Moss-Morris, R, Spence, M J, Hou, R · Psychological medicine · 2011 · DOI
This study followed 246 people with glandular fever (infectious mononucleosis) to see who developed chronic fatigue syndrome (CFS) in the months after infection. The researchers found that certain psychological factors—like anxiety, depression, perfectionism, and negative beliefs about the illness—were associated with developing CFS. Interestingly, an 'all-or-nothing' approach to activity (pushing hard then stopping completely) was the strongest predictor of CFS at 6 months.
This study provides prospective evidence that psychological factors and behavioural patterns may influence who develops CFS after infection, supporting the cognitive behavioural model. Understanding these predictive factors could help clinicians identify at-risk individuals and develop early prevention or intervention strategies to reduce CFS incidence post-infection.
This study does not prove that psychological factors *cause* CFS; it shows associations only. The study cannot establish whether these psychological factors existed before infection or were consequences of acute illness. Additionally, because only 7.8% of the cohort developed CFS, the generalizability to the broader post-infection population and causality mechanisms remain unclear.
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
Moss-Morris, R, Spence, M J, & Hou, R (2011). The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map?. Psychological medicine. https://doi.org/10.1017/S003329171000139X
BibTeX
@article{mecfsatlas-moss-morris-2011-pathway-glandular,
author = {Moss-Morris, R and Spence, M J and Hou, R},
title = {The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map?},
journal = {Psychological medicine},
year = {2011},
doi = {10.1017/S003329171000139X},
note = {PubMed: 20663256},
url = {https://www.mecfsatlas.com/evidence/moss-morris-2011-pathway-glandular},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/moss-morris-2011-pathway-glandular
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