Abstract
Fatigue syndromes (FSs) affect large numbers of individuals, yet evidence from epidemiological studies on adverse outcomes, such as premature death, is limited. Cohort study involving 385 general practices in England that contributed to the Clinical Practice Research Datalink (CPRD) with linked inpatient Hospital Episode Statistics (HES) and Office for National Statistics (ONS) cause of death information. A total of 10 477 patients aged 15 years and above, diagnosed with a FS during 2000-2014, were individually matched with up to 20 comparator patients without a history of having a FS. Prevalence ratios (PRs) were estimated to compare the FS and comparison cohorts on clinical characteristics. Adjusted hazard ratios (HRs) for subsequent adverse outcomes were estimated from stratified Cox regression models. Among patients diagnosed with FSs, we found elevated baseline prevalence of: any psychiatric illness (PR 1.77; 95% CI 1.72-1.82), anxiety disorders (PR 1.92; 1.85-1.99), depression (PR 1.89; 1.83-1.96), psychotropic prescriptions (PR 1.68; 1.64-1.72) and comorbid physical illness (PR 1.28; 1.23-1.32). We found no significant differences in risks for: all-cause mortality (HR 0.99; 0.91-1.09), natural death (HR 0.99; 0.90-1.09), unnatural death (HR 1.00; 0.59-1.72) or suicide (HR 1.68; 0.78-3.63). We did, however, observe a significantly elevated non-fatal self-harm risk: HR 1.83; 1.56-2.15. The absence of elevated premature mortality risk is reassuring. The raised prevalence of mental illness and increased non-fatal self-harm risk indicate a need for enhanced assessment and management of psychopathology associated with fatigue syndromes.
Highlights
The term ‘fatigue syndrome’ (FS) describes a set of debilitating illnesses that affect large numbers of individuals and can greatly restrict the quality of life
In response to conflicting findings reported from previously published studies (Jason et al, 2011; McManimen et al, 2016; Roberts et al, 2016), we tested the specific hypothesis that suicide and self-harm risks would be elevated in patients with an Fatigue syndromes (FSs) diagnosis, but that all-cause mortality risk would not be greater than in the rest of the population without an FS
We identified a subset of patients nested within the broadly classified FS cohort consisting of patients with a definitive diagnosis of chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) on their index date
Summary
The term ‘fatigue syndrome’ (FS) describes a set of debilitating illnesses that affect large numbers of individuals and can greatly restrict the quality of life. While a large number of studies have reported on the prevalence of comorbid psychiatric disorders (Afari and Buchwald, 2003; Ranjith, 2005; Cella et al, 2013; Mariman et al, 2013; Daniels et al, 2017; Larkin and Martin, 2017; Williams et al, 2017), the prevalence of comorbid physical illnesses appears to have been largely neglected. Evidence regarding premature mortality risk is comparatively sparse To address these gaps in the existing evidence-base we conducted a large cohort study among general practice-registered patients to estimate the prevalence of comorbid mental and physical illnesses, and risks of non-fatal self-harm, suicide and all-cause mortality, among patients diagnosed with a FS v. In response to conflicting findings reported from previously published studies (Jason et al, 2011; McManimen et al, 2016; Roberts et al, 2016), we tested the specific hypothesis that suicide and self-harm risks would be elevated in patients with an FS diagnosis, but that all-cause mortality risk would not be greater than in the rest of the population without an FS
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