Psychological Medicine

Original Articles

The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study

S. B. Harveya1, M. Wadswortha2, S. Wesselya1 and M. Hotopfa1 c1

a1 Department of Psychological Medicine, Institute of Psychiatry, Kings College London, London, UK

a2 MRC National Survey of Health and Development, Department of Epidemiology and Public Health, Royal Free and UCL Medical School, London, UK


Background Increased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms.

Method A total of 5362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years.

Results Thirty-four (1.1%) of the 3035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26–5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose–response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME.

Conclusions This temporal, dose–response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.

(Received March 15 2007)

(Revised August 15 2007)

(Accepted August 24 2007)

(Online publication November 02 2007)


c1 Address for correspondence: Professor M. Hotopf, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. (Email: