Shi, Jieyao, Shen, Jie, Xie, Jian et al. · Medicine · 2018 · DOI
Researchers in China surveyed over 18,000 middle school students to see how many had chronic fatigue syndrome (CFS). They found that about 1 in 100 students met the criteria for CFS, with older students and boys more commonly affected. Beyond typical tiredness, these students also reported school anxiety, sadness, and irritability, suggesting CFS in teenagers may involve emotional symptoms alongside physical exhaustion.
This study demonstrates that ME/CFS affects adolescents in non-Western populations and highlights previously underrecognized psychological symptoms (school fear, despondency) that may be integral to the condition in this demographic. Understanding CFS burden across different cultures and age groups strengthens the case for early recognition and intervention in teenagers worldwide.
This study does not prove that school anxiety and irritability cause CFS—only that they co-occur. The cross-sectional design cannot determine whether psychological symptoms are primary drivers, consequences, or coincidental features. The prevalence estimate may not generalize to other Chinese regions or countries with different healthcare awareness and diagnostic practices.
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
Shi, Jieyao, Shen, Jie, Xie, Jian, Zhi, Jianming, & Xu, Yong (2018). Chronic fatigue syndrome in Chinese middle-school students.. Medicine. https://doi.org/10.1097/MD.0000000000009716
BibTeX
@article{mecfsatlas-shi-2018-chronic-fatigue,
author = {Shi, Jieyao and Shen, Jie and Xie, Jian and Zhi, Jianming and Xu, Yong},
title = {Chronic fatigue syndrome in Chinese middle-school students.},
journal = {Medicine},
year = {2018},
doi = {10.1097/MD.0000000000009716},
note = {PubMed: 29369204},
url = {https://www.mecfsatlas.com/evidence/shi-2018-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/shi-2018-chronic-fatigue
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