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July 10, 1999
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.
METHODS:
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
disorders.
Hickie I, Koschera A, Hadzi-Pavlovic D, Bennett B, Lloyd A
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