OBSERVED Tired , weak , or in need of rest : fatigue among general practice

Objectives-To determine the prevalence and associations of symptoms of fatigue. Design-Questionnaire survey. Setting-London general practice. Participants-611 General practice attenders. Main outcome measures-Scores on a fatigue questionnaire and reasons given for fatigue. Results-10*2% Of men (17/167) and 10.6% of women (47/444) had substantial fatigue for one month or more. Age, occupation, and marital status exerted minor effects. Subjects attributed fatigue equally to physical and non-physical causes. Physical ill health, including viral infection, was associated with more severe fatigue. Women rather than men blamed family responsibilities for their fatigue. The profile of persistent fatigue did not differ from that of short duration. Only one person met criteria for the chronic fatigue syndrome. Conclusions-Fatigue is a common complaint among general practice attenders and can be severe. Patients may attribute this to physical, psychological, and social stress. Section of Epidemiology and General Practice, Institute of Psychiatry, London SE5 8AF Anthony David, MRCPSYCH, lecturer Elizabeth McDonald, MRCPSYCH, research worker Anthony Mann, FRCPSYCH, professor University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh EH1O 5HF Anthony Pelosi, MRCPSYCH, lecturer London SE24 9HJ David Stephens, MRCGP, general practitioner David Ledger, MRCGP, general practitioner Richard Rathbone, MRCGP, general practitioner Correspondence to: Dr David. BrMedJ 1990;301:1199-202 Introduction Fatigue is a common, perhaps universal complaint. In a recent British survey about 20% ofmen and 30% of women admitted to "always feeling tired" during the previous week,' and similar data have been reported from the United States. Fatigue is also common among people attending their doctors, though the reported prevalence depends on the way the question is asked. One large study on general practice showed that 23% of women and 13% of men answered positively the question, "Do you often get spells of complete exhaustion or fatigue?"4 Similarly, an investigation into fatigue in a United States army primary medical care centre found that 28% of female and 19% of male attenders indicated that this had been a "major problem" for a month or more.5 In both primary care and community studies higher rates of fatigue have often been found in women,'6 though age does not seem to have a consistent association with fatigue,5 except perhaps an inverse association in women . Data from this last survey also showed a modest increase in the prevalence of fatigue among those with semiskilled and unskilled manual occupations. Fatigue is a non-specific symptom; it occurs in most physical illnesses' and many psychiatric disorders.9"' It has recently caught the public and professional imagination with the emergence of a possibly specific chronic fatigue syndrome, perhaps of postinfectious origin.'4'" Anecdotally it is said to occur in early adult life, to occur after acute infection, to have a female preponderance, and to occur particularly in those of high occupational status, especially medical and paramedical professionals.'416"-8 As a group, subjects with chronic fatigue syndromes are said to make physical attributions about ill health.7" Some or all of these associations could be explained on the basis of a selection bias which results in a subgroup of sufferers who are investigated in hospital based studies.'4 To date there has been no study in primary care in the United Kingdom which has specifically investigated the various components of fatigue. We therefore conducted a questionnaire survey about fatigue among adults attending a south London group general practice between November 1989 and January 1990. The aims were: (a) to estimate the prevalence of the various symptoms offatigue in a primary care population using a specially developed questionnaire; (b) to examine the associations with fatigue discussed above; and (c) to explore patients' own explanations for this symptom.