Cho, Hyong Jin, Menezes, Paulo Rossi, Hotopf, Matthew et al. · The British journal of psychiatry : the journal of mental science · 2009 · DOI
This study looked at how often ME/CFS occurs in two very different cities—London and São Paulo, Brazil—and whether doctors recognize it as a real condition. Researchers surveyed over 6,000 primary care patients and found that ME/CFS affected roughly the same number of people in both places (about 2%). However, while British doctors had diagnosed some cases, Brazilian doctors had not diagnosed any, suggesting that cultural and healthcare system differences affect how the disease is recognized rather than how common it actually is.
This study provides important evidence that ME/CFS is a genuine global health condition affecting similar proportions of populations across diverse cultures and economic contexts. It highlights how healthcare systems and cultural attitudes significantly impact whether patients receive a diagnosis, which has implications for understanding patient experiences worldwide and advocating for better recognition of the disease in underserving healthcare systems.
This study does not prove that ME/CFS is identically caused or experienced across all cultures, nor does it explain the specific mechanisms behind differential recognition. It cannot establish whether differences in diagnosis reflect true diagnostic bias, different patient presentation patterns, or healthcare access barriers, and cross-sectional surveys cannot determine whether recognition patterns have changed over time.
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, Hyong Jin, Menezes, Paulo Rossi, Hotopf, Matthew, Bhugra, Dinesh, & Wessely, Simon (2009). Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: prevalence and recognition.. The British journal of psychiatry : the journal of mental science. https://doi.org/10.1192/bjp.bp.108.051813
BibTeX
@article{mecfsatlas-cho-2009-comparative-epidemiology,
author = {Cho, Hyong Jin and Menezes, Paulo Rossi and Hotopf, Matthew and Bhugra, Dinesh and Wessely, Simon},
title = {Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: prevalence and recognition.},
journal = {The British journal of psychiatry : the journal of mental science},
year = {2009},
doi = {10.1192/bjp.bp.108.051813},
note = {PubMed: 19182171},
url = {https://www.mecfsatlas.com/evidence/cho-2009-comparative-epidemiology},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/cho-2009-comparative-epidemiology
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