured diagnostic assessment. One hundred forty-seven
patients met case criteria for CFS, 28 for FM, 61 for CFS+FM,
and 166 fell in the residual chronic fatigue group. Of these
patients, 388 completed a follow-up questionnaire an average
of 1.7 years later. Chi-squared tests and analysis of variance
were used to compare groups on follow-up measures of
health-care use and disability.
RESULTS: Patients with chronic
fatigue, CFS, FM, and CFS+FM were similar in terms of
disability and health-care use, though those with CFS+FM were
significantly more likely to be unemployed and to use more
chiropractic and “other” provider services. Rates of
unemployment ranged from 26% (chronic fatigue) to 51%
(CFS+FM). Overall, patients reported a mean of 21 visits to a
wide variety health-care providers during the previous year,
with no significant differences between groups.
Chronic fatigue, CFS, and FM are associated with considerable
personal and occupational disability and low rates of
employment. The potentially large economic burden of these
disorders underscores the need for accurate estimates of
direct and indirect costs, the relative contribution of
individual factors to disability, and the need to develop
targeted rehabilitation programs.
MCM: Reports rates of unemployment at intake of 26.1% in CF,
37.4% in CFS, 35.7% in FM, and 50.8% in CFS+FM.