Mann, A H, Mc Donald, E, Cope, H et al. · L'Encephale · 1994
Researchers studied fatigue in patients visiting regular doctors' offices to understand how common it is and what causes it. They found that some patients had long-lasting, disabling fatigue, but these patients were very different from each other in why they thought they were tired. Most of these patients also had depression or other mental health conditions alongside their fatigue.
This study highlights important differences between ME/CFS patients in specialist hospital settings versus those in primary care, suggesting that diagnostic criteria and patient populations may significantly differ. Understanding these distinctions is crucial for proper patient identification, appropriate referral pathways, and tailoring treatment approaches.
This study does not prove that ME/CFS does not exist as a distinct condition; rather, it suggests that primary care patients with fatigue complaints form a heterogeneous group that differs from hospital clinic populations. The cross-sectional design cannot establish causation between psychiatric conditions and fatigue, nor can it definitively determine whether depression is primary or secondary to fatigue. Attribution patterns reported by patients do not necessarily reflect actual etiology.
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
Mann, A H, Mc Donald, E, Cope, H, Pelosi, A, & David, A (1994). [Epidemiologic study of chronic fatigue in primary care (general practice)].. L'Encephale. https://pubmed.ncbi.nlm.nih.gov/7843054/
BibTeX
@article{mecfsatlas-mann-1994-epidemiologic-study,
author = {Mann, A H and Mc Donald, E and Cope, H and Pelosi, A and David, A},
title = {[Epidemiologic study of chronic fatigue in primary care (general practice)].},
journal = {L'Encephale},
year = {1994},
note = {PubMed: 7843054},
url = {https://www.mecfsatlas.com/evidence/mann-1994-epidemiologic-study},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/mann-1994-epidemiologic-study
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