title: Temporal relations between unexplained fatigue and depression: longitudinal data from an international study in primary care.
abstract: OBJECTIVE
  Unexplained fatigue syndromes, such as chronic fatigue syndrome and neurasthenia, are strongly associated with depression, but the temporal nature of this association is not clear.
  
  
  METHODS
  The authors examined this issue by using data from the World Health Organization collaborative study of psychological problems in general health care. Three thousand two hundred one subjects from 15 primary care centers in 14 countries were followed up for 12 months. The Composite International Diagnostic Interview was the main instrument used. Odds ratios and their 95% confidence intervals (CI) were calculated using logistic regression models adjusted for sociodemographic variables, physical morbidity and intercenter variability.
  
  
  RESULTS
  Cases of depression were found to have an increased risk of developing a new episode of unexplained fatigue at follow-up with an adjusted odds ratio of 4.15 (95% CI = 2.64-6.54). Similarly, cases of unexplained fatigue were found to have an increased risk of developing a new episode of depression at follow-up with an adjusted odds ratio of 2.76 (95% CI = 1.32-5.78). Further adjustment for subthreshold symptoms at baseline weakened the reported associations, especially between fatigue and development of a new episode of depression, but these remained significant.
  
  
  CONCLUSIONS
  The findings support the view that unexplained fatigue and depression might act as independent risk factors for each other.
authors.affiliation: Department of Psychiatry, University of Ioannina, School of Medicine, Greece. pskapin@cc.uoi.gr
authors.forename: Petros
authors.initials: P
authors.lastname: Skapinakis
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
authors.forename: Venetsanos
authors.initials: V
authors.lastname: Mavreas
mesh_terms: D000328:Adult; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009440:Neurasthenia / Q000175:diagnosis* / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014944:World Health Organization