title: Prolonged fatigue in Ukraine and the United States: Prevalence and risk factors.
abstract: BACKGROUND
  Prolonged, severe, unalleviated fatigue may be disabling whether it occurs on its own or in conjunction with medical or psychiatric conditions. This paper compares the prevalence and correlates of prolonged fatigue in general population samples in Ukraine versus the U.S.
  
  
  METHODS
  Population surveys were conducted in 2002 in both Ukraine (Ukraine World Mental Health [WMH] Survey) and the U.S. (National Comorbidity Survey-Replication; NCS-R). Both surveys administered the Composite International Diagnostic Interview (CIDI 3.0), which contained modules assessing: neurasthenia (prolonged fatigue); mood, anxiety, and alcohol/drug use disorders; chronic medical conditions; and demographic characteristics. Multivariable logistic regression was used to examine risk factors in each country.
  
  
  RESULTS
  The lifetime prevalence of prolonged fatigue was higher in Ukraine (5.2%) than the U.S. (3.7%). In both countries, one-fifth of individuals with prolonged fatigue had no medical or DSM-IV psychiatric condition. Also in both settings, fatigue was significantly associated with sociodemographic characteristics (being female, not working, and married before) as well as early onset and adult episodes of mood/anxiety disorder. Fatigue prevalence in Ukraine increased with age, but decreased in the U.S. at age 70. Unique risk factors for fatigue in Ukraine included lower socio-economic status, Ukrainian vs Russian ethnicity, and cardiovascular disease. Unique risk factors in the U.S. were parental depression/anxiety, adult episodes of alcohol/drugs, pain conditions, and other health problems.
  
  
  CONCLUSIONS
  The lifetime prevalence of prolonged fatigue in Ukraine was 40% higher than that found in U.S. data. In addition, fatigue prevalence increased sharply with age in Ukraine perhaps due to limited social and medical resources and greater comorbidity.
authors.affiliation: Psychiatry and Behavioral Science, Putnam Hall/South Campus, Stony Brook University, Stony Brook, NY 11794-8790, fred.friedberg@stonybrookmedicine.edu .
authors.forename: Fred
authors.initials: F
authors.lastname: Friedberg
authors.affiliation: Dordt College, Sioux Center, IA 51250, nathan.tintle@dordt.edu .
authors.forename: Nathan
authors.initials: N
authors.lastname: Tintle
authors.affiliation: Dordt College, Math and Statistics, Dordt College, Sioux Center, IA 51250, jclark@dordt.edu .
authors.forename: Jake
authors.initials: J
authors.lastname: Clark
authors.affiliation: Putnam Hall/South Campus, Stony Brook University, Stony Brook, NY 11794-8790, evelyn.bromet@stonybrookmedicine.edu .
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
keywords: Ukraine; chronic fatigue syndrome; comorbidities; neurasthenia; prevalence; prolonged fatigue