Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-27T22:16:33.505Z Has data issue: false hasContentIssue false

Neurasthenia: Prevalence, disability and health care characteristics in the Australian community

Published online by Cambridge University Press:  02 January 2018

Ian Hickie*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia; and Chief Executive Officer, ‘beyondblue: the national depression initiative’, Melbourne, Australia
Tracey Davenport
Affiliation:
School of Psychiatry, University of New South Wales at St George Hospital, Sydney, Australia
Cathy Issakidis
Affiliation:
World Health Organization Collaborating Centre for Evidence for Mental Health Policy; and, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Sydney Australia
Gavin Andrews
Affiliation:
World Health Organization Collaborating Centre for Evidence for Mental Health Policy; and, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Sydney, Australia
*
Professor Ian Hickie, Academic Department of Psychiatry, 7 Chapel Street, Kogarah, NSW 2217, Australia. Tel: +61293502035; fax: +61293502098; e-mail: ian.hickie@beyondblue.org.au
Rights & Permissions [Opens in a new window]

Abstract

Background

Neurasthenia imposes a high burden on primary medical health care systems in all societies.

Aims

To determine the prevalence of ICD-10 neurasthenia and associated comorbidity, disability and health care utilisation.

Method

Utilisation of a national sample of Australian households previously surveyed using the Composite International Diagnostic Interview and other measures.

Results

Prolonged and excessive fatigue was reported by 1465 people (13.29% of the sample). Of these, one in nine people meet current ICD-10 criteria for neurasthenia. Comorbidity was associated with affective, anxiety and physical disorders. People with neurasthenia alone (< 0.5% of the population) were less disabled and used less services than those with comorbid disorders.

Conclusions

Fatigue is frequent in the Australian community and is common in people attending general practice. Neurasthenia is disabling and demanding of services largely because of its comorbidity with other mental and physical disorders. Until a remedy for persistent fatigue is provided, doctors should take an active psychological approach to treatment.

Type
Papers
Copyright
Copyright © 2002 The Royal College of Psychiatrists 

Neurasthenia as a diagnostic entity has a long and chequered history in psychiatry (Reference WesselyWessely, 1990; Reference Hickie, Scott and DavenportHickie et al, 1998). Despite changes in diagnostic fashion, aetiological theorising and modes of treatment, people who essentially report mental and physical fatigue, a range of other neuropsychological and mood symptoms (e.g. impaired concentration and short-term memory, irritable mood, non-restorative sleep) as well as other non-specific physical symptoms (e.g. muscle aches and pains, headache, general malaise) continue to impose a high burden on primary medical health care systems in all societies (Reference Üstün and SartoriusÜstün & Sartorius, 1995; Reference Hickie, Davenport and NaismithHickie et al, 2001a).

Classification of neurasthenia

Although the diagnostic concept fell into disrepute in the English-speaking world in the 20th century (being seen more simply as a variant of depression or anxiety), it persisted in most non-English speaking countries. Consequently, the ICD-10 (World Health Organization (WHO), 1992) contains a clear definition of the concept and the World Psychiatric Association (WPA) has promoted a renewed diagnostic and research effort (WPA, 1999). In doing so, the WPA sought to broaden the concept to include cognitive, emotional, somatic, energy and sleep variables that could give the syndrome specific attributes that are clearly different to the symptoms of depressive and anxiety disorders (WPA, 1999).

The ICD-10 diagnostic criteria for research (WHO, 1993) are included in the chapter on ‘Neurotic, stress-related and somatoform disorders’ in a subsidiary section entitled ‘Other neurotic disorders’, implying a disorder of uncertain lineage. The diagnostic criteria for neurasthenia can be summarised as follows:

  1. (a) either, persistent and distressing feelings of exhaustion after minor mental effort or persistent and distressing feelings of fatigue after minor physical effort;

  2. (b) accompanied by one or more of the following symptoms: muscular aches or pains; dizziness; tension headache; sleep disturbance; inability to relax; and irritability;

  3. (c) inability to recover through rest, relaxation or enjoyment;

  4. (d) duration exceeds 3 months;

  5. (e) does not occur in the presence of organic mental disorders, affective disorders or panic or generalised anxiety disorder.

Although the WHO thought neurasthenia sufficiently different to other ‘Neurotic, stress-related and somatoform disorders’ to justify its own category, research groups have tended to be more conservative. Traditionally, most psychiatric epidemiologists highlight the comorbidity with depressive and anxiety disorders (Reference WesselyWessely, 1990) and have rejected the utility of differentiating the concept until social covariates, course or response to treatment distinguish it from (say) dysthymia (Reference Goldberg, Bridges, Gastpar and KielholzGoldberg & Bridges, 1991). Such disorders have not been included in the major North American epidemiological studies of the past decade (Reference Kessler, McGonagle and ZhaoKessler et al, 1994). A more proactive view, however, has argued for evidence of independence from depression and anxiety at the levels of multivariate modelling of symptom data (Reference Gillespie, Kirk and HeathGillespie et al, 1999), genetic vulnerabilities (Reference Hickie, Kirk and MartinHickie et al, 1999a), longitudinal course (Reference Hickie, Koschera and Hadzi-PavlovicHickie et al, 1999b) and treatment response. Although such studies link neurasthenia more closely with other somatoform disorders, there is evidence that the category can be distinguished from entities such as fibromyalgia, irritable bowel, somatic depression and somatic anxiety (Reference Kirmayer, Robbins, Kirmayer and RobbinsKirmayer & Robbins, 1991).

Although the nosological debate is complex, studies in primary care indicate that prolonged fatigue syndromes are common. Prevalence rates for prolonged fatigue (typically greater than 1 month) vary from 18 to 37% (Reference Pawlikowska, Chalder and HirschPawlikowska et al, 1994; Hickie et al, Reference Hickie, Hooker and Hadzi-Pavlovic1996, Reference Hickie, Davenport and Naismith2001a), whereas the WHO Primary Care Study (Reference Sartorius, Üstün and Costa e SilvaSartorius et al, 1993) found that an average of 5.3% of general practice patients met criteria for neurasthenia (range 1.1-10.5%). All studies have emphasised that the syndrome is associated with disability, chronicity, comorbidity and high service utilisation. The Australian National Survey of Mental Health and Wellbeing (Reference Andrews, Henderson and HallAndrews et al, 2001) is the first national community based psychiatric survey to include a module specifically designed to identify people who met criteria for ICD-10 neurasthenia. This paper is an account of the key findings, emphasising not only prevalence rates but also patterns of comorbidity, disability and health care utilisation.

METHOD

Sample

The national survey was conducted by the Australian Bureau of Statistics under the terms of their Act that guarantees the privacy of respondents. A multi-stage sample of private dwellings in rural and urban Australia was drawn. Each state and territory was stratified and each dwelling within a stratum had an equal and known probability of selection. In all, 13 624 private dwellings were initially selected in the survey sample, and one adult member aged 18 years and over randomly selected as the possible respondent. A total of 10 641 people participated, a response rate of 78.1%. The age and gender characteristics of the sample were weighted to match the age and gender distribution in the national census.

Assessment

The whole interview was administered from a laptop computer. The Composite International Diagnostic Interview (CIDI v 2.1; WHO, 1997) was used to determine, using ICD-10 criteria, the presence of seven anxiety disorders, three affective disorders and four substance use disorders in the 12 months prior to interview.

Neurasthenia was identified using an interview developed by Tacchini et al (Reference Tacchini, Janca and Issacs1995). All results in this paper are with the exclusion criteria not applied for other mental or physical disorders. Personality disorders were identified using a screening questionnaire (Reference Loranger, Janca and SartoriusLoranger et al, 1997).

Disability was measured at the beginning of the interview by the SF-12 (Reference Ware, Kosinski and KellerWare et al, 1996) and by the National Comorbidity Survey ‘days out of role’ questions. Neuroticism was measured using the 12-item version of the Eysenck scale (Reference Eysenck, Eysenck and BarrattEysenck et al, 1985). Demographic and service utilisation data were also obtained. The method of the survey has been described previously (Reference Andrews, Henderson and HallAndrews et al, 2001).

Data analysis

Routine data analysis procedures were used but, as a result of the complex sample design and weighting, specific software was required to estimate standard errors (s.e.). The s.e. of prevalence estimates and confidence intervals around odds ratios (ORs) derived from logistic regression models were estimated using delete-1 jackknife repeated replication in 30 design-based subsamples (Reference Kish and FrankelKish & Frankel, 1974). These calculations used the SUDAAN software package (Reference Shah, Barnwell and BieglerShah et al, 1997).

RESULTS

Diagnosis

The criteria for neurasthenia are listed above. Criterion A, prolonged and excessive fatigue, was endorsed by 1465 people (13.2% of the sample). These responses were probed to ensure that the symptom was clinically significant and not attributed by the respondent to drugs or alcohol, physical illness or injury (601 persons agreed that this was so). Criterion C requires that the fatigue does not respond to rest and 318 of the 601 participants endorsed this. Criterion D requires that the fatigue lasts 3 months or more, and this was so for 186 participants. Finally we asked about the presence of the Criterion B symptoms, 172 of the 186 met this criterion. Thus, although complaints of fatigue are common, only one in nine people who complain of fatigue meet current ICD-10 criteria for neurasthenia. As distinct from non-specific complaints of fatigue, neurasthenia is not a common mental disorder.

Prevalence

Data on the weighted prevalence of neurasthenia are displayed in Table 1, by age and gender, for people meeting criteria in the past month (1.2%) and sometimes in the past year (1.5%). Only 20% of people who met criteria during the year were not current cases. The disorder is chronic. The female to male ratio was small (1.4 and 1.2) in contrast to what is often believed, and different from the pattern seen in health care facilities. On further examination of the numbers of people in the population who reported fatigue (13.2%), significantly more females than males said ‘yes’ (14.9% v. 11.3%; P<0.05). In addition, when respondents were asked whether it was clinically significant (601 said ‘yes’), female rates were still higher but the confidence intervals just overlapped (6.3% v. 4.4%; P>0.05). For all other criteria (B-D) the rates of endorsement were almost identical for males and females. Thus, although more women than men in the population report fatigue the prevalence of neurasthenia is not higher in women. The multivariate associations of demographic variables are shown in Table 2 together with those for people with any 12-month mental disorder. Both sets of disorders decline with age, both are more common among people who are separated, widowed or divorced, both are more common among those with less education and both are more common among those born in Australia. That is, as the socio-demographic characteristics of neurasthenia are similar to other mental disorders, it is likely that social risk factors are shared. Employment is not significant in neurasthenia, whereas psychological morbidity generally is associated with not being in the labour force.

Table 1 Weighted prevalence of 12— and 1-month ICD-10 neurasthenia by age and gender

Age 12-month 1-month
Males Females Persons Males Females Persons
% (s.e.) % (s.e.) % (s.e.) % (s.e.) % (s.e.) % (s.e.)
18-24 1.0 (1.2) 2.4 (0.9) 1.7 (0.7) 1.0 (1.2) 1.6 (0.7) 1.3 (0.7)
25-34 1.1 (0.4) 1.8 (0.4) 1.5 (0.3) 0.7 (0.4) 1.5 (0.4) 1.1 (0.3)
35-44 1.6 (0.3) 1.7 (0.6) 1.6 (0.3) 1.4 (0.3) 1.2 (0.6) 1.3 (0.3)
45-54 1.8 (0.5) 2.8 (0.7) 2.3 (0.4) 1.7 (0.6) 2.1 (0.5) 1.9 (0.4)
55-64 0.8 (0.4) 1.1 (0.5) 1.0 (0.4) 0.8 (0.4) 1.1 (0.5) 1.0 (0.4)
> 65 0.7 (0.4) 0.5 (0.2) 0.6 (0.2) 0.7 (0.4) 0.3 (0.2) 0.5 (0.2)
Total 1.2 (0.3) 1.7 (0.3) 1.5 (0.2) 1.1 (0.3) 1.3 (0.2) 1.2 (0.2)

Table 2 Multivariate associations of socio-demographic correlates for 12-month neurasthenia and any 12-month ICD—10 mental disorder

Correlates1 ICD—10 mental disorder
12-month neurasthenia Any 12-month mental disorder2
Odds ratio 95% CI Odds ratio 95% CI
Age
18-24 1.0 1.0
25-34 1.0 0.4-2.9 1.0 0.8-1.3
35-44 1.1 0.3-4.3 1.0 0.8-1.2
45-54 1.6 0.5-4.8 0.8 0.6-1.1
55-64 0.4* 0.2-1.0 0.4** 0.3-0.6
> 65 0.4 0.1-1.8 0.2** 0.1-0.2
\batchmode \documentclass[fleqn,10pt, legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\chi}_{5}^{2}(P)\) \end{document} 17.7 0.003 218.5 <0.001
Marital status
Married/de facto 1.0 1.0
Separated/divorced/widowed 2.4* 1.5-3.7 2.0** 1.5-2.5
Never married 1.2 0.6-2.3 1.5** 1.3-1.8
\batchmode \documentclass[fleqn,10pt, legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\chi}_{2}^{2}(P)\) \end{document} 14.4 0.001 48.9 <0.001
Education
Bachelor degree or higher 1.0 1.0
Diploma 0.8 0.2-4.2 1.2 0.9-1.6
Vocational qualification 1.9 0.6-6.2 1.5* 1.1-2.0
High school only 2.3 0.6-8.1 1.6** 1.3-1.8
\batchmode \documentclass[fleqn,10pt, legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\chi}_{3}^{2}(P)\) \end{document} 7.9 0.048 36.3 <0.001
Employment
Employed (f/t or p/t) 1.0
Short-term unemployed3 1.6* 1.1-2.3
Long-term unemployed4 2.6** 1.8-3.8
Not in the labour force 1.6** 1.3-1.9
\batchmode \documentclass[fleqn,10pt, legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\chi}_{3}^{2}(P)\) \end{document} NS 38.5 <0.001
Country of birth
Australia 1.0 1.0
Other English speaking country 0.5 0.2-1.0 0.9 0.7-1.2
Other non-English speaking country 0.6 0.3-1.1 0.8* 0.6-1.0
\batchmode \documentclass[fleqn,10pt, legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\chi}_{2}^{2}(P)\) \end{document} 6.6 0.037 6.6 0.037

Comorbidity is regarded as a hallmark of neurasthenia. In Table 3 we present data on the prevalence of comorbid disorders among people with neurasthenia. In Model 1 we show that there is more comorbidity with major depression, panic disorder and generalised anxiety disorder than could be expected by chance after adjustment for the prevalence of the comorbid disorder and the average level of comorbidity of that disorder. These are the disorders specified as exclusion criteria in ICD-10. In Model 2 we calculate the same information, not for individual disorders but for disorder groups. Now the significant associations are with affective, anxiety and personality disorders. Naturally the association with any mental disorder is significant, as is the association with any self-reported physical disorder. People who meet criteria for neurasthenia report symptoms that suggest they are at increased risk for specific mental and any physical disorder. Their risk of a substance misuse disorder is not increased.

Table 3 Weighted prevalence and odds ratios of comorbid ICD—10 mental disorders and any physical disorder among persons with 12-month neurasthenia

Comorbid disorder1 Prevalence of disorder among persons with 12-month neurasthenia
% (s.e.) OR1(95% CI)
Model 1: Individual disorders
Major depression 50.4 (4.6)** 5.2 (3.0-9.0)
Dysthymia 14.6 (2.7) 1.5 (0.7-3.2)
Panic with or without agoraphobia 27.8 (3.9)* 2.6 (1.4-4.9)
Social phobia 19.0 (4.8) 2.2 (0.8-6.3)
Generalised anxiety disorder 40.4 (4.6)* 2.7 (1.3-5.4)
Obsessive—compulsive disorder 3.1 (1.9) 0.7 (0.2-2.2)
Post-traumatic stress disorder 27.5 (8.5) 2.7 (0.8-9.5)
Alcohol misuse or dependence 14.0 (3.3) 0.8 (0.4-1.6)
Drug misuse or dependence 10.0 (2.4) 2.0 (0.9-4.6)
Model 2: Disorder groups
Any affective disorder 53.7 (4.4)** 5.2 (3.3-8.1)
Any anxiety disorder 64.9 (4.3)** 6.6 (4.2-10.6)
Any substance use disorder 19.9 (4.1) 1.1 (0.5-2.1)
Any personality disorder 35.5 (4.7)* 2.0 (1.2-3.5)
Model 3: Any other mental disorders 79.3 (4.8)** 14.4 (7.9-26.5)
Model 4: Any physical disorder2 62.3 (4.4)** 2.7 (1.8-4.0)

When comorbidity is endemic it is difficult to know whether the attribute being measured belongs to the target disorder or to the comorbid disorder. In clinical practice, when the patient has more than one disorder, the patient and doctor agree on a priority and usually deal with the main problem first. In the survey, after all disorders had been enumerated, we listed the groups of symptoms they had complained of, and asked people who had met criteria for more than one disorder: ‘Which of these problems troubles you the most?’. We regarded this as the patient's main problem. In 13 people neurasthenia was the only disorder present, whereas a further 36 who did have comorbid disorders, identified neurasthenia as their main problem. Thus, neurasthenia was the main problem in 49 people (less than 0.5% of the population). Of the remainder of people with neurasthenia and comorbid disorders, 50 nominated an affective disorder as their main problem, 39 an anxiety disorder and 31 a physical disorder as their main problem. Three people thought personality or substance misuse disorders were their main problem.

In Table 4 we present data on neuroticism, disability measured by the SF-12 and by disability days, and service utilisation in terms of consultations and hospital admissions. People with neurasthenia as a main problem were less likely to be comorbid with a mental or a physical disorder, less disabled and used fewer services than the complete group. We then examined all people with neurasthenia, divided into those with neurasthenia as a main problem and those with neurasthenia who identified affective, anxiety or physical disorders as their main problem. People with neurasthenia as a main problem were less disabled (P=0.026) and used fewer services (P=0.005) than did the other three groups.

Table 4 Chronicity, neuroticism, disability and health service utilisation among all persons with 12-month neurasthenia, those with neurasthenia as their principal complaint and among those with an anxiety, affective or a physical disorder as their principal complaint

12-month neurasthenia1
All 12-month neurasthenia (n=172) A. Neurasthenia as main problem (n=49) B. Affective as main problem (n=50) C. Anxiety as main problem (n=39) D. Physical illness as main problem (n=31)
Neuroticism, mean (s.e.)
EPQ—N 6.7 (0.3) 5.7 (0.5) 7.4 (0.8) 8.3 (0.9) 5.7 (0.6)
Disability, mean (s.e.)
SF-12 mental component score 36.4 (1.1) 42.5 (1.5) 31.4 (2.7)* 34.3 (2.5)* 36.6 (4.5)
SF-12 physical component score 40.4 (1.0) 44.7 (1.9) 42.3 (2.3) 37.6 (2.3) 33.7 (2.8)
Disability days 12.8 (1.1) 7.5 (2.4) 16.2 (2.5) 15.3 (2.2) 13.1 (3.0)
Service utilisation, % (s.e.)
Any consultation2 95.8 (2.1) 87.2 (8.0) 100 (-) 97.5 (4.0) 100 (-)
Any mental health consultation3 60.5 (4.6) 50.9 (11.9) 88.4 (4.8)* 61.2 (10.8) 38.1 (11.7)
Any hospital admission4 23.0 (3.1) 9.2 (5.6) 27.3 (7.2) 17.8 (8.2) 46.6 (14.6)*

DISCUSSION

Complaints of fatigue are frequent in the general population and are particularly common in people attending general practitioners. Generally, the rates of most mental disorder in primary care patients are increased over community rates by a factor of 2-3 (Reference Hickie, Davenport and Hadzi-PavlovicHickie et al, 2001b). In this national community survey, 13.2% of the Australian adult population report prolonged and excessive fatigue as a problem. Previous Australian general practice surveys indicate prevalence rates of 25-37% (Hickie et al, Reference Hickie, Hooker and Hadzi-Pavlovic1996, Reference Hickie, Davenport and Naismith2001a). This study indicates that the prevalence of the more chronic and disabling syndrome of neurasthenia is 1.5% in the general population and this is consistent with Australian and international studies in primary care that report rates of neurasthenia (1.3-5.2%; Reference Sartorius, Üstün and Costa e SilvaSartorius et al, 1993; Reference Hickie, Hooker and Hadzi-PavlovicHickie et al, 1996). There have been a series of community and primary care-based studies for the closely related condition of chronic fatigue syndrome (6 months of prolonged and excessive fatigue without other medical or psychiatric cause). Here community estimates range from 0.2 to 0.7% (Reference Buchwald, Umali and UmaliBuchwald et al, 1995; Reference Lawrie, Manders and GeddesLawrie et al, 1997; Reference Jason, Richman and RademakerJason et al, 1999) and primary care estimates from 0.5 to 2.5% (Reference Bates, Schmitt and BuchwaldBates et al, 1993; Reference Wessely, Chalder and HirschWessely et al, 1997).

Although neurasthenia is by definition prolonged (>3 months), this study indicates that it is chronic, with 80% of people who met criteria in the past 12 months also being current cases. This is consistent with our previous longitudinal reports in primary care that emphasised early ages of onset and chronic course (Reference Hickie, Koschera and Hadzi-PavlovicHickie et al, 1999b). The multivariate associations between age, gender, marital status, education and country of birth are also similar to those identified for other mental disorders in the wider survey. People who meet criteria for neurasthenia do report more symptoms of anxiety, affective and physical disorders than is expected, even after allowing for the probability of association and level of comorbidity in the other disorders. Both these patterns are consistent with the notion that neurasthenia is indeed, typically, a mental disorder. The patterns of comorbidity are very similar to patients with neurasthenia seen in clinical settings (Reference Farmer, Jones and HillierFarmer et al, 1995).

Interestingly, neuroticism levels were not increased in persons with neurasthenia as their main problem. This is consistent with other reports (Reference Chubb, Jones and HillierChubb et al, 1999). This could suggest that such people are different not only at a symptom-reporting level (emphasising more overtly physical rather than psychological symptoms) but also at the level of important vulnerability factors. Given the evidence from other genetic modelling studies, it could be seen as consistent with less relevance for traditional psychological risk factors in this patient group (Reference Farmer, Scourfield and MartinFarmer et al, 1999; Reference Hickie, Kirk and MartinHickie et al, 1999a).

When people with neurasthenia were subdivided according to the disorder that they regarded as their main problem, people with neurasthenia as a main problem were less disabled and used fewer services than the others with neurasthenia who regarded other disorders as their main problem. This suggests that the degree of disability and service use typically associated with neurasthenia is more because of the comorbid symptoms (depression and anxiety) than prolonged fatigue. In this survey people with neurasthenia as a main problem did not differ in these respects from the large numbers of people who identified, irrespective of neurasthenia, depression or anxiety as their main problem (see Reference Andrews, Henderson and HallAndrews et al, 2001). We argue that neurasthenia is recognised as disabling and demanding of services largely because of its comorbidity with other affective, anxiety and physical disorders. However, as with other disorders, the higher the degree of ‘comorbidity’ the higher the rates of disability and health care service utilisation.

Such cross-sectional surveys can provide only limited insights. Other longitudinal work (Reference Hickie, Koschera and Hadzi-PavlovicHickie et al, 1999b; Reference Addington, Gallo and FordAddington et al, 2001) has emphasised that when fatigue and psychological symptoms co-occur, persons are at high risk of going on to experience further episodes again characterised by both prolonged fatigue and psychological disorder. Those experiencing prolonged fatigue only, however, appear to have a more stable pattern of future fatigue without increased rates of later psychological disorder. Along with other genetic and treatment data, this suggests differing aetiological and illness course determinants. All such studies imply that when prolonged fatigue occurs in the context of other dysphoria that doctors should take an active psychological approach to treatment. It is likely, however, that medical and psychological debate surrounding prolonged fatigue states will persist until doctors provide a remedy for persistent idiopathic fatigue.

CLINICAL IMPLICATIONS

  1. While complaints of prolonged and excessive fatigue are common in the community, the syndrome of neurasthenia is uncommon.

  2. Neurasthenia is typically chronic and is associated with high levels of comorbid affective and anxiety disorders.

  3. More pure forms of neurasthenia are associated with lower levels of neuroticism, disability and health care utilisation.

LIMITATIONS

  1. Cross-sectional surveys provide only limited insight into the nature of the association between neurasthenic and affective and anxiety disorders.

  2. The clinical significance of the disorders identified by such community surveys is inferred from self-reported disability data.

  3. Self-reported comorbid physical disorders are assumed to reflect clinically significant medical conditions.

Acknowledgements

This paper was supported by a contract from the Australian Department of Health and Aged Services to the WHO Collaborating Centre for Evidence in Mental Health Policy, Sydney, to support a survey data analysis consortium (G. A., V. Carr, G. Carter, R. Crino, W. Hall, A. Henderson, I. H., C. Hunt, L. Lampe, J. McGrath, A. McFarlane, P. Mitchell, L. Peters, M. Teesson and K. Wilhelm). The survey was conducted by the Australian Bureau of Statistics, who do not necessarily endorse the view expressed in this paper.

Footnotes

Declaration of interest

None.

References

Addington, A. M. Gallo, J. J. Ford, D. E. et al (2001) Epidemiology of unexplained fatigue and major depression in the community: the Baltimore ECA follow-up, 1981–1994. Psychological Medicine, 31, 10371044.Google Scholar
Andrews, G. Henderson, S. & Hall, W. (2001) Prevalence, comorbidity, disability and service utilisation: overview of the Australian National Mental Health Survey. British Journal of Psychiatry, 178, 145153.Google Scholar
Bates, D. W. Schmitt, W. Buchwald, D. et al (1993) Prevalence of fatigue and chronic fatigue syndrome in a primary care practice. Archives of Internal Medicine, 153, 27592765.Google Scholar
Buchwald, D. Umali, P. Umali, J. et al (1995) Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system. Annals of Internal Medicine, 123, 8188.CrossRefGoogle Scholar
Chubb, H. L. Jones, I. Hillier, J. et al (1999) Chronic fatigue syndrome – personality and attributional style of patients in comparison to healthy controls and depressed individuals. Journal of Mental Health, 8, 351359.Google Scholar
Eysenck, S. B. G. Eysenck, H. J. & Barratt, P. A. (1985) A revised version of the psychoticism scale. Personality and Individual Differences, 6, 2129.Google Scholar
Farmer, A. Jones, I. Hillier, J. et al (1995) Neurasthenia revisited: ICD – 10 and DSM – III – R psychiatric syndromes in chronic fatigue patients and comparison subjects. British Journal of Psychiatry, 167, 503506.Google Scholar
Farmer, A. Scourfield, J. Martin, N. et al (1999) Is disabling fatigue in childhood influenced by genes? Psychological Medicine, 29, 279282.Google Scholar
Gillespie, N. Kirk, K. M. Heath, A. C. et al (1999) Somatic distress as a distinct psychological dimension. Social Psychiatry and Psychiatric Epidemiology, 34, 451458.Google Scholar
Goldberg, D. P. & Bridges, K. W. (1991) Minor psychiatric disorders and neurasthenia in general practice. In Problems of Psychiatry in General Practice (eds Gastpar, M. & Kielholz, P.), pp. 7988. Lewiston, NY: Hogrefe & Huber Publishers.Google Scholar
Hickie, I. Kirk, K. & Martin, N. (1999a) Unique genetic and environmental determinants of prolonged fatigue: a twin study. Psychological Medicine, 29, 259268.Google Scholar
Hickie, I. Koschera, A. Hadzi-Pavlovic, D. et al (1999b) The temporal stability and co-morbidity of prolonged fatigue: a longitudinal study in primary care. Psychological Medicine, 29, 855861.Google Scholar
Hickie, I. B. Hooker, A. W. Hadzi-Pavlovic, D. et al (1996) Fatigue in selected primary care settings: sociodemographic and psychiatric correlates. Medical Journal of Australia, 164, 585588.Google Scholar
Hickie, I. B. Scott, E. M. & Davenport, T. A. (1998) Somatic distress: developing more integrated concepts. Current Opinion in Psychiatry, 11, 153158.Google Scholar
Hickie, I. B. Davenport, T. A. Naismith, S. L. et al (2001a) Conclusions about the assessment and management of common mental disorders in Australian general practice. Medical Journal of Australia, 175 (Suppl), S52S55.Google Scholar
Hickie, I. B. Davenport, T. A. Hadzi-Pavlovic, D. et al (2001b) Development of a simple screening tool for common mental disorders in general practice. Medical Journal of Australia, 175 (Suppl), S10S17.Google Scholar
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.Google Scholar
Kessler, R. C. McGonagle, K. A. Zhao, S. et al (1994) Lifetime and 12-month prevalence of DSM – III – R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 819.Google Scholar
Kirmayer, L. J. & Robbins, J. M. (1991) Functional somatic syndromes. In Current Concepts of Somatization: Research and Clinical Perspectives (eds Kirmayer, L. J. & Robbins, J. M.), pp. 79106. Washington, DC: American Psychiatric Press, Inc.Google Scholar
Kish, L. & Frankel, M. R. (1974) Inference from complex samples. Journal of the Royal Statistical Society (Series B), 36, 137.Google Scholar
Lawrie, S. M. Manders, D. N. Geddes, J. R. et al (1997) A population-based incidence study of chronic fatigue. Psychological Medicine, 27, 343353.Google Scholar
Loranger, A. W. Janca, A. & Sartorius, N. (1997) Assessment and Diagnosis of Personality Disorders. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Pawlikowska, T. Chalder, T. Hirsch, S. R. et al (1994) Population based study of fatigue and psychological distress. BMJ, 308, 763766.Google Scholar
Sartorius, N. Üstün, T. B. Costa e Silva, J. A. et al (1993) An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on ‘Psychological Problems in General Health Care’. Archives of General Psychiatry, 50, 819824.Google Scholar
Shah, B. V. Barnwell, B. G. & Biegler, G. S. (1997) SUDAAN User's Manual. Research Triangle Park, NC: Research Triangle Institute.Google Scholar
Tacchini, R. Janca, A. & Issacs, M. (1995) Neurasthenia. Geneva: Division of Mental Health, World Health Organization.Google Scholar
Üstün, T. B. & Sartorius, N. (1995) Mental Illness in General Health Care: An International Study. Chichester: John Wiley and Sons.Google Scholar
Ware, J. E. Kosinski, M. & Keller, S. D. (1996) A12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220233.Google Scholar
Wessely, S. (1990) Old wine in new bottles: neurasthenia and “ME”. Psychological Medicine, 20, 3553.Google Scholar
Wessely, S. Chalder, T. Hirsch, S. et al (1997) The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study. American Journal of Public Health, 87, 14491455.Google Scholar
World Health Organization (1992) International Classification of Disease and Related Disorders (IDC – 10). Geneva: World Health Organization.Google Scholar
World Health Organization (1993) The ICD – 10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization.Google Scholar
World Health Organization (1997) Composite International Diagnostic Interview – Version 2.1. Geneva: World Health Organization.Google Scholar
World Psychiatric Association (1999) World Psychiatric Association Consensus Statement on the Syndrome of Neurasthenia. Chatswood, NSW: Excerpta Medica Communications.Google Scholar
Figure 0

Table 1 Weighted prevalence of 12— and 1-month ICD-10 neurasthenia by age and gender

Figure 1

Table 2 Multivariate associations of socio-demographic correlates for 12-month neurasthenia and any 12-month ICD—10 mental disorder

Figure 2

Table 3 Weighted prevalence and odds ratios of comorbid ICD—10 mental disorders and any physical disorder among persons with 12-month neurasthenia

Figure 3

Table 4 Chronicity, neuroticism, disability and health service utilisation among all persons with 12-month neurasthenia, those with neurasthenia as their principal complaint and among those with an anxiety, affective or a physical disorder as their principal complaint

Submit a response

eLetters

No eLetters have been published for this article.