title: Fatigue as a manifestation of psychosocial distress in a low-income country: a population-based panel study.
abstract: OBJECTIVE
  Fatigue is a common complaint worldwide and associated with disability and high health service use costs. We tested the hypothesis that maternal fatigue would be associated independently with maternal common mental disorder ('maternal CMD') in a rural, low-income country setting.
  
  
  METHODS
  The analysis was conducted using data from a population-based cohort located in the Butajira demographic surveillance site, Ethiopia. A total of 1065 women were recruited in pregnancy and followed up to 2.5 (n = 1009; 94.7%) and 3.5 years post-partum (n = 989; 92.9%). Maternal CMD symptoms were measured using a locally validated version of the Self-Reporting Questionnaire and fatigue was measured using a dichotomised item from the Patient Health Questionnaire-15. Physical health indicators included haemoglobin level, body mass index and illness episodes. Generalised estimating equations were used to conduct hypothesis-driven and exploratory multivariable analyses in the panel at 2.5 and 3.5 years.
  
  
  RESULTS
  The prevalence of maternal fatigue was 8.3% at 2.5 years and 5.5% at 3.5 years post-partum. Psychological symptoms of maternal CMD were associated independently with complaints of fatigue after adjusting for anaemia, body mass index, physical ill health, poverty and other confounding variables: adjusted odds ratio (aOR), 1.46; 95% confidence interval (CI), 1.28-1.66 for each one point increase in SRQ score. In the multivariable model, only psychosocial factors (CMD and stressful life events) and self-reported physical ill health were associated significantly with complaints of fatigue.
  
  
  CONCLUSIONS
  Complaints of fatigue are associated strongly with maternal CMD and other psychosocial risk factors in this rural, low-income country setting with a high burden of undernutrition and infectious disease. Fatigue should be understood as a potential indicator of CMD in primary care to improve detection and treatment.
authors.affiliation: Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Smartt
authors.affiliation: Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.affiliation: Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Atalay
authors.initials: A
authors.lastname: Alem
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK.|Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Sangath, Goa, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.affiliation: Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003906:Developing Countries / Q000706:statistics & numerical data*; D005002:Ethiopia / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006304:Health Status; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D006454:Hemoglobins
keywords: DMC materno; Ethiopia; Ethiopie; Etiopía; PFR-PRI; PIBMs; angustia psicosocial; détresse psychosociale; estudio poblacional de paneles; fatiga; fatigue; low-and middle-income countries; maternal CMD; population-based panel study; psychosocial distress; étude de panel basée sur la population