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Predictors of chronic “postviral” fatigue

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We set out to determine the relation between a general practitioner

(GP) diagnosis of viral illness and development of chronic

fatigue 6 months later. 618 subjects who attended GPs clinics

in London, south, and southwest England and who received a

diagnosis of viral illness were followed prospectively and

fatigue was assessed by questionnaire after 6 months. At

presentation, GPs recorded fatigue in 62.6% of subjects,

usually since the onset of symptoms. 502 (81.2%) subjects

completed the 6-month questionnaire, of whom 88 (17.5%) met

criteria for chronic fatigue and 65 (12.9%) had no reported

fatigue before the viral illness. Compared with a similar

group of non-postviral GP attenders, the risk ratio for

chronic fatigue in the present cohort was 1.45 (95% CI

1.14-2.04). Infective symptoms did not predict fatigue 6

months later. Psychiatric morbidity, belief in vulnerability

to viruses, and attributional style at initial presentation

were all associated with self-designated postviral fatigue.

Logistic regression showed that (1) somatic attributional

style, (2) less definite diagnosis by the GP, and (3) sick

certification were the only significant predictors of chronic

fatigue after viral infection when other factors were

controlled for. Chronic severe fatigue 6 months after

GP-diagnosed viral illness is related to symptom-attributional

style and doctor behaviour, rather than to features of the

viral illness. Some subjects with apparent postviral fatigue

had complained of tiredness before their presentation with a

viral illness.

Cope H, David A, Pelosi A, Mann A

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