McDonald, E, David, A S, Pelosi, A J et al. · Psychological medicine · 1993 · DOI
Researchers studied 77 primary care patients with chronic fatigue and found that 26% met criteria for chronic fatigue syndrome (CFS). Most patients received other diagnoses, including depression and a condition called neurasthenia. Interestingly, patients seen in general practice were more likely to recognize that stress and emotional factors played a role in their fatigue, unlike hospital patients who often blamed purely physical causes like viruses.
This study highlights how CFS presents differently in primary care versus hospital settings and demonstrates the significant overlap between CFS and psychiatric conditions. Understanding these patterns helps clinicians recognize and manage persistent fatigue earlier, potentially preventing the escalation and disability often seen in undiagnosed CFS cases.
This study does not establish causation between psychiatric conditions and fatigue severity—only correlation. The cross-sectional design cannot determine whether psychiatric symptoms cause fatigue, result from chronic fatigue, or occur independently. The study also does not validate CFS diagnostic criteria or prove that early primary care identification prevents long-term disability.
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
McDonald, E, David, A S, Pelosi, A J, & Mann, A H (1993). Chronic fatigue in primary care attenders.. Psychological medicine. https://doi.org/10.1017/s0033291700026453
BibTeX
@article{mecfsatlas-mcdonald-1993-chronic-fatigue,
author = {McDonald, E and David, A S and Pelosi, A J and Mann, A H},
title = {Chronic fatigue in primary care attenders.},
journal = {Psychological medicine},
year = {1993},
doi = {10.1017/s0033291700026453},
note = {PubMed: 8134522},
url = {https://www.mecfsatlas.com/evidence/mcdonald-1993-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/mcdonald-1993-chronic-fatigue
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