Henningsen, Peter, Zimmermann, Thomas, Sattel, Heribert · Psychosomatic medicine · 2003 · DOI
This large review of 244 studies examined whether people with ME/CFS, fibromyalgia, IBS, and similar conditions experience more anxiety and depression than healthy people or those with other illnesses. The researchers found moderate but consistent links between these conditions and depression/anxiety, but importantly, the conditions cannot be fully explained by mental health alone. This suggests these syndromes are distinct medical conditions rather than simply psychiatric problems.
This systematic review provides robust evidence that ME/CFS is legitimately associated with mood disturbances but is not primarily a psychiatric condition, helping validate patients' experience that their illness is biological. For researchers, it establishes that anxiety and depression in ME/CFS are significant comorbidities warranting clinical attention, while supporting independent disease mechanisms.
This study does not prove that anxiety and depression *cause* ME/CFS or these other syndromes; it only documents correlation. The review also does not clarify the biological mechanisms linking mood changes to these conditions, nor does it establish whether psychological treatments alone can resolve the underlying disease. Meta-analyses are limited by the quality and comparability of included studies.
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
Henningsen, Peter, Zimmermann, Thomas, & Sattel, Heribert (2003). Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review.. Psychosomatic medicine. https://doi.org/10.1097/01.psy.0000075977.90337.e7
BibTeX
@article{mecfsatlas-henningsen-2003-medically-unexplained,
author = {Henningsen, Peter and Zimmermann, Thomas and Sattel, Heribert},
title = {Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review.},
journal = {Psychosomatic medicine},
year = {2003},
doi = {10.1097/01.psy.0000075977.90337.e7},
note = {PubMed: 12883101},
url = {https://www.mecfsatlas.com/evidence/henningsen-2003-medically-unexplained},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/henningsen-2003-medically-unexplained
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