title: Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue.
abstract: OBJECTIVE
  Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety.
  
  
  METHODS
  We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms.
  
  
  RESULTS
  Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N=93) had unexplained chronic widespread pain and 12.6% (N=125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression.
  
  
  CONCLUSIONS
  This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression.
authors.affiliation: Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK. Electronic address: john.mcbeth@manchester.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: McBeth
authors.affiliation: Biostatistics Unit, Institute of Population Health, The University of Manchester, Manchester, UK.
authors.forename: B
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs, ST5 5BG, UK.
authors.forename: C A
authors.initials: CA
authors.lastname: Chew-Graham
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Macfarlane
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Jackson
authors.affiliation: Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Littlewood
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
authors.forename: F H
authors.initials: FH
authors.lastname: Creed
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications*; D059350:Chronic Pain; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003863:Depression / Q000150:complications*; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D012494:Sampling Studies; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Chronic fatigue; Epidemiology; Fibromyalgia; Functional somatic syndromes; Medically unexplained symptoms; Population based