Psychological Medicine

Original Article

Epidemiology of unexplained fatigue and major depression in the community: The Baltimore ECA Follow-up, 1981–1994

A. M.  ADDINGTON  a1, J. J.  GALLO  a1, D. E.  FORD  a1 and W. W.  EATON  c1 a1
a1 From the Department of Mental Hygiene, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD; and Department of Family Practice and Community Medicine, University of Pennsylvania, PA, USA


Background. Fatigue is a common, non-specific, subjective symptom associated with several medical and psychiatric illnesses. The purpose of this investigation was to explore further the epidemiology of unexplained fatigue in the general population and the relationship between fatigue and depression.

Methods. The design was a prospective population-based study. Subjects included community-dwelling adults who were participants of the Baltimore sample of the Epidemiologic Catchment Area Program in 1981 and who were reinterviewed 13 years later. Lay interviewers using the Diagnostic Interview Schedule interviewed subjects.

Results. Number of somatization symptoms and history of a dysphoric episode at baseline were the two strongest predictors of both new onset of fatigue as well as recurrent/chronic fatigue over the 13-year follow-up interval. In addition, individuals who reported a history of unexplained fatigue at baseline as well as during the follow-up, were at markedly increased risk for new onset major depression as compared to those who never reported such fatigue, (RR = 28·4, 95% CI) (11·7, 68·0). Similarly, respondents who developed new fatigue or had remitted fatigue after 1981 were also at increased risk for developing major depression.

Conclusions. Somatization was the strongest predictor of both new and chronic fatigue with unknown cause. In addition, fatigue was both predictive and a consequence of the depression syndrome.

c1 Address for correspondence: Professor William W. Eaton, Department of Mental Hygiene, Johns Hopkins University School of Hygiene and Public Health, 624 North Broadway, Room 880, Baltimore, MD 21205, USA.