Psychological Medicine



Original Article

Mortality in a cohort of chronically fatigued patients


WAYNE R. SMITH a1c1, CAROLYN NOONAN a1 and DEDRA BUCHWALD a1
a1 Departments of Psychiatry and Behavioral Sciences and Medicine, University of Washington, Seattle, WA, USA

Article author query
smith wr   [PubMed][Google Scholar] 
noonan c   [PubMed][Google Scholar] 
buchwald d   [PubMed][Google Scholar] 

Abstract

Background. Comprehensive studies of mortality among patients with chronic fatigue (CF) and chronic fatigue syndrome (CFS) have not been published, but several sources suggest that CFS is associated with an elevated risk for suicide.

Method. Data on 1201 chronically fatigued patients followed in a university-affiliated tertiary-care clinic for up to 14 years were submitted to the Center for Disease Control and Prevention (CDC) National Death Index (NDI) to evaluate all-cause and suicide-caused death rates against standardized mortality rates (SMRs). We used Life Table Analysis to examine the influence of sex and diagnoses of CFS and depression.

Results. All-cause mortality in chronically fatigued patients was no higher than expected, but suicide-caused death rates were more than eight times higher than in the US general population. The significant elevation in the SMR of suicide was restricted to those who did not meet criteria for CFS [SMRCF=14·2, 95% confidence interval (CI) 5·7–29·3 versus SMRCFS=3·6, 95% CI 0·4–12·9]. Among chronically fatigued patients who did not meet CFS criteria, those with a lifetime history of major depression (MD) had higher suicide-caused death rates than among their non-depressed counterparts (SMRMD=19·1, 95% CI 7·0–41·5 versus SMRNMD=5·6, 95% CI 0·1–31·4), although the difference was not significant.

Conclusions. CFS does not appear to be associated with increased all-cause mortality or suicide rates. Clinicians, however, should carefully evaluate patients with CF for depression and suicidality.

(Published Online August 8 2006)


Correspondence:
c1 Harborview Medical Center, 325 9th Avenue, Box 359797, Seattle, WA 98104, USA. (Email: wrsmith@u.washington.edu)


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