Lee, S, Yu, H, Wing, Y et al. · The American journal of psychiatry · 2000 · DOI
This study looked at 100 people in Hong Kong who had severe tiredness lasting at least 6 months to understand how common mental health conditions like depression and anxiety were in this group. Researchers found that over half of these patients had experienced depression or anxiety at some point in their lives, and about a quarter had these conditions at the time of the study. Interestingly, patients' main complaints were often pain, sleep problems, and worry—not just fatigue—and most believed their illness started from stressful life events.
This study highlights that patients with chronic fatigue often experience co-occurring psychiatric conditions and that culturally-informed diagnostic frameworks may better capture the illness experience than narrow categorical diagnoses alone. Understanding the heterogeneity of psychiatric morbidity in chronic fatigue populations is important for developing culturally sensitive assessment and treatment approaches across different healthcare systems.
This study does not establish that psychiatric conditions cause chronic fatigue, nor does it prove that all chronic fatigue is primarily psychiatric in origin—the cross-sectional design cannot determine temporal relationships. The small proportion meeting strict 1988 CFS criteria (3%) suggests that many patients with chronic fatigue do not fit the CFS case definition, so findings may not apply directly to ME/CFS populations as currently defined. The study was conducted in a specific cultural and healthcare context (Hong Kong primary care), which may limit generalizability.
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
Lee, S, Yu, H, Wing, Y, Chan, C, Lee, A M, Lee, D T, et al. (2000). Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong.. The American journal of psychiatry. https://doi.org/10.1176/appi.ajp.157.3.380
BibTeX
@article{mecfsatlas-lee-2000-psychiatric-morbidity,
author = {Lee, S and Yu, H and Wing, Y and Chan, C and Lee, A M and Lee, D T and Chen, C and Lin, K and Weiss, M G},
title = {Psychiatric morbidity and illness experience of primary care patients with chronic fatigue in Hong Kong.},
journal = {The American journal of psychiatry},
year = {2000},
doi = {10.1176/appi.ajp.157.3.380},
note = {PubMed: 10698813},
url = {https://www.mecfsatlas.com/evidence/lee-2000-psychiatric-morbidity},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/lee-2000-psychiatric-morbidity
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