title: Mortality in a cohort of chronically fatigued patients.
abstract: BACKGROUND
  Comprehensive studies of mortality among patients with chronic fatigue (CF) and chronic fatigue syndrome (CFS) have not been published, but several sources suggest that CFS is associated with an elevated risk for suicide.
  
  
  METHODS
  Data on 1201 chronically fatigued patients followed in a university-affiliated tertiary-care clinic for up to 14 years were submitted to the Center for Disease Control and Prevention (CDC) National Death Index (NDI) to evaluate all-cause and suicide-caused death rates against standardized mortality rates (SMRs). We used Life Table Analysis to examine the influence of sex and diagnoses of CFS and depression.
  
  
  RESULTS
  All-cause mortality in chronically fatigued patients was no higher than expected, but suicide-caused death rates were more than eight times higher than in the US general population. The significant elevation in the SMR of suicide was restricted to those who did not meet criteria for CFS [SMR(CF)=14.2, 95% confidence interval (CI) 5.7-29.3 versus SMR(CFS)=3.6, 95% CI 0.4-12.9]. Among chronically fatigued patients who did not meet CFS criteria, those with a lifetime history of major depression (MD) had higher suicide-caused death rates than among their non-depressed counterparts (SMR(MD)=19.1, 95% CI 7.0-41.5 versus SMR(NMD)=5.6, 95% CI 0.1-31.4), although the difference was not significant.
  
  
  CONCLUSIONS
  CFS does not appear to be associated with increased all-cause mortality or suicide rates. Clinicians, however, should carefully evaluate patients with CF for depression and suicidality.
authors.affiliation: Department of Psychiatry, University of Washington, Seattle, WA, USA. wrsmith@u.washington.edu
authors.forename: Wayne R
authors.initials: WR
authors.lastname: Smith
authors.forename: Carolyn
authors.initials: C
authors.lastname: Noonan
authors.forename: Dedra
authors.initials: D
authors.lastname: Buchwald
mesh_terms: D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012307:Risk Factors; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data; D013997:Time Factors