E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
Tired, weak, or in need of rest: fatigue among general practice attenders.
David, A, Pelosi, A, McDonald, E et al. · BMJ (Clinical research ed.) · 1990 · DOI
Quick Summary
This study asked over 600 people visiting their doctor about fatigue and what they thought caused it. About 1 in 10 people reported severe fatigue lasting a month or longer. People blamed fatigue on different causes—some physical (like infections), some psychological or social (like stress or family responsibilities)—and the study found that fatigue itself looked similar whether it lasted a short time or persisted longer.
Why It Matters
This study demonstrates that disabling fatigue is common in general practice and often attributed to multiple causes—a finding relevant to ME/CFS because it shows how difficult it is to distinguish ME/CFS from other fatigue conditions in primary care settings and highlights the need for clearer diagnostic criteria.
Observed Findings
Approximately 10.2% of men and 10.6% of women reported substantial fatigue lasting ≥1 month
Physical ill health, including viral infection, was associated with more severe fatigue
Women attributed fatigue to family responsibilities more often than men did
Only 1 of 611 participants met chronic fatigue syndrome criteria
The symptom profile of persistent fatigue did not differ significantly from short-duration fatigue
Inferred Conclusions
Fatigue is a common and sometimes severe complaint in primary care populations
Fatigue etiology is multifactorial, with patients recognizing physical, psychological, and social contributors
Gender differences exist in attributions—women more often cite family/social responsibilities
The authors suggest persistent fatigue and short-duration fatigue may represent a continuum rather than distinct entities
Remaining Questions
What specific diagnostic criteria and methods would accurately identify ME/CFS in primary care populations?
Does the attribution of fatigue to a particular cause predict treatment response or prognosis?
What This Study Does Not Prove
This study does not establish causation between the attributed causes and fatigue; it only shows what patients believed caused their symptoms. The cross-sectional design cannot determine whether physical illness causes fatigue or vice versa. Most importantly, the study's minimal ME/CFS case identification suggests its brief questionnaire was not designed to detect ME/CFS accurately, limiting conclusions about ME/CFS prevalence or characteristics.
Tags
Symptom:Fatigue
Method Flag:PEM Not DefinedWeak Case DefinitionNo ControlsExploratory Only
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 →
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