Experiences of Fatigue in Chronic Disease: Effects on Mental Health

At the recent Chronic Disease & Mental Health virtual event, Iona Pickett discussed experiences of fatigue in chronic disease: effects on mental health.

Methods

Using a crowdsourcing website (https://www.prolific.co), we surveyed 83 adults with chronic health conditions and high levels of self-reported fatigue. Participants answered primarily open-ended questions about their experiences, their fatigue-related symptoms, and their fatigue management. Responses were analysed using a qualitative thematic approach completed in three stages: (1) data familiarization; (2) identifying key issues and concepts; (3) clustering and organizing themes, defining main concepts, and mapping relationships.

Results

Participants reported a range of chronic health conditions, with three-quarters reporting multiple ICD-10 diagnoses. Of those with multiple chronic illnesses, 75% reported at least one mental health condition. Depression and anxiety were particularly common, affecting 47% and 39% of all participants, respectively. Fatigue was also specifically associated with poor mental health. Low mood was the most frequently reported symptom of fatigue, and fatigue-related depressive symptoms were described by 64% of participants, including those with no reported mental health conditions. Anxiety and stress, emotional lability and cognitive symptoms were also frequently reported symptoms of fatigue. Most participants reported that the intensity of fatigue-related symptoms changed over time. Many participants also expressed frustration at the impact of fatigue on their ability to engage in physical and social activities, which may limit patients’ ability to manage fatigue-related mental health symptoms.

Conclusions

Poor mental health, in particular symptoms related to depression, are ubiquitous in those suffering from chronic disease and fatigue. This was seen both in the high rate of comorbid mental health disorders in those with chronic illness, and in the high frequency of mood-related fatigue symptoms. This qualitative study highlights the relationship between fatigue and mental health but is limited by small sample size and lack of data describing whether reported health conditions are current, concurrent, or historical. Our findings are discussed in relation to development of sensitive patient-reported outcomes which can capture change over time, such as high-frequency cognitive assessment.