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Articles   |    
Prevalence and Correlates of Prolonged Fatigue in a U.S. Sample of Adolescents
Femke Lamers, Ph.D.; Ian Hickie, M.D., F.R.A.N.Z.C.P.; Kathleen R. Merikangas, Ph.D.
Am J Psychiatry 2013;170:502-510. doi:10.1176/appi.ajp.2012.12040454
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Dr. Hickie reports that 1) he currently serves on the board of the Psychosis Australia Trust (unpaid position) and on the Defence Mental Health Advisory Group (government committee); 2) he currently receives fees for consulting or reports from Bupa Australia (private health insurance) as a member of the Medical Advisory Panel; 3) he has received travel support in the last 5 years from Servier, AstraZeneca, PricewaterhouseCoopers, the American Psychiatric Association, Returned and Services League (RSL) National Congress, the Chinese Society of Psychiatry and Neurology, Australian General Practice Network, and Focus—Sunshine Coast; 4) he has received research support in the last 5 years from Servier and Pfizer; 5) he has received payments for educational seminars or resources in the last 5 years from Servier, AstraZeneca, Pfizer (Wyeth), Eli Lilly, Broadcast Psychiatry, Janssen Cilag, Merck Sharp and Dohme, Elixir Healthcare Education, the Australian Mental Health Leadership Program, Australian Independent Schools of New South Wales, Australian Doctor Education, and Intelligence Squared Australia; 6) he previously had a business interest in St. George Neuropsychiatry Pty. Ltd. (director); 7) he previously held positions at the Australian Department of Health and Ageing (sitting fee for the National Advisory Council on Mental Health), the Australian National Council on Drugs, and Headspace: the National Youth Mental Health Foundation (director on behalf of the University of Sydney, a member of the company); 8) he previously served on the following government advisory committees: Mental Health Expert Working Group (member), Access to Allied Psychological Services (member of expert advisory committee), National Advisory Council for Mental Health (member), and Common Approach to Assessment Referral and System Task Force co-convened by the Minister for Families, Housing, and Community Services (member); 9) he previously received payments for consulting, reports, or advisory work from Drinkwise Australia, Western Australia (Labor) Government, the Australian Department of Health and Ageing, Sydney Magazine, Sydney City Council, the Royal Australian and New Zealand College of Psychiatry, Wyeth, and Eli Lilly; 10) his partner Dr. Elizabeth Scott is Clinical Director of Headspace Camperdown and Cambebelltown and previously had a business interest in Pearl 100, a partnership (ABN 55 251 484 962) trading as The Clinical Centre and registered to S. Duncan and St. George Neuropsychiatry Pty. Ltd.; 11) mental health research conducted at the Brain & Mind Research Institute has been supported by Servier, Pfizer, the Heart Foundation, Beyond Blue, and the Bupa Foundation. The other authors report no financial relationships with commercial interests.

Supported by NIMH Intramural Research Program grant Z01 MH-002808-08 and, through the National Comorbidity Survey Adolescent Supplement (NCS-A) and the larger program of related NCS surveys, NIMH grant U01 MH-60220. Dr. Lamers is supported by a Rubicon Fellowship from the Netherlands Organisation for Scientific Research (NWO) and by a Supplemental Intramural Research Training Award from the NIMH Genetic Epidemiology Research Branch.

The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or the U.S. government.

From the Genetic Epidemiology Research Branch, Intramural Research Program, NIMH, Bethesda, Md.; and the Clinical Research Unit, Brain & Mind Research Institute, University of Sydney.

Address correspondence to Dr. Merikangas (merikank@mail.nih.gov).

Copyright © 2013 by the American Psychiatric Association

Received April 06, 2012; Revised September 21, 2012; Revised November 27, 2012; Accepted December 04, 2012.

Abstract

Objective  Prolonged fatigue in adolescents has a major impact on social functioning and school attendance. In adults, prolonged fatigue substantially overlaps with mood and anxiety disorders. Extending the data to adolescents, the authors studied the prevalence and correlates of fatigue in a representative U.S. sample.

Method  The participants were 10,123 adolescents ages 13–18 years from the National Comorbidity Survey Adolescent Supplement. They were interviewed about prolonged fatigue, defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months.

Results  The prevalence of prolonged fatigue was 3.0% (SE=0.3), with 1.4% (SE=0.2) for prolonged fatigue only and 1.6% (SE=0.2) for prolonged fatigue concomitant with a depressive or anxiety disorder. Nearly 60% of the adolescents with prolonged fatigue only had severe or very severe disability, and their rates of poor physical and mental health were comparable to those of adolescents with mood or anxiety disorders only. Adolescents with prolonged fatigue and comorbid mood or anxiety disorders had significantly greater disability, poorer mental health, and more health service use than those with either condition alone.

Conclusions  These findings suggest that prolonged fatigue is associated with disability and is an important clinical entity independent of mood and anxiety disorders in adolescents. Persistent fatigue with a comorbid mood or anxiety state is related to even more functional impairment, suggesting that prolonged fatigue may reflect greater severity of mood and anxiety disorders in adolescents.

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FIGURE 1. Disability, Health Perception, and Comorbidity of U.S. Adolescents With Prolonged Fatigue Only, Depression or Anxiety Only, Both, or Neithera

a Prolonged fatigue was defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months.

b Depressive and anxiety disorders included lifetime DSM-IV diagnoses of major depressive disorder, dysthymia, bipolar disorder, generalized anxiety disorder, or panic disorder.

c Measured only in adolescents with prolonged fatigue, depression, and/or an anxiety disorder.

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TABLE 1.Demographic Characteristics of U.S. Adolescents With Prolonged Fatigue Only, Depression/Anxiety Only, Both, or Neither
Table Footer Note

aProlonged fatigue was defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months.

Table Footer Note

bDepressive and anxiety disorders included lifetime DSM-IV diagnoses of major depressive disorder, dysthymia, bipolar disorder, generalized anxiety disorder, or panic disorder.

Table Footer Note

cNo lifetime prolonged fatigue.

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TABLE 2.Rates of Mood, Anxiety, and Substance Abuse Disorders in 291 U.S. Adolescents With Prolonged Fatiguea
Table Footer Note

aProlonged fatigue was defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months.

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TABLE 3.Clinical and Somatic Correlates of Prolonged Fatigue in U.S. Adolescents With Prolonged Fatigue Only, Depression or Anxiety Only, Both, or Neither
Table Footer Note

aProlonged fatigue was defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months.

Table Footer Note

bDepressive and anxiety disorders included lifetime DSM-IV diagnoses of major depressive disorder, dysthymia, bipolar disorder, generalized anxiety disorder, or panic disorder.

Table Footer Note

cNo lifetime prolonged fatigue.

Table Footer Note

dMedian ages at onset were compared by means of a proportional hazard model. Percentages were compared by means of chi-square analyses. Mean sleep durations were compared by analyses of variance.

Table Footer Note

eSignificant post hoc difference between groups 1 and 2 (p<0.05).

Table Footer Note

fSignificant post hoc difference between groups 2 and 3 (p<0.05).

Table Footer Note

gSignificant post hoc difference between groups 1 and 3 (p<0.05).

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TABLE 4.Self-Rated Health Status of U.S. Adolescents With Prolonged Fatigue Only, Depression or Anxiety Only, Both, or Neither
Table Footer Note

aProlonged fatigue was defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months.

Table Footer Note

bDepressive and anxiety disorders included lifetime DSM-IV diagnoses of major depressive disorder, dysthymia, bipolar disorder, generalized anxiety disorder, or panic disorder.

Table Footer Note

cNo lifetime prolonged fatigue.

Table Footer Note

dSignificant post hoc difference between groups 1 and 2 (p<0.05).

Table Footer Note

eSignificant post hoc difference between groups 2 and 3 (p<0.05).

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TABLE 5.Service Use for Emotional or Behavioral Symptoms in Preceding Year by 6,483 U.S. Adolescents With Prolonged Fatigue Only, Depression/Anxiety Only, Both, or Neither
Table Footer Note

aProlonged fatigue was defined as extreme fatigue with at least one associated symptom (pains, dizziness, headache, sleep disturbance, inability to relax, irritability) that does not resolve by resting or relaxing and lasting at least 3 months.

Table Footer Note

bDepressive and anxiety disorders included lifetime DSM-IV diagnoses of major depressive disorder, dysthymia, bipolar disorder, generalized anxiety disorder, or panic disorder.

Table Footer Note

cNo lifetime prolonged fatigue.

Table Footer Note

dSignificant post hoc difference between groups 1 and 2 (p<0.05).

Table Footer Note

eSignificant post hoc difference between groups 1 and 3 (p<0.05).

Table Footer Note

fSignificant post hoc difference between groups 2 and 3 (p<0.05).

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