Smith, Mark S, Martin-Herz, Susanne P, Womack, William M et al. · Pediatrics · 2003 · DOI
This study compared teenage girls and boys with chronic fatigue, migraine headaches, and healthy peers to understand their emotional health and how much school they missed. Teenagers with chronic fatigue that met official diagnostic criteria had higher rates of anxiety, depression, and physical complaints than the other groups, and missed far more school days. Interestingly, parents of teenagers with unexplained chronic fatigue were less likely to think psychological stress was contributing to their child's illness compared to parents of teenagers with migraines.
This study provides evidence that ME/CFS in adolescents presents with distinct psychological and functional profiles compared to other chronic illnesses, which may help clinicians recognize and appropriately manage the condition. Understanding that higher anxiety and depression co-occur with ME/CFS—and that parents may underestimate psychological contributions—informs holistic treatment approaches and validates the serious functional impact of the illness.
This cross-sectional design cannot establish causation: elevated anxiety and depression may result from living with a disabling illness rather than causing it, and the study does not track whether these symptoms persist or change over time. The study also does not evaluate post-exertional malaise, orthostatic intolerance, or immunological markers, so it does not address core ME/CFS physiological features. Additionally, differences in illness attribution between parent groups may reflect different illness models rather than objective differences in disease etiology.
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
Smith, Mark S, Martin-Herz, Susanne P, Womack, William M, & Marsigan, Julie L (2003). Comparative study of anxiety, depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue or migraine.. Pediatrics. https://doi.org/10.1542/peds.111.4.e376
BibTeX
@article{mecfsatlas-smith-2003-comparative-study,
author = {Smith, Mark S and Martin-Herz, Susanne P and Womack, William M and Marsigan, Julie L},
title = {Comparative study of anxiety, depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue or migraine.},
journal = {Pediatrics},
year = {2003},
doi = {10.1542/peds.111.4.e376},
note = {PubMed: 12671155},
url = {https://www.mecfsatlas.com/evidence/smith-2003-comparative-study},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/smith-2003-comparative-study
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