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Chronic Fatigue and the Chronic Fatigue Syndrome: Prevalence in a Pacific Northwest Health Care System

Dedra Buchwald; Phoebe Umali; Jovine Umali; Phalla Kith; Tsilke Pearlman; and Anthony L. Komaroff
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From the University of Washington, Seattle, Washington. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Requests for Reprints: Dedra Buchwald, MD, Harborview Medical Center, 325 9th Avenue ZA-60, Seattle, WA 98104. Grant Support: In part by grants RO1 AI26788, RO1 AI27314, and UO1 AI32246 from the National Institute of Allergy and Infectious Diseases; grant RO1 AG08240 from the National Institute of Mental Health; a Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression (Dr. Buchwald); and the S. Sydney DeYoung Foundation.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;123(2):81-88. doi:10.7326/0003-4819-123-2-199507150-00001
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Objectives: To investigate the point prevalence of the chronic fatigue syndrome and unexplained debilitating chronic fatigue in a community-based sample of persons and to describe demographic, clinical, and psychosocial differences among those with the chronic fatigue syndrome, those with chronic fatigue, and healthy controls.

Design: Prospective cohort study.

Setting: A health maintenance organization in Seattle, Washington.

Participants: A random sample of 4000 members of the health maintenance organization was surveyed by mail for the presence of chronic fatigue.

Measurements: Persons with chronic fatigue were evaluated using a questionnaire that requested information about medical history and fatigue and related symptoms; validated measures of functional status and psychological distress; a physical examination; and standardized blood tests. A structured psychiatric interview was done in persons who appeared to meet the original Centers for Disease Control and Prevention (CDC) criteria for the chronic fatigue syndrome. Participants completed self-report measures at 12 and 24 months. Those with chronic fatigue were reevaluated in person 1 year after study enrollment.

Results: 3066 (77%) of the 4000 members surveyed responded. Chronic fatigue was reported by 590 persons (19%). Of these, 388 (66%) had a medical or psychiatric condition that could account for the fatigue. Of the 74 persons (37%) with chronic fatigue who were enrolled in the study, only 3 met the CDC criteria for the chronic fatigue syndrome. The remaining 71 persons were designated as having chronic fatigue alone. Seventy-four healthy, age- and sex-matched controls who were drawn from the same sample but who denied having chronic fatigue were also studied. Demographic characteristics were similar in persons with the chronic fatigue syndrome, persons with chronic fatigue alone, and controls. Those with the chronic fatigue syndrome or chronic fatigue alone had more frequent cervical and axillary adenopathy, poorer functional status, and greater psychological distress than controls. Women and minorities were not overrepresented among cases with chronic fatigue.

Conclusions: Using different assumptions about the likelihood that persons who did not participate in the study had the chronic fatigue syndrome, the estimated crude point prevalence of the syndrome in this community ranged from 75 to 267 cases per 100 000 persons. The point prevalence of chronic fatigue alone was strikingly higher; it ranged from 1775 to 6321 cases per 100 000 persons.

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