Bhui, Kamaldeep S, Dinos, Sokratis, Ashby, Deborah et al. · BMC medicine · 2011 · DOI
This study looked at how common ME/CFS is in different ethnic groups in England and found that people from ethnic minority backgrounds had higher rates of the illness than White British people. The researchers discovered that anxiety, depression, lack of physical activity, stress in relationships, and poor social support were all linked to higher rates of ME/CFS, and together these factors explained why some ethnic groups had more cases.
This study is important because it highlights how social, psychological, and physical factors intersect in ME/CFS across diverse populations, and suggests that ethnic disparities in CFS diagnosis and symptom burden may partly reflect differences in psychosocial stressors rather than genetic or biological differences alone. Understanding these risk factors could improve identification and support for underdiagnosed communities.
This study does not establish causation—it cannot prove that anxiety, depression, or physical inactivity cause CFS, only that they are associated with it. The cross-sectional design means we cannot determine whether these factors precede CFS or result from it. Additionally, the study does not explain what biological mechanisms might link these psychosocial factors to CFS symptoms, and the operational definition of CFS used may not capture all cases or variants of the condition.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Bhui, Kamaldeep S, Dinos, Sokratis, Ashby, Deborah, Nazroo, James, Wessely, Simon, & White, Peter D (2011). Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity.. BMC medicine. https://doi.org/10.1186/1741-7015-9-26
BibTeX
@article{mecfsatlas-bhui-2011-chronic-fatigue,
author = {Bhui, Kamaldeep S and Dinos, Sokratis and Ashby, Deborah and Nazroo, James and Wessely, Simon and White, Peter D},
title = {Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity.},
journal = {BMC medicine},
year = {2011},
doi = {10.1186/1741-7015-9-26},
note = {PubMed: 21418640},
url = {https://www.mecfsatlas.com/evidence/bhui-2011-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/bhui-2011-chronic-fatigue
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