Chester, A C, Levine, P H · Journal of psychiatric research · 1997 · DOI
This study followed 23 people who developed fatigue and other symptoms during an outbreak linked to a problem building environment. Four years later, about two-thirds of the group had improved significantly or felt much better, while about one-third remained quite ill and unable to work. People who improved tended to also see their respiratory symptoms, sore throats, and headaches get better over time.
This study provides rare long-term outcome data for ME/CFS, particularly in a clustered setting. It suggests that the source of illness matters for prognosis—CFS linked to environmental exposures may have different natural history than sporadic cases. Understanding factors associated with recovery is critical for informing patient expectations and clinical management.
This study does not establish causality between sick building syndrome and CFS, nor does it prove that environmental exposure causes better outcomes in all CFS cases. The absence of a control group of sporadic CFS patients with similar severity limits direct comparison. The association between symptom improvement and better outcomes does not identify which symptoms drive recovery or whether they are causative.
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
Chester, A C & Levine, P H (1997). The natural history of concurrent sick building syndrome and chronic fatigue syndrome.. Journal of psychiatric research. https://doi.org/10.1016/s0022-3956(96)00054-4
BibTeX
@article{mecfsatlas-chester-1997-natural-history,
author = {Chester, A C and Levine, P H},
title = {The natural history of concurrent sick building syndrome and chronic fatigue syndrome.},
journal = {Journal of psychiatric research},
year = {1997},
doi = {10.1016/s0022-3956(96)00054-4},
note = {PubMed: 9201647},
url = {https://www.mecfsatlas.com/evidence/chester-1997-natural-history},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/chester-1997-natural-history
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