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Physical, behavioral, and psychological risk factors for chronic fatigue syndrome: A central role for stress?

Dobbins JG, Natelson BH, Brassloff I, Drastal S, Sisto S-A.
Physical, behavioral, and psychological risk factors for chronic fatigue syndrome: A central role for stress?
Journal of Chronic Fatigue Syndrome, vol. 1, pages 43-58, 1995.

Summary

This report describes the results of a case-control study of well-defined CFS cases conducted in the Newark, New Jersey metropolitan area. The principal aim of the study was to identify physical, behavioral, and psychological factors related to the development of CFS. The study included 20 patients and 20 controls who were matched with the patients for age, sex and race. The greatest difference between cases and controls was the reported level of stress from any of 5 sources during the five years immediately before a patient became ill. Onset of CFS was also associated with the number of stressful events during that 5-year period, especially among persons with stressful events in three or more of the five categories. Several other risk factors were also identified. The results suggested that stress may be a factor in the development of CFS.

Abstract

In spite of the distinct epidemiologic features of chronic fatigue syndrome, its cause remains unknown and no risk factors for the illness have been identified. In order to better characterize CFS, we conducted a case-control study of well-defined CFS cases to identify physical, behavioral, and psychological factors related to the occurrence of CFS. The study, conducted in the metropolitan area surrounding Newark, New Jersey, USA, included 20 patients who fulfilled the CFS case definition and 20 matched controls. All subjects completed a self-administered questionnaire. The greatest difference between cases and controls was the reported level of stress from any of five sources in the 5 years prior to onset of illness (95% vs. 55%; P = 0.011). In addition, the risk of CFS was significantly related to the number of sources of stress, especially three or more. Other significant risk factors included a history of premenstrual syndrome, a history of eczema, loss of interest in daily activities, and panic attacks. Our results suggest that stress may be one of the factors related to the development of CFS. However, the possibility remains that the observed relationship resulted from a biased recollection of events preceding the illness. It is also possible that the perception of stress is correlated with some other variable related to the pathogenesis of CFS.

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