Carreira, Helena, Williams, Rachael, Strongman, Helen et al. · BMJ open · 2019 · DOI
Researchers reviewed 120 studies that used UK patient medical records to track mental health and quality of life problems like depression, anxiety, fatigue, and cognitive issues. They found that different studies used different definitions and coding systems to identify these conditions, making it hard to compare results across studies. The authors recommend that researchers agree on standard definitions and validated code lists so findings are more consistent and reliable.
For ME/CFS research, this study is important because it reveals how inconsistently fatigue and related conditions like cognitive dysfunction are defined and coded in UK medical records—the primary data source for many epidemiological studies. Standardizing these definitions could improve the identification and study of ME/CFS in large population databases, leading to better estimates of disease prevalence and outcomes.
This study does not establish which definitions are most accurate or clinically meaningful; it only documents how existing research has defined outcomes. It does not evaluate whether current coding systems can adequately capture ME/CFS specifically, nor does it provide evidence about the validity of any particular diagnostic approach.
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
Carreira, Helena, Williams, Rachael, Strongman, Helen, & Bhaskaran, Krishnan (2019). Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review.. BMJ open. https://doi.org/10.1136/bmjopen-2019-029227
BibTeX
@article{mecfsatlas-carreira-2019-identification-mental,
author = {Carreira, Helena and Williams, Rachael and Strongman, Helen and Bhaskaran, Krishnan},
title = {Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review.},
journal = {BMJ open},
year = {2019},
doi = {10.1136/bmjopen-2019-029227},
note = {PubMed: 31270119},
url = {https://www.mecfsatlas.com/evidence/carreira-2019-identification-mental},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/carreira-2019-identification-mental
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