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Chronic fatigue and anxiety/depression: A twin study

  • Peter Roy-Byrne (a1), Niloofar Afari (a2), Suzanne Ashton (a3), Mary Fischer (a4), Jack Goldberg (a4) and Dedra Buchwald (a4)...
Abstract
Background

Up to three-quarters of patients with fatigue syndromes have comorbid mood or anxiety disorders, suggesting that chronic fatigue is a forme fruste of anxiety or depressive states.

Aims

To establish whether the association of chronic fatigue with psychological distress is causal or due to a common genetic or environmental factor.

Method

69 monozygotic (MZ) and 31 dizygotic (DZ) female twin pairs, with only one co-twin reporting at least 6 months of fatigue, completed questions on fatigue, the General Health Questionnaire (GHQ) and a structured psychiatric interview. We examined the effects of three progressively more stringent definitions of chronic fatigue on four GHQ sub-scales.

Results

Fatigued MZ and DZ twins by all definitions were significantly more depressed, anxious, somatically preoccupied and socially dysfunctional than their non-fatigued co-twins. Intrapair differences were similar in DZ and MZ twins, but non-significant differences were observed for the somatic symptoms and anxiety/insomnia sub-scales.

Conclusions

In this sample, chronic fatigue and psychological distress are strongly associated without evidence for genetic covariation, implying that the association is environmental, or due to overlapping definitions. Any genetic covariation missed is likely to involve anxiety rather than depression.

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Copyright
Corresponding author
Dr D. Buchwald, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA. Tel: 1 206 731 8218; Fax: + 1 206 731 8247; e-mail: dedra@u.washington.edu
References
Hide All
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.
Buchwald, D. Pearlman, T. Kith, P. et al (1997) Screening for psychiatric disorders in chronic fatigue and chronic fatigue syndrome. Journal of Psychosomatic Research, 42, 8794.
Buchwald, D. Herrell, R. Ashton, S. et al (1999) The chronic fatigue twin registry: method of construction, composition, and zygosity assignment. Twin Research, 2, 203211.
Buchwald, D. Herrell, R. Hartman, S. et al (2001) A twin study of chronic fatigue. Psychosomatic Medicine, in press.
Demitrack, M. A. (1997) Neuroendocrine correlates of chronic fatigue syndrome: a brief review. Journal of Psychiatric Research, 31, 6982.
Eisen, S. A. Neuman, R. Goldberg, J. et al (1989) Determining zygosity in the Vietnam Era Twin Registry: an approach using questionnaires. Clinical Genetics, 35, 423432.
Farmer, A. Scourfield, J. Martin, N. et al (1999) Is disabling fatigue in childhood influenced by genes? Psychological Medicine, 29, 279282.
Fukuda, A. Scourfield, J. Martin, N. et al (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Case Definition Study Group. Annals of Internal Medicine, 121, 953959.
Gold, P. W. Licinio, J. Wong, M. L. et al (1995) Corticotropin releasing hormone in the pathophysiology of melancholic and atypical depression and in the mechanism of action of antidepressant drugs. Annals of the New York Academy of Sciences, 771, 716729.
Goldberg, D. P. & Hillier, V. F. (1979) A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139145.
Hickie, I. Koschera, A. Hadzi-Pavlovic, D. et al (1999a) The temporal stability and co-morbidity of prolonged fatigue: a longitudinal study in primary care. Psychological Medicine, 29, 855861.
Hickie, I. Kirk, K. & Martin, N. (1999b) Unique genetic and environmental determinants of prolonged fatigue: a twin study. Psychological Medicine, 29, 259268.
Jason, L. A. Richman, J. A. Rademaker, A. W. et al (1999) A community-based study of chronic fatigue syndrome. Archives of Internal Medicine, 159, 21292137.
Katon, W. & Walker, E. A. (1993) The relationship of chronic fatigue to psychiatric illness in community, primary care and tertiary care samples. In Chronic Fatigue Syndrome (Ciba Foundation Symposium No. 173) (eds Bock, G. R. & Whelan, J.), pp. 193211. Chichester: John Wiley & Sons.
Kendler, K. S. Neale, M. C. Kessler, R. C. et al (1993) The lifetime history of major depression in women. Reliability of diagnosis and heritability. Archives of General Psychiatry, 50, 863870.
Kendler, K. S. Karkowski, I. M. & Prescott, C. A. (1999) Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156, 837841.
Lyons, M. J. Eisen, S. A. Goldberg, J. et al (1998) A registry-based twin study of depression in men. Archives of General Psychiatry, 55, 468472.
Manu, P. Lane, T. J. & Matthews, D. A. (1988) The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue. [Published erratum appears in Annals of Internal Medicine, 109, 997.] Annals of Internal Medicine, 109, 554556.
Manu, P. Matthews, D. A. Lane, T. J. et al (1989) Depression among patients with a primary complaint of chronic fatigue. Journal of Affective Disorders, 17, 165172.
Moldin, S. O. Reich, T. & Rice, J. P. (1991) Current perspectives on the genetics of unipolar depression. Behavioral Genetics, 21, 211242.
Nisenbaum, R. Reyes, M. Mawle, A. C. et al (1998) Factor analysis of unexplained severe fatigue and interrelated symptoms: overlap with criteria for chronic fatigue syndrome. American Journal of Epidemiology, 148, 7277.
Robins, I. N. & Helzer, J. E. (1985) Diagnostic Interview Schedule (DIS): Version III-A. St Louis, MO: Department of Psychiatry, Washington University School of Medicine.
Schluederberg, A. Straus, S. Peterson, P. et al (1992) Chronic fatigue syndrome research: definition and medical outcome assessment. Annals of Internal Medicine, 117, 325331.
Steele, L. Dobbins, J. G. Fukuda, K. et al (1998) The epidemiology of chronic fatigue in San Francisco. American Journal of Medicine, 105, 83S90S.
Terman, M. Levine, S. M. Terman, J. S. et al (1998) Chronic fatigue syndrome and seasonal affective disorder: comorbidity, diagnosticoverlap, and implications for treatment. American Journal of Medicine, 105, 115S124S.
Torgersen, S. (1979) The determination of twin zygosity by means of a mailed questionnaire. Acta Genetica Medica et Gemellogica (Rome), 28, 225236.
van der Linden, G. Chalder, T. Hickie, I. et al (1999) Fatigue and psychiatric disorder: different or the same? Psychological Medicine, 29, 863868.
Vercoulen, J. H. Swanink, C. M. Zitman, F. G. et al (1996) Randomised, double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome. Lancet, 347, 858861.
Wessely, S. (1995) The epidemiology of chronic fatigue syndrome. Epidemiological Review, 17, 139151.
Wessely, S. Chalder, T. Hirsch, S. et al (1996) Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. American Journal of Psychiatry, 153, 10501059.
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  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Chronic fatigue and anxiety/depression: A twin study

  • Peter Roy-Byrne (a1), Niloofar Afari (a2), Suzanne Ashton (a3), Mary Fischer (a4), Jack Goldberg (a4) and Dedra Buchwald (a4)...
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