Nater, Urs M, Maloney, Elizabeth, Heim, Christine et al. · Psychiatry research · 2011 · DOI
This study looked at whether stressful life events are more common in people with ME/CFS compared to healthy people. Researchers found that people with ME/CFS had experienced more stressors and reported higher levels of psychological distress, and were more likely to have post-traumatic stress disorder. This suggests that life stress may play a role in ME/CFS.
Understanding the relationship between life stress and ME/CFS is important because it may help explain how the condition develops and could inform therapeutic approaches. This was the first population-based study of stress in ME/CFS, making it more representative than studies recruiting from patient clinics, which strengthens confidence in the findings.
This study demonstrates association, not causation—it cannot prove that stress causes ME/CFS. The cross-sectional design means we cannot determine whether stress preceded illness onset or whether having ME/CFS led to increased stress and trauma exposure. The study also does not explain the biological mechanisms by which stress might contribute to ME/CFS.
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
Nater, Urs M, Maloney, Elizabeth, Heim, Christine, & Reeves, William C (2011). Cumulative life stress in chronic fatigue syndrome.. Psychiatry research. https://doi.org/10.1016/j.psychres.2011.07.015
BibTeX
@article{mecfsatlas-nater-2011-cumulative-life,
author = {Nater, Urs M and Maloney, Elizabeth and Heim, Christine and Reeves, William C},
title = {Cumulative life stress in chronic fatigue syndrome.},
journal = {Psychiatry research},
year = {2011},
doi = {10.1016/j.psychres.2011.07.015},
note = {PubMed: 21840607},
url = {https://www.mecfsatlas.com/evidence/nater-2011-cumulative-life},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/nater-2011-cumulative-life
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