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Chronic fatigue: risk factors for symptom persistence in a 2 1/2-year follow-up study.
Am J Med. 1995 Feb; 98(2):187-95.AJ

Abstract

BACKGROUND

The prolonged disability of patients suffering from chronic fatigue may be due to sustaining factors that are independent of the cause and subject to intervention. This study reexamined a cohort of patients with chronic fatigue to define medical and psychiatric predictors of persistent symptoms.

METHODS

Seventy-eight patients with chronic fatigue present for 6 months or more (not required to meet the Centers for Disease Control case definition for chronic fatigue syndrome [CFS]) completed a self-report, follow-up questionnaire to measure the overall improvement or worsening of their condition at a mean of 2.5 years after their initial examination. At the time of initial evaluation, patients underwent a structured psychiatric examination, physical examination, laboratory studies, and self-report measures of psychological distress and functional disability. The psychiatric examination queried the patient about 28 somatic symptoms that are separate from those associated with CFS. Discriminant analysis was used to determine which variables present at the initial examination were significant predictors of persistent symptoms and disability at 2.5 years.

RESULTS

The factors most important at the time of initial presentation in predicting persistent illness were: (1) more than eight medically unexplained physical symptoms separate from those associated with CFS case definition; (2) lifetime history of dysthymia; (3) duration of chronic fatigue symptoms greater than 1.5 years; (4) less than 16 years of formal education; and (5) age older than 38 years. None of the results of the initial physical examination, or immunologic, general laboratory, or viral antibody measurements were significant in predicting persistence of symptoms. Recovery rates for those who met the criteria for CFS by either of two case definitions were lower than the rate of noncases, but the differences were not statistically significant. The five aforementioned variables formed a significant discriminative function, correctly classifying 78% of those who recovered and 74% of those with persistent symptoms.

CONCLUSIONS

At initial examination, patients with chronic fatigue, more than eight medically unexplained physical symptoms (excluding symptoms in the case criteria for CFS), a lifetime history of dysthymic disorder, longer than 1.5 years of chronic fatigue, less than 16 years of formal education, and who were older than 38 years were the most likely to have persistence of symptoms of chronic fatigue at the 2.5-year follow-up.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Baltimore, Maryland 21287-5371.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7847436

Citation

Clark, M R., et al. "Chronic Fatigue: Risk Factors for Symptom Persistence in a 2 1/2-year Follow-up Study." The American Journal of Medicine, vol. 98, no. 2, 1995, pp. 187-95.
Clark MR, Katon W, Russo J, et al. Chronic fatigue: risk factors for symptom persistence in a 2 1/2-year follow-up study. Am J Med. 1995;98(2):187-95.
Clark, M. R., Katon, W., Russo, J., Kith, P., Sintay, M., & Buchwald, D. (1995). Chronic fatigue: risk factors for symptom persistence in a 2 1/2-year follow-up study. The American Journal of Medicine, 98(2), 187-95.
Clark MR, et al. Chronic Fatigue: Risk Factors for Symptom Persistence in a 2 1/2-year Follow-up Study. Am J Med. 1995;98(2):187-95. PubMed PMID: 7847436.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic fatigue: risk factors for symptom persistence in a 2 1/2-year follow-up study. AU - Clark,M R, AU - Katon,W, AU - Russo,J, AU - Kith,P, AU - Sintay,M, AU - Buchwald,D, PY - 1995/2/1/pubmed PY - 1995/2/1/medline PY - 1995/2/1/entrez SP - 187 EP - 95 JF - The American journal of medicine JO - Am J Med VL - 98 IS - 2 N2 - BACKGROUND: The prolonged disability of patients suffering from chronic fatigue may be due to sustaining factors that are independent of the cause and subject to intervention. This study reexamined a cohort of patients with chronic fatigue to define medical and psychiatric predictors of persistent symptoms. METHODS: Seventy-eight patients with chronic fatigue present for 6 months or more (not required to meet the Centers for Disease Control case definition for chronic fatigue syndrome [CFS]) completed a self-report, follow-up questionnaire to measure the overall improvement or worsening of their condition at a mean of 2.5 years after their initial examination. At the time of initial evaluation, patients underwent a structured psychiatric examination, physical examination, laboratory studies, and self-report measures of psychological distress and functional disability. The psychiatric examination queried the patient about 28 somatic symptoms that are separate from those associated with CFS. Discriminant analysis was used to determine which variables present at the initial examination were significant predictors of persistent symptoms and disability at 2.5 years. RESULTS: The factors most important at the time of initial presentation in predicting persistent illness were: (1) more than eight medically unexplained physical symptoms separate from those associated with CFS case definition; (2) lifetime history of dysthymia; (3) duration of chronic fatigue symptoms greater than 1.5 years; (4) less than 16 years of formal education; and (5) age older than 38 years. None of the results of the initial physical examination, or immunologic, general laboratory, or viral antibody measurements were significant in predicting persistence of symptoms. Recovery rates for those who met the criteria for CFS by either of two case definitions were lower than the rate of noncases, but the differences were not statistically significant. The five aforementioned variables formed a significant discriminative function, correctly classifying 78% of those who recovered and 74% of those with persistent symptoms. CONCLUSIONS: At initial examination, patients with chronic fatigue, more than eight medically unexplained physical symptoms (excluding symptoms in the case criteria for CFS), a lifetime history of dysthymic disorder, longer than 1.5 years of chronic fatigue, less than 16 years of formal education, and who were older than 38 years were the most likely to have persistence of symptoms of chronic fatigue at the 2.5-year follow-up. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/7847436/Chronic_fatigue:_risk_factors_for_symptom_persistence_in_a_2_1/2_year_follow_up_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(99)80403-3 DB - PRIME DP - Unbound Medicine ER -