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Aetiology of fatigue in Sri Lanka and its overlap with depression

  • Harriet A. Ball (a1), Athula Sumathipala (a2), Sisira H. Siribaddana (a3), Yulia Kovas (a1), Nick Glozier (a4), Peter McGuffin (a1) and Matthew Hotopf (a5)...

Abstract

Background

Fatigue is a common symptom in Western high-income countries but is often medically unexplained and little is known about its presentation in other populations.

Aims

To explore the epidemiology and aetiology of fatigue in Sri Lanka, and of its overlap with depression.

Method

A total of 4024 randomly selected twins from a population-based register in Sri Lanka (Colombo district) completed home interviews including the Chalder Fatigue Questionnaire.

Results

The prevalence of fatigue was similar to that in other countries, although prolonged fatigue may be less common. There was substantial comorbidity with a screen for lifetime depression. Non-shared environmental factors made the largest contributions, although genetic/family factors also contributed. The aetiology appeared consistent across the spectrum of severity.

Conclusions

The aetiology of fatigue is broadly similar in Sri Lanka and Western high-income countries. Abnormal experiences of fatigue appear to be the extreme form of more common fatigue, rather than representing independent entities with different genetic or environmental risk factors.

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Copyright

Corresponding author

Harriet A. Ball, MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF. Email: harriet.ball@kcl.ac.uk

Footnotes

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See editorial pp. 86–87, this issue.

The Wellcome Trust provided funding for the CoTASS study, and the Institute for Research and Development, Sri Lanka, provided infrastructural support. H.A.B. is supported by an ESRC research studentship. M.H. is funded by the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, National Institute of Health Research, Biomedical Research Centre.

Declaration of interest

P.M. has received honoraria from Eli Lilly and GlaxoSmithKline and has acted as a consultant in the recent past for GlaxoSmithKline and AstraZeneca. N.G. has received honoraria from Sanofi-Aventis and Servier.

Footnotes

References

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Aetiology of fatigue in Sri Lanka and its overlap with depression

  • Harriet A. Ball (a1), Athula Sumathipala (a2), Sisira H. Siribaddana (a3), Yulia Kovas (a1), Nick Glozier (a4), Peter McGuffin (a1) and Matthew Hotopf (a5)...
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eLetters

Aetiology of fatigue in Sri Lanka and its overlap with depression - A reply from the authors

Harriet A Ball
08 October 2010

Many thanks to Professor Bhatia for the comments in your eLetter. Ourstudy examined (subjective) symptoms, whether or not they were present in conjunction with a medical condition. We do acknowledge in our paper that the lack of screening for common medical disorders is a limitation, because we cannot assume that fatigue is not due to a diagnosable condition.

Hierarchical diagnostic criteria - with psychiatric diagnoses trumping a symptom (such as fatigue), and medical diagnoses trumping a psychiatric diagnosis - do not necessarily explain the overlap of these conditions with fatigue, merely allowing us to put fatigue experiences into different categories. This approach is not necessarily always optimal, given the clear dimensionality of many psychiatric and non-psychiatric symptoms. Splitting people into categories leads to a more homogenous sample, but moves us away from the more common presentations ofsymptoms in the community. Excluding patients with diagnosed medical conditions would assume that their fatigue was entirely due to the medicalcondition, which may not be the case. Therefore it can be informative to examine the associations between depression and fatigue without necessarily excluding people if they meet criteria for a medical condition.

Many somatic symptoms in the community are medically unexplained (Kroenke et al 2003), of which fatigue is a very common one. If substantially more of the fatigue in the current study was due to common medical disorders than in Western countries, it is interesting that the prevalence of abnormal fatigue is similar.

Also, because this sample has many participants under the age of 50, and is in a relatively affluent region of Sri Lanka, the incidence of somecommon medical disorders may not be as high as one might expect.

Our assessment of depression was based on standardised scales, using items from the Composite International Diagnostic Interview; that of fatigue used items from the Chalder Fatigue Questionnaire. Where items were not included this was to obtain as broad a picture as possible of thephenotypes under study, without excluding people on the basis of culture-specific factors.

Kroenke, K. (2003). Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. International Journal of Methods in Psychiatric Research 12, 34-43.
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Conflict of interest: None Declared

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Aetiology of fatigue and its overlap with depression

Manjeet Singh Bhatia
23 September 2010

Aetiology of fatigue and its overlap with depressionM.S. Bhatia, Anurag Jhanjee Department of Psychiatry, University College of Medical Sciences, Delhi – 110095, India The study by Ball et al (1) on aetiology of fatigue in Sri Lanka and its overlap with depression is an excellent one highlighting the presentation of fatigue in a large sample in a developing country. In a developing country there are many common medical disorders (2,3) causing fatigue likechronic anemia, hypothyroidism, parasitic infestation, common microbial infections, diabetes, malnutrition, malabsorption syndromes, acid peptic disease, medications (antihypertensive, analgesics etc), alcohol, caffeinewithdrawal etc. Consequently, a study on fatigue merits careful exclusion of these common medical disorders. In addition to depression, fatigue is acommon presentation in other psychiatric disorders like various anxiety disorders, somatoform disorders, and some culture bound syndromes (Dhat syndrome (4)). In the present study, objective assessment of depression using standardized scales should have been used to exhibit overlapping of fatigue and depression reliably.

Declaration of Interest: None References 1. Ball HA, Sumathipala A, Siribaddana SH, et al. Aetiology of fatigue in Sri Lanka and its overlap with depression. Br J Psychiatry 2010; 197: 106-13.2. Kaltsas G, Vgontzas A, Chrousos G. Fatigue, endocrinopathies and metabolic disorders. PM R 2010; 2(5): 393-8.3. Jason LA, Evans M, Brown M, Porter M. What is fatigue ? Pathological and non-pathological fatigue. PM R 2010; 2(5): 327-31.4. Bhatia MS, Malik SC. Dhat Syndrome - A useful diagnostic entity in Indian culture. Br J Psychiatry 1991; 159: 691-5.
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