Critical life events, infections, & symptoms during the year preceding Chronic Fatigue Syndrome (CFS): an examination of CFS patients & subjects with a nonspecific life crisis

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OBJECTIVE: The purpose of this study was to describe the
sequence of psychosocial events and infections preceding the
onset of chronic fatigue syndrome (CFS). This information was
related to the temporal development of crucial symptoms in
relation to the onset of, namely, fatigue, sadness,
irritability, pain, and feeling of fever.

METHODS: A personal
interview was conducted in 46 patients (mean age, 39.5 years;
SD, 9 years) who fulfilled international CFS criteria. These
patients were matched with regard to age and gender to 46
carefully matched control subjects. Twenty-three percent of
the study subjects were men, and 77% were women. The patient
at first identified the month that coincided with the onset of
CFS. Similarly, each control subject was asked to identify a
"very difficult period" within approximately the same period
as the patient with whom the control subject was matched. A
list of 14 different life events was perused. Participants
were asked to identify for each month whether each of the
listed events had occurred. Furthermore, they were asked to
rate the importance of the events they had experienced. In
addition, for each of the cardinal symptoms (fatigue, sadness,
irritability, pain, and feeling of fever) and for each month,
the subjects were asked to rate, on a visual analogue scale,
the symptom intensity. Also, the number of infections was
noted.

RESULTS: A statistically significant group difference
in fatigue intensity existed during the period 4 to 10 months
before the onset of CFS. During the 3 months preceding the
diagnosis for the CFS patients or the peak of the crisis for
the control group, there was a dramatic rise in fatigue in
both groups. The CFS group reached a much higher fatigue
level, which leveled off somewhat during the first year of
follow-up but still remained very high in comparison with the
control group, which reached precrisis levels 4 months after
the peak. Similar patterns were observed for fever and pain.
With regard to sadness and irritability, no group difference
was observed during the period preceding the crisis. In the
patient group, the level stayed high throughout the whole
first year of follow-up, whereas a slow return started in the
control group; precrisis levels were reached after 1 year in
this group. The prevalence ratio (CFS patients/control
subjects) for negative events was around 1.0 for the periods 4
to 12 months preceding CFS but 1.9 during the quarter year
preceding the onset. For infections, the prevalence ratio
increased successively during the four quarters preceding CFS
(from 1.4 to 2.3).

CONCLUSIONS: According to the retrospective
self-reports, there were differences between the groups in
fatigue, pain, and feeling of fever during the months
preceding the crisis. With regard to depressive and irritable
feelings, no preillness differences were reported between the
groups. There was a reported excess prevalence of both
infections and negative life events during the quarter year
preceding the onset of CFS or crisis. Potential sources of
error are discussed. These findings must be replicated in
longitudinal studies.

Theorell T, Blomkvist V, Lindh G, Evengard B

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