Raanes, Emilie F W, Stiles, Tore C · Frontiers in psychiatry · 2021 · DOI
This review looked at 14 studies to understand how the mind and immune system are connected in ME/CFS. Researchers found that psychological factors like sleep quality, how people manage emotions, and how well they interact with others were linked to immune markers called cytokines. While these connections exist, the evidence is still limited and most studies were done at single points in time rather than following patients over years.
Understanding how psychological and immune factors interact in ME/CFS could lead to better treatment approaches and help explain why this illness affects both mental and physical health. This review identifies an important gap in research—the lack of long-term studies tracking these relationships—which researchers can now address with improved study designs.
This review cannot establish whether psychological factors cause immune changes or vice versa, as most studies are correlational. The findings do not prove that treatments targeting psychological factors will change immune function or improve ME/CFS outcomes. Additionally, the small number of studies and heterogeneous methods mean these associations may not be consistent across all ME/CFS 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 →
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Primary citation
Raanes, Emilie F W & Stiles, Tore C (2021). Associations Between Psychological and Immunological Variables in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review.. Frontiers in psychiatry. https://doi.org/10.3389/fpsyt.2021.716320
BibTeX
@article{mecfsatlas-raanes-2021-associations-between,
author = {Raanes, Emilie F W and Stiles, Tore C},
title = {Associations Between Psychological and Immunological Variables in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Systematic Review.},
journal = {Frontiers in psychiatry},
year = {2021},
doi = {10.3389/fpsyt.2021.716320},
note = {PubMed: 34887782},
url = {https://www.mecfsatlas.com/evidence/raanes-2021-associations-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/raanes-2021-associations-between
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