ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke et al. · Pediatrics · 2008 · DOI
This study followed 653 teenage girls over one year to understand why some develop long-lasting fatigue while others recover. Researchers found that about 26% of girls who were severely fatigued at the start remained fatigued throughout the year. Depression, anxiety, low physical activity, and poor sleep were linked to persistent or new fatigue, suggesting that emotional health and lifestyle habits play important roles in fatigue development.
This study provides longitudinal evidence that ME/CFS-like fatigue in adolescents is substantially persistent and linked to psychological and lifestyle factors, supporting the need for early intervention targeting emotional well-being and physical activity. Understanding what predicts fatigue persistence versus transient episodes can help clinicians identify high-risk adolescents and develop preventive strategies before fatigue becomes chronic.
This study does not establish causation—only associations between depression, anxiety, inactivity, and fatigue trajectories. It involves general adolescent fatigue rather than confirmed ME/CFS diagnoses, so findings may not apply specifically to ME/CFS populations. The study cannot explain the biological mechanisms underlying fatigue persistence or determine whether psychological factors cause fatigue or result from it.
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
ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke, & Heijnen, Cobi J (2008). Predictors of persistent and new-onset fatigue in adolescent girls.. Pediatrics. https://doi.org/10.1542/peds.2007-1093
BibTeX
@article{mecfsatlas-ter-wolbeek-2008-predictors-persistent,
author = {ter Wolbeek, Maike and van Doornen, Lorenz J P and Kavelaars, Annemieke and Heijnen, Cobi J},
title = {Predictors of persistent and new-onset fatigue in adolescent girls.},
journal = {Pediatrics},
year = {2008},
doi = {10.1542/peds.2007-1093},
note = {PubMed: 18310166},
url = {https://www.mecfsatlas.com/evidence/ter-wolbeek-2008-predictors-persistent},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/ter-wolbeek-2008-predictors-persistent
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