The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review.
The prognosis of chronic fatigue syndrome and chronic fatigue has been studied in numerous small case series. We performed a systematic review of all studies to determine the proportion of individuals with the conditions who recovered at follow-up, the risk of developing alternative physical diagnoses, and the risk factors for poor prognosis. A literature search of all published studies which included a follow-up of patients with chronic fatigue syndrome or chronic fatigue were performed. Of 26 studies identified, four studied fatigue in children, and found that 54-94% of children recovered over the periods of follow-up. Another five studies operationally defined chronic fatigue syndrome in adults and found that < 10% of subjects return to pre-morbid levels of functioning, and the majority remain significantly impaired. The remaining studies used less stringent criteria to define their cohorts. Among patients in primary care with fatigue lasting < 6 months, at least 40% of patients improved. As the definition becomes more stringent the prognosis appears to worsen. Consistently reported risk factors for poor prognosis are older age, more chronic illness, having a comorbid psychiatric disorder and holding a belief that the illness is due to physical causes.
Joyce
J
J
Institute of Psychiatry, London, UK.
Hotopf
M
M
Wessely
S
S
D000328:Adult; D002648:Child; D005221:Fatigue / Q000453:epidemiology / Q000523:psychology; D015673:Fatigue Syndrome, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D011379:Prognosis; D012657:Self-Help Groups