Marques, M, De Gucht, V, Leal, I et al. · International journal of behavioral medicine · 2013 · DOI
This study compared ME/CFS patients from Portugal and the Netherlands to see how their experiences with fatigue, physical symptoms, and quality of life were similar or different. Researchers found that while both groups experienced worse quality of life when fatigue was more severe, the psychological and behavioral factors that made fatigue worse were somewhat different between the two countries.
This study highlights that ME/CFS may not present or be driven by identical factors across different cultures, which has important implications for how physicians diagnose and treat the condition in diverse populations. Understanding these cultural differences could help clinicians provide more culturally tailored and effective care.
This study does not establish that cultural differences cause variations in ME/CFS determinants—it only documents associations. The cross-sectional design prevents any causal conclusions about whether psychological/behavioral factors drive fatigue severity or vice versa, and results may not generalize to male patients or non-Portuguese/Dutch populations.
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
Marques, M, De Gucht, V, Leal, I, & Maes, S (2013). A cross-cultural perspective on psychological determinants of chronic fatigue syndrome: a comparison between a Portuguese and a Dutch patient sample.. International journal of behavioral medicine. https://doi.org/10.1007/s12529-012-9265-y
BibTeX
@article{mecfsatlas-marques-2013-cross-cultural,
author = {Marques, M and De Gucht, V and Leal, I and Maes, S},
title = {A cross-cultural perspective on psychological determinants of chronic fatigue syndrome: a comparison between a Portuguese and a Dutch patient sample.},
journal = {International journal of behavioral medicine},
year = {2013},
doi = {10.1007/s12529-012-9265-y},
note = {PubMed: 22972378},
url = {https://www.mecfsatlas.com/evidence/marques-2013-cross-cultural},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/marques-2013-cross-cultural
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