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

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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