Natelson, Benjamin H, Lin, Jin-Mann S, Lange, Gudrun et al. · Annals of medicine · 2019 · DOI
This study looked at whether ME/CFS patients who also have other conditions—like depression, anxiety, fibromyalgia, or irritable bowel syndrome—experience worse fatigue or more severe ME/CFS symptoms. Researchers found that psychiatric conditions were common in ME/CFS patients but didn't actually make their fatigue or other core ME/CFS symptoms worse, though they did affect mental well-being. However, having multiple medically unexplained syndromes together (like fibromyalgia plus IBS) was linked to greater disability and more symptoms.
This research directly challenges the misconception that ME/CFS is primarily psychiatric in origin, showing that depression and anxiety—while common—do not drive the core fatigue and symptom burden of ME/CFS. Instead, the study highlights that physicians should screen for overlapping medically unexplained syndromes, which better predict disability, supporting the concept of ME/CFS as a distinct medical illness that often co-occurs with other somatic conditions rather than being caused by mental illness.
This cross-sectional study cannot establish causality or temporal relationships—it cannot prove whether psychiatric conditions develop before, after, or independently of ME/CFS. The study also does not clarify whether psychiatric diagnoses might influence symptom reporting or help-seeking behavior rather than actual ME/CFS pathophysiology, nor does it examine whether treatment of psychiatric comorbidities might improve ME/CFS outcomes.
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
Natelson, Benjamin H, Lin, Jin-Mann S, Lange, Gudrun, Khan, Sarah, Stegner, Aaron, & Unger, Elizabeth R (2019). The effect of comorbid medical and psychiatric diagnoses on chronic fatigue syndrome.. Annals of medicine. https://doi.org/10.1080/07853890.2019.1683601
BibTeX
@article{mecfsatlas-natelson-2019-effect-comorbid,
author = {Natelson, Benjamin H and Lin, Jin-Mann S and Lange, Gudrun and Khan, Sarah and Stegner, Aaron and Unger, Elizabeth R},
title = {The effect of comorbid medical and psychiatric diagnoses on chronic fatigue syndrome.},
journal = {Annals of medicine},
year = {2019},
doi = {10.1080/07853890.2019.1683601},
note = {PubMed: 31642345},
url = {https://www.mecfsatlas.com/evidence/natelson-2019-effect-comorbid},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/natelson-2019-effect-comorbid
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