Chronic fatigue, Chronic Fatigue Syndrome (CFS), & Fibromyalgia (FM). Disability & health-care use

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.

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