Cho, H J, Bhugra, D, Wessely, S · Acta psychiatrica Scandinavica · 2008 · DOI
This study compared how patients with long-term unexplained fatigue in Brazil and Britain understand what caused their illness. British patients were more likely to believe their fatigue had a physical cause, while both groups experienced similar levels of disability despite their different beliefs about its origin. The findings suggest that culture and society influence how people understand and talk about their chronic fatigue.
Understanding how culture influences whether patients attribute fatigue to physical versus psychological causes has important implications for treatment-seeking behavior, clinical encounters, and health outcomes in ME/CFS. This study highlights that the same level of disability may be interpreted very differently across cultures, which could affect diagnosis, stigma, and access to appropriate care.
This study does not establish whether physical or psychological attributions are more accurate, nor does it prove that cultural beliefs actually cause differences in fatigue severity or chronicity. The cross-sectional design cannot determine whether sociocultural factors genuinely shape illness perception or whether they simply influence how patients communicate about pre-existing differences. It also does not clarify the mechanisms by which attribution affects prognosis or outcomes.
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
Cho, H J, Bhugra, D, & Wessely, S (2008). 'Physical or psychological?'- a comparative study of causal attribution for chronic fatigue in Brazilian and British primary care patients.. Acta psychiatrica Scandinavica. https://doi.org/10.1111/j.1600-0447.2008.01200.x
BibTeX
@article{mecfsatlas-cho-2008-physical-psychological,
author = {Cho, H J and Bhugra, D and Wessely, S},
title = {'Physical or psychological?'- a comparative study of causal attribution for chronic fatigue in Brazilian and British primary care patients.},
journal = {Acta psychiatrica Scandinavica},
year = {2008},
doi = {10.1111/j.1600-0447.2008.01200.x},
note = {PubMed: 18498433},
url = {https://www.mecfsatlas.com/evidence/cho-2008-physical-psychological},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/cho-2008-physical-psychological
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