Psychological Medicine

Invited Review

Risk factors for chronic fatigue syndrome/myalgic encephalomyelitis: a systematic scoping review of multiple predictor studies

S. Hempela1 c1, D. Chambersa1, A.-M. Bagnalla1 and C. Forbesa1

a1 Centre for Reviews and Dissemination, University of York, York, UK


Background The aetiology of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is still unknown. The identification of risk factors for CFS/ME is of great importance to practitioners.

Method A systematic scoping review was conducted to locate studies that analysed risk factors for CFS/ME using multiple predictors. We searched for published and unpublished literature in 11 electronic databases, reference lists of retrieved articles and guideline stakeholder submissions in conjunction with the development of a forthcoming national UK guideline. Risk factors and findings were extracted in a concise tabular overview and studies synthesized narratively.

Results Eleven studies were identified that met inclusion criteria: two case-control studies, four cohort studies, three studies combining a cohort with a case-control study design, one case-control and twin study and one cross-sectional survey. The studies looked at a variety of demographic, medical, psychological, social and environmental factors to predict the development of CFS/ME. The existing body of evidence is characterized by factors that were analysed in several studies but without replication of a significant association in more than two studies, and by studies demonstrating significant associations of specific factors that were not assessed in other studies. None of the identified factors appear suitable for the timely identification of patients at risk of developing CFS/ME within clinical practice.

Conclusions Various potential risk factors for the development of CFS/ME have been assessed but definitive evidence that appears meaningful for clinicians is lacking.

(Received October 09 2006)

(Revised July 11 2007)

(Accepted July 18 2007)

(Online publication September 25 2007)


c1 Address for correspondence: Dr S. Hempel, Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK. (Email:


The views expressed in this paper are those of the authors and not necessarily those of the NCC-PC, RCGP or National Institute for Health and Clinical Excellence.