title: A comparison of the characteristics of chronic fatigue syndrome in primary and tertiary care.
abstract: BACKGROUND
  To evaluated the characteristics of Chronic Fatigue Syndrome (CFS) in primary and tertiary care.
  
  
  METHODS
  A comparison of subjects fulfilling criteria for CFS, identified as part of a prospective cohort study in primary care, compared to 79 adults fulfilling the same criteria referred for treatment to a specialist CFS clinic.
  
  
  RESULTS
  Hospital cases were more likely to belong to upper socio-economic groups, and to have physical illness attributions. They had higher levels of fatigue and more somatic symptoms, and were more impaired functionally, but had less overt psychological morbidity. Women were over-represented in both primary care and hospital groups. Nearly half of those referred to a specialist clinic did not fulfil operational criteria for CFS.
  
  
  CONCLUSIONS
  The high rates of psychiatric morbidity and female excess that characterise CFS in specialist settings are not due to selection bias. On the other hand higher social class and physical illness attributions may be the result of selection bias and not intrinsic to CFS.
authors.affiliation: Academic Department of Psychological Medicine, King's College School of Medicine and Dentistry, London.
authors.forename: R
authors.initials: R
authors.lastname: Euba
authors.forename: T
authors.initials: T
authors.lastname: Chalder
authors.forename: A
authors.initials: A
authors.lastname: Deale
authors.forename: S
authors.initials: S
authors.lastname: Wessely
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D015331:Cohort Studies; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010555:Personality Inventory / Q000706:statistics & numerical data; D011320:Primary Health Care; D011446:Prospective Studies; D011594:Psychometrics; D012047:Rehabilitation Centers; D015983:Selection Bias; D012803:Sick Role