title: Predictors of fatigue following the onset of infectious mononucleosis.
abstract: BACKGROUND
  Infectious mononucleosis (IM) is a risk factor for chronic fatigue. Reduced activity is the most consistent factor found to be associated with poor outcome following the onset of infectious mononucleosis. However, little is known about the biological mechanisms involved in the pathogenesis of chronic fatigue following IM and no study, so far, has examined the relation between certain illness beliefs and poor outcome. This study explored immunological, endocrine, behavioural and cognitive responses to the acute illness and assessed which components of these groups of risk factors predicted a chronic course.
  
  
  METHODS
  Using a prospective cohort design, 71 primary care patients with IM were enrolled onto the study and interviewed. Their recovery was explored by postal questionnaire up to 1 year later.
  
  
  RESULTS
  In the univariate analysis, increased baseline levels of immune activation were associated with fatigue at baseline and 3 months. Cortisol levels were not associated with fatigue at any point. Using multivariate models of clinical and psychosocial baseline factors, severity of symptoms and illness perceptions were found to predict fatigue 3 months later. At 6 months, fatigue was best predicted by female gender and illness perceptions, and at 12 months by female gender and a symptoms-disability factor.
  
  
  CONCLUSIONS
  In the multivariate analysis no factors were found to predict poor outcome at all time-points. Instead the pattern of predictors changed over time, partly but not completely consistent with our a priori predictions. Larger studies are needed to explore further the predictive nature of biopsychosocial factors in the pathogenesis of chronic fatigue related to IM. The psycho-behavioural predictors found in this study are amenable to intervention. Such interventions should be tested in randomized controlled trials.
authors.affiliation: Department of Psychological Medicine, Public Health Laboratory and Medical Microbiology, Guy's, King's and St Thomas' School of Medicine and Institute of Psychiatry, London.
authors.forename: B
authors.initials: B
authors.lastname: Candy
authors.forename: T
authors.initials: T
authors.lastname: Chalder
authors.forename: A J
authors.initials: AJ
authors.lastname: Cleare
authors.forename: A
authors.initials: A
authors.lastname: Peakman
authors.forename: A
authors.initials: A
authors.lastname: Skowera
authors.forename: S
authors.initials: S
authors.lastname: Wessely
authors.forename: J
authors.initials: J
authors.lastname: Weinman
authors.forename: M
authors.initials: M
authors.lastname: Zuckerman
authors.forename: M
authors.initials: M
authors.lastname: Hotopf
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D005221:Fatigue / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007244:Infectious Mononucleosis / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D008297:Male; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone