Sociodemographic & psychosocial correlates of fatigue & chronic fatigue: A cross-sectional study from a South East London community survey, 2025,Zhang

[Dolphin]

https://www.sciencedirect.com/science/article/pii/S0022399925001102?via=ihub

Journal of Psychosomatic Research
Available online 8 May 2025, 112146
In Press, Journal Pre-proof
Short communication
Sociodemographic and psychosocial correlates of fatigue and chronic fatigue: A cross-sectional study from a South East London community survey

Shuo Zhang, Stephani L. Hatch, Matthew Hotopf, Sir Graham Thornicroft, Trudie Chalder, Jayati Das-Munshi

https://doi.org/10.1016/j.jpsychores.2025.112146
Open access

Highlights

• •
  There is a high prevalence of fatigue and chronic fatigue in urban populations
• •
  Those who report fatigue and chronic fatigue also report greater disability.
• •
  The quality of perceived social support is an important protective factor.

Abstract

Objective
A better understanding of fatigue and chronic fatigue symptoms in the community may lead to better targeted preventative interventions. This study aims to estimate the prevalence of fatigue and chronic fatigue and explore relationships with sociodemographic and psychosocial factors in a representative community population survey in London, UK.

Methods
The first wave of the South East London Community Health study (2008 to 2010) surveyed face-to-face 1698 individuals aged 16 years and over from 1075 randomly selected households in the boroughs of Southwark and Lambeth. Self-reported fatigue and/or chronic fatigue was determined using the Chalder fatigue scale. Ordinal and binary logistic regression analyses were undertaken to assess the association of sociodemographic and psychosocial factors with higher levels of fatigue symptoms.

Results
The point prevalence of fatigue was 23.5 % (95 % CI 21.5–25.7). After adjusting for age and sex, higher levels of fatigue were substantially associated with impacts on work and other activities due to physical (OR: 4.87 (95 % CI 3.44–6.88)) or emotional symptoms (OR: 4.52 (95 % CI, 3.16–6.48)). Higher levels of fatigue were also associated with seeking emotional help from professionals (OR: 2.73 (95 % CI, 1.91–3.92) or family or friends (OR: 2.37 (95 % CI,1.68–3.34) and reporting less perceived instrumental (OR: 2.01 (0.75–5.37)) and emotional support (OR: 3.76 (1.46–9.68)).

Conclusion
Our findings highlight the high prevalence of fatigue and chronic fatigue in a representative urban community sample. Higher levels of fatigue were significantly associated with greater disability and formal and informal help-seeking. The quality of perceived social support is an important protective factor.

Keywords
Fatigue
Chronic fatigue
Ethnicity
Sociodemographic factors
Social support
Community health survey

 

[Hutan]

The first wave of the South East London Community Health study (2008 to 2010) surveyed face-to-face 1698 individuals aged 16 years and over

I had to check what year this was from. Yes, it's a 2025 preproof, still "in press". I wonder what is going on? Is there a planned follow up study?

Higher levels of fatigue were also associated with seeking emotional help from professionals (OR: 2.73 (95 % CI, 1.91–3.92) or family or friends (OR: 2.37 (95 % CI,1.68–3.34) and reporting less perceived instrumental (OR: 2.01 (0.75–5.37)) and emotional support (OR: 3.76 (1.46–9.68)).

People with higher levels of fatigue were more likely to report not getting any useful practical or emotional support. 15 years on, I suspect things haven't changed much on that front.

Higher levels of fatigue were significantly associated with greater disability and formal and informal help-seeking. The quality of perceived social support is an important protective factor.

What's the bet that the suggested solution is to change the way people perceive social support, rather than actually provide more useful social support.

 

[rvallee]

Hey that's only been done at least 50x, let's just re-do the last 4 decades at the most entry-level. That's just what real pros do, start over their own work doing the same pilot entry-level fishing studies they started with, exactly the same way they started.

Just like pro athletes keep going back to their amateur glory days when they didn't achieve much, and that one game where they almost, but did not, win the game single-handedly. Totally normal human behavior, do not look for the aliens behind the curtain.

Higher levels of fatigue were also associated with seeking emotional help from professionals

No, I don't think so. The idea that people go and seek emotional help from health care professionals is ridiculous, let alone that this is a reason when the complaint is fatigue.

Looking at the paper does not inform in any way why they chose to frame this as 'emotional help'. Just entirely their decision and framing, for no other reason than to label it this way. Asinine fake research that completely under-performs compared to what complete amateurs can easily achieve.

 

[Hutan]

Few studies have investigated the role of psychosocial factors associated with fatigue and chronic fatigue, in comparison to factors such as sex, occupation status, and physical health co-morbidities [6]. Social participation [9], lack of social support or over solicitous behaviour have been identified as important factors in understanding ME/CFS [10-12] . More specifically, negative quality of responses from a significant other, such as high expressed emotion are an important maintaining factor of ME/CFS [13]

This is all pretty much wrong.

Trained lay interviewers conducted a computer assisted interview schedule with eligible household members. Response rates were 51.9% for household participation.

The Chalder fatigue questionnaire(CFQ) is an 11 item scale to measure mental and physical fatigue that was validated against the fatigue item of the Revised Clinical Interview Schedule (CIS-R) in a general practice population [21]. To determine clinically significant fatigue, the bimodal scoring system was used. A cut off of 4 or more differentiates non-cases from likely cases of fatigue with a sensitivity of 75.5 and specificity of 74.5 compared with the CIS-R [21]. People who reported that fatigue was present for more than 6 months were classified as having chronic fatigue.

Employment status was classified as ‘employed’, ‘unemployed’, ‘student’, and ‘economically inactive’ (groups such as being temporarily sick or permanent sick/disabled, retired or looking after the home with children).

Just had to comment on that. Labelling 'looking after the home with children' as 'Economically inactive' is the most egregious.

But, really? Everyone is economically active, we are all consumers and most of us are other economically relevant things as well. Trudie Chalder might be employed, but I think her contribution to society, even to the economy, is in the negatives. She takes substantial NIHR and other research funding, and sinks it into this harmful unproductive nonsense.

 

[Hutan]

Social Support
Participants were asked whether they had someone who: 1) could lend them money to pay bills or help them get along; 2) help with a minor or health emergency; 3) they could talk to when something bothered them or when they felt lonely and 4) could make them feel good, loved or cared for. These questions were developed for SELCoH with reference to the literature [18], and are reported in line with other SELCoH papers [23]. The first two items were combined to capture sources of ‘perceived instrumental support’, whilst the latter two were combined as sources of ‘perceived emotional support.’ Scores ranged from excellent (0) to poor (2) for each indicator.

Help seeking
Participants self-rated no (0) or yes (1) to specifically developed questions about whether in the last 12 months they had sought help from a professional, a non-professional, a GP for physical health problems, or used any hospital services including accident and emergency, or outpatient departments in the last 12 month. The variable is reported in line with other SELCoH papers [24] .

I was interested to know what this paper was defining as 'seeking emotional help from professionals'. Going to reference 24, another SELCoH paper by Hotopf, it is this:

“In the past 12 months, have you spoken to a GP or family doctor, a psychological therapist/counsellor or other sources of help on your own behalf, either in person or by telephone about being anxious or depressed or a mental, nervous or emotional problem?”

 

[Hutan]

Results

In the South East London community sample, the prevalence of fatigue was 23.5% (95% CI: 21.5-25.7) and chronic fatigue 10.1% (8.7-11.7). The relationship with demographic and clinical variables is presented in table 1.

This study has essentially nothing to do with ME/CFS. It says a lot about the authors' lack of understanding of what ME/CFS is, that they think that it is useful to talk about the maintaining factors of ME/CFS in the introduction.

Presence of a common mental disorder (CIS-R score of <12) was associated with greater fatigue (OR 8.43 (95% CI: 5.81-12.22).

That's a high odds ratio - if you have depression or anxiety, you have a high likelihood of reporting fatigue.

Being economically inactive increased the odds of reporting higher levels of fatigue OR 1.97 (95% CI: 1.28-3.01), whereas being unemployed seemed to confer a small degree of protection OR 0.58 (95% CI: 0.34-0.98). Having a degree or higher level of education was protective OR 0.50 (95% CI: 0.29-0.85).

Given how being 'economically inactive' was defined, it is not at all surprising that 'being economically inactive' was associated with higher levels of fatigue. Of course older people are more likely to report fatigue. Of course primary care givers of young children are more likely to report fatigue. Of course people who are sick are more likely to report fatigue.

Weighted prevalences of chronic fatigue
Employed 7.9%
Unemployed 7.5%
Student 9.5%
Other 18.5% (retired, looking after children and not in paid work, sick/disabled)

It must have been quite disappointing for the authors to find that the people who were unemployed had the lowest levels of fatigue, by quite a margin.

 

[Utsikt]

Weighted prevalences of chronic fatigue
Employed 7.9%
Unemployed 7.5%
Student 9.5%
Other 18.5% (retired, looking after children and not in paid work, sick/disabled)

It must have been quite disappointing for the authors to find that the people who were unemployed had the lowest levels of fatigue, by quite a margin.

I wouldn’t put it past them to claim that this shows that fatigue is normal, and therefore fatigued people should be able to work.

 

[Hutan]

Discussion

In line with other studies we found that fatigue was associated with impaired function and emotional symptoms [36]. The role of social support [9, 37, 38] and help seeking [39] has been explored in studies on ME/CFS, and in fatigue in primary care [3]. Our study found that individuals with lower levels of perceived emotional and instrumental support reported higher levels of fatigue, consistent with a previous study which found univariable associations with social support [3].

Again, ME/CFS is jammed in there. It makes as much sense as only highlighting fatigue in people with, for example, kidney disease - it's just one of the many reasons people might have fatigue, and it's almost certainly not the most common reason. It's hardly surprising that people who feel that they have less support feel more exhausted.

There is a role for clinicians across all disciplines to screen for fatigue symptoms, explore an individual’s social networks, and consider referral to psychosocial interventions that strengthen social support. Future research should assess the efficacy of social support interventions on fatigue in community populations.

It's hard to work out exactly what they are suggesting there with 'psychosocial interventions' and 'social support interventions on fatigue'. No doubt some of what is envisaged is training people to understand that it is their fault that they feel fatigued and that they could stop feeling that way if they tried a bit harder. But, just perhaps some of the authors are also thinking about useful responses to a large proportion of society feeling chronically exhausted, things like improving the incomes of the poorest people.

 

[hotblack]

They seem to equate fatigue with tiredness, chronic fatigue with tiredness all the time and ME/CFS with tired all the time with a couple of other symptoms. Looking at the papers they reference is very telling, stuff about how people’s partners talked to them and their social support.

Here’s the results from their 12th reference “Social support and the persistence of complaints in chronic fatigue syndrome” (https://pubmed.ncbi.nlm.nih.gov/15031590/)

Results: CFS patients and fatigued employees reported more negative interactions and insufficiency of supporting interactions than cancer patients and healthy controls. No differences in frequency of supporting interactions were found. Negative interactions decreased significantly after treatment with CBT, but did not change in support groups or natural course. In the natural course, higher fatigue severity at 8 months was predicted by more negative interactions at baseline.

That this sort of paper is coming from someone linked to King’s, an NHS Foundation Trust and a project funded by UKRI (https://www.phiuk.org/about) is a bit of a concern tbh. It either shows very little understanding or a deliberate motivation to not understand

 

[Trish]

Anything about fatigue or ME/CFS with Trudie Chalder involved is always rubbish. She seems to still cling to the old idea that CFS is the same as chronic fatigue, and it's CBT for everything, and lots of reliance on inappropriate questionnaires.

 

[hotblack]

Ah, the inappropriate questionnaires will continue until morale improves

 

[rvallee]

But, really? Everyone is economically active, we are all consumers and most of us are other economically relevant things as well. Trudie Chalder might be employed, but I think her contribution to society, even to the economy, is in the negatives. She takes substantial NIHR and other research funding, and sinks it into this harmful unproductive nonsense.

Bit of a tangent but absolutely this, each and every one of us here has a far higher positive contribution to society than any of those quacks, whose net contribution is excessively negative. Probably compares to organized crime, because they have been so effective at spreading their harmful ideology.

In sports, there is the concept of "addition by subtraction", when a team trades a below-replacement player to another team and so improves their situation despite adding nothing. Sometimes it's even "for future considerations", simply offloading a bad contract. They added to their net value by subtracting a negative performing asset.

So much that it can actually be claimed that, though by a trivial amount, national GDP goes slightly up whenever a major psychosomatic quack retires. This is impossible to calculate but there is just zero question that this is true. Calling us dregs on society while we have a very low, but net positive, contribution while they have a giant net negative is, well, very symbolic of what they do.

 

[Sean]

Self-reported fatigue and/or chronic fatigue was determined using the Chalder fatigue scale.

Stopped there. Seriously.

Subsequent comments from members simply confirmed that choice.

It either shows very little understanding or a deliberate motivation to not understand

At some point – and I think it is way past that point now – ignorance about the problems with studies like this, particularly in relation to ME/CFS, is simply not available as an excuse.