Fatigue across physical and mental health conditions: results from a multicenter study at the German Center for Mental Health, 2026, Erschens+

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Journal of Psychosomatic Research​

Available online 2 October 2026, 113004
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Fatigue across physical and mental health conditions: results from a multicenter study at the German Center for Mental Health​


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R. Erschens a b, S. Zipfel a b, C. Schröpel a, S.H. Adam a b, C. Rometsch a c, M. Bentele a b, H. Heitmann d e, M. Binneböse c f, V. Zimmermann-Schlegel g h, J. Reichert g i, I. Ottlewski j k, A. Schappert j k, A. Berthele l, P. Martus m, H.-C. Friederich g h, F. Junne c f, M. Rose j k, J. Tesarz g i, A. Stengel a b n 1, P. Henningsen d e 1

aUniversity Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Baden-Württemberg, GermanybGerman Center for Mental Health (DZPG), Tübingen Site, Tübingen, GermanycUniversity Hospital Magdeburg, Department of Psychosomatic Medicine and Psychotherapy, Magdeburg, Saxony-Anhalt, GermanydKlinikum Rechts der Isar, Technical University of Munich, Department of Psychosomatic Medicine and Psychotherapy, Munich, Bavaria, GermanyeGerman Center for Mental Health (DZPG), Munich/Augsburg Site, Munich, GermanyfGerman Center for Mental Health (DZPG), Jena/Halle/Magdeburg Site, Magdeburg, GermanygUniversity Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Baden-Württemberg, GermanyhGerman Center for Mental Health (DZPG), Mannheim/Heidelberg/Ulm Site, Ulm, GermanyiUniversity Medical Center Mainz, Clinic for Psychosomatic Medicine and Psychotherapy, Department of Prevention and Psychosocial Medicine, Mainz, Rhineland-Palatinate, GermanyjCharité – Universitätsmedizin Berlin, Department of Psychosomatic Medicine, Berlin, GermanykGerman Center for Mental Health (DZPG), Berlin/Potsdam Site, Berlin, GermanylKlinikum Rechts der Isar, Technical University of Munich, Department of Neurology, Munich, Bavaria, GermanymUniversity Hospital Tübingen - Institute for Clinical Epidemiology and Applied Biometry, Tübingen, GermanynClinic for Psychosomatic Medicine and Psychotherapy, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany



Received 23 April 2026, Revised 24 September 2026, Accepted 1 October 2026, Available online 2 October 2026.




https://doi.org/10.1016/j.jpsychores.2026.113004
https://s100.copyright.com/AppDispa...ntentID=S0022399926004885&orderBeanReset=true
Open access

Highlights​

  • •
    Identical multidimensional fatigue screening enabled direct comparisons across seven diagnostic cohorts.
  • •
    Similar pattern across psychological and somatic symptom measures.
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    CFS, Post-COVID, chronic primary pain, and cancer showed the highest fatigue burden.
  • •
    Inflammatory bowel disease shows lowest relative fatigue burden.
  • •
    Most cohorts showed elevated fatigue and psychological symptom burden relative to population reference values.

Abstract​

Background​

Fatigue is a frequent and disabling symptom across many physical and mental health conditions. Despite similar phenomenology, research has largely focused on single conditions using heterogeneous assessments, limiting cross-condition comparability. This study examines fatigue-related symptom burden across diverse clinical conditions within a shared framework.

Methods​

In this multicenter cross-sectional study, adult outpatients (18–65 years) were recruited at five German university hospitals into seven cohorts: chronic primary pain, multiple sclerosis, cancer, chronic renal failure, inflammatory bowel disease, post-COVID condition, and chronic fatigue syndrome. Fatigue was assessed using established self-report measures, including the Fatigue Severity Scale and the Chalder Fatigue Scale, alongside mental health measures. Group differences were analyzed using ANOVA and chi-square tests with adjusted post hoc comparisons.

Results​

A total of 538 patients were included. Fatigue burden varied substantially across cohorts, with a largely consistent pattern across assessment instruments. Despite significant overall between-cohort differences, the post-COVID (n = 91), chronic primary pain (n = 110), and cancer (n = 124) cohorts showed comparable fatigue levels across several assessment instruments. Multiple sclerosis (n = 63) showed intermediate levels, whereas inflammatory bowel disease (n = 95) consistently showed the lowest fatigue burden. Due to the small sample size, chronic renal failure (n = 30) and chronic fatigue syndrome (n = 25) were analyzed descriptively. Across cohorts, fatigue and most psychological and somatic symptom measures were elevated relative to population reference values.

Conclusions​

Using a harmonized assessment framework across seven diagnostic cohorts, this study demonstrates meaningful differences in fatigue burden, with convergent patterns across instruments. The findings provide a reference for contextualizing fatigue severity across conditions and support future hypothesis-driven and mechanistic analyses.

Keywords​

Chronic conditions
Cross-condition comparison
Fatigue
Mental health
Multicenter study
Post-COVID syndrome
Symptom burden
 
Useless as usual, but it's really inexplicable that this gets published in a psychosomatics journal. It makes no sense, even more so as they note no actual differences with cases they label as mental health. Every study result they get tells them they are wrong, and they always ignore it.
 
Some caution regarding the 25 CFS patients in this study:
The CFS cohort reflects clinically assigned diagnoses documented in the medical record and should not be equated with research case definitions requiring structured verification of postexertional malaise.
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They also note the following about PEM which was measured with the DSQ-PEM :
Overall, self-report PEM/SEID indicators appeared to track general fatigue severity rather than functioning as cohort-specific or pathognomonic markers. While post-exertional symptom exacerbation represents a clinically meaningful and potentially differentiating feature in specific diagnostic contexts, its distribution in the present sample scaled with overall symptom burden across conditions
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