Fatigue in patients with chronic disease: results from the population-based Lifelines Cohort Study

Yvonne Goërtz ,Judith Rosmalen ,Rosanne J.h.c.g Beijers ,Melissa S Y Thong,Mirjam A G Sprangers,Martijn A Spruit,Jos W R Twisk,Zjala Ebadi,Femke Lamers,Chris Burtin,Suzanne E Geerlings,Jeannette B Peters,A.m.w.j Schols ,Maarten Van Herck,Anouk W Vaes,J.h.m.m Vercoulen ,Annemarie Braamse ,Martijn Van Beers,Daisy J.a Janssen ,Hans Knoop

doi:10.1038/s41598-021-00337-z

Abstract

(1) To evaluate the prevalence of severe and chronic fatigue in subjects with and without chronic disease; (2) to assess to which extent multi-morbidity contributes to severe and chronic fatigue; and (3) to identify predisposing and associated factors for severe and chronic fatigue and whether these are disease-specific, trans-diagnostic, or generic. The Dutch Lifelines cohort was used, including 78,363 subjects with (n = 31,039, 53 ± 12 years, 33% male) and without (n = 47,324, 48 ± 12 years, 46% male) ≥ 1 of 23 chronic diseases. Fatigue was assessed with the Checklist Individual Strength-Fatigue. Compared to participants without a chronic disease, a higher proportion of participants with ≥ 1 chronic disease were severely (23% versus 15%, p < 0.001) and chronically (17% versus 10%, p < 0.001) fatigued. The odds of having severe fatigue (OR [95% CI]) increased from 1.6 [1.5–1.7] with one chronic disease to 5.5 [4.5–6.7] with four chronic diseases; for chronic fatigue from 1.5 [1.5–1.6] to 4.9 [3.9–6.1]. Multiple trans-diagnostic predisposing and associated factors of fatigue were found, explaining 26% of variance in fatigue in chronic disease. Severe and chronic fatigue are highly prevalent in chronic diseases. Multi-morbidity increases the odds of having severe and chronic fatigue. Several trans-diagnostic factors were associated with fatigue, providing a rationale for a trans-diagnostic approach.

Highlights

IntroductionFatigue is an everyday experience. It becomes a symptom when it is an overwhelming feeling of exhaustion that interferes with the ability to function and perform a ctivities[1]
For most people, fatigue is an everyday experience
Participants with a chronic disease were less often involved in leisure-time sports activities, more often depressed and anxious, experienced substantially more bodily pain that hampers in performing activities, and scored higher on the neuroticism facets of anger/hostility, self-consciousness, impulsivity, and vulnerability

Summary

Introduction

Fatigue is an everyday experience. It becomes a symptom when it is an overwhelming feeling of exhaustion that interferes with the ability to function and perform a ctivities[1]. Knowledge about pre-morbid predisposing factors (hereafter called ‘predisposing factors’) will help identify patients at risk for developing clinically relevant levels of fatigue, while time-dependent associated factors (hereafter called ‘associated factors’) can be addressed in interventions that can reduce fatigue or help patients to manage fatigue Predisposing sociodemographic characteristics such as a lower education[21,22,23] and being female[21,23] were found to be related to higher levels of fatigue in specific chronic diseases. There is evidence from research in patients with MS that there is a link between neuroticism and fatigue[24,25,26] Besides these predisposing factors, modifiable factors such as depressed mood and anxiety may be associated with, or maintain, fatigue in specific chronic d iseases[6,27,28,29,30]. Lower physical activity levels[31,32,33], sleep d isturbances[7], lower body mass index (BMI)[34], hyper- or hypotension35,36, pain[6,28,37,38], and smoking s tatus[39,40] have been identified as factors possibly contributing to fatigue in specific chronic diseases

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Results

Conclusion