Biopsychosocial risk factors of persistent fatigue after acute infection: A systematic review to inform interventions

Hulme, Katrin; Hudson, Joanna; Rojczyk, Philine; Little, Paul; Moss‐Morris, Rona

doi:10.1016/j.jpsychores.2017.06.013

Cited by 32 publications

(33 citation statements)

References 42 publications

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“…Risk factors were female sex and pre-existing psychiatric diagnoses. This is consistent with a review identifying risk factors for persistent fatigue following acute infections ( Hulme et al, 2017 ).…”

Section: Discussionsupporting

confidence: 91%

Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review

Schou

Joca

Wegener

et al. 2021

Brain, Behavior, and Immunity

318

278

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It has become evident that coronavirus disease 2019 (COVID-19) has a multi-organ pathology that includes the brain and nervous system. Several studies have also reported acute psychiatric symptoms in COVID-19 patients. An increasing number of studies are suggesting that psychiatric deficits may persist after recovery from the primary infection. In the current systematic review, we provide an overview of the available evidence and supply information on potential risk factors and underlying biological mechanisms behind such psychiatric sequelae. We performed a systematic search for psychiatric sequelae in COVID-19 patients using the databases PubMed and Embase. Included primary studies all contained information on the follow-up period and provided quantitative measures of mental health. The search was performed on June 4th 2021. 1725 unique studies were identified. Of these, 66 met the inclusion criteria and were included. Time to follow-up ranged from immediately after hospital discharge up to 7 months after discharge, and the number of participants spanned 3 to 266,586 participants. Forty studies reported anxiety and/or depression, 20 studies reported symptoms- or diagnoses of post-traumatic stress disorder (PTSD), 27 studies reported cognitive deficits, 32 articles found fatigue at follow-up, and sleep disturbances were found in 23 studies. Highlighted risk factors were disease severity, duration of symptoms, and female sex. One study showed brain abnormalities correlating with cognitive deficits, and several studies reported inflammatory markers to correlate with symptoms. Overall, the results from this review suggest that survivors of COVID-19 are at risk of psychiatric sequelae but that symptoms generally improve over time.

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Section: Discussionsupporting

confidence: 91%

Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review

Schou

Joca

Wegener

et al. 2021

Brain, Behavior, and Immunity

318

278

View full text Add to dashboard Cite

show abstract

“…The importance of cognitive and behavioral processes for fatigue and related symptoms has been clearly demonstrated in other areas of research, including work on chronic fatigue syndrome and pain. For example, the tendency to interpret everyday symptoms as physical in nature, negative beliefs about the experience of illness and symptoms, and an “all‐or‐nothing” coping response have been shown to predict the development of chronic fatigue syndrome after viral infection . Similarly, research on chronic pain has emphasized the importance of cognitive and emotional factors in pain persistence …”

Section: Psychosocial Risk Factors For Crfmentioning

confidence: 99%

The role of neuro‐immune interactions in cancer‐related fatigue: Biobehavioral risk factors and mechanisms

Bower

2019

Cancer

133

120

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Fatigue is a common and distressing symptom in both patients with cancer and cancer survivors. There is substantial variation in the severity and persistence of cancer‐related fatigue that may be driven by individual differences in host factors, including characteristics that predate the cancer experience as well as responses to cancer and its treatment. This review examines biobehavioral risk factors linked to fatigue and the mechanisms through which they influence fatigue across the cancer continuum, with a focus on neuro‐immune processes. Among psychosocial risk factors, childhood adversity is a strong and consistent predictor of cancer‐related fatigue; other risk factors include history of depression, catastrophizing, lack of physical activity, and sleep disturbance, with compelling preliminary evidence for loneliness and trait anxiety. Among biologic systems, initial work suggests that alterations in immune, neuroendocrine, and neural processes are associated with fatigue. The identification of key risk factors and underlying mechanisms is critical for the development and deployment of targeted interventions to reduce the burden of fatigue in the growing population of cancer survivors. Given the multidimensional nature of fatigue, interventions that influence multiple systems may be most effective.

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“…One way to guide early treatment is to understand risk factors associated with moving from acute to chronic fatigue. A recent systematic review of risk factors following an acute infection (Hulme, Hudson, Rojczyk, Little, & Moss‐Morris, ) supported existing biopsychosocial models of chronic fatigue which suggest a complex interaction of predisposing, precipitating, and perpetuating factors in the aetiology of chronic fatigue (Deary, Chalder, & Sharpe, ; Surawy, Hackmann, Hawton, & Sharpe, ). The data suggest that pre‐existing health issues, lack of fitness, and distress/stress may predispose individuals to be vulnerable to post‐infectious fatigue.…”

Section: Introductionmentioning

confidence: 81%

“…The response may be to rest again rather than risk activity. This in turn produces more symptoms and an ongoing vicious cycle (Hulme et al ., ).…”

Section: Introductionmentioning

confidence: 97%

Subacute fatigue in primary care – two sides of the story

Hulme

Little

Burrows

et al. 2019

British J Health Psychol

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Objectives Fatigue is a common symptom in primary care. Chronic fatigue research highlights the value of preventing chronicity, but little research has investigated the early, subacute stage of the fatigue trajectory (<3 months). We aimed to examine patient and general practitioner ( GP ) perspectives of subacute fatigue in primary care: (1) to gain a better understanding of fatigue during this stage and (2) to explore how management could be improved. Design A qualitative study design was used. In‐depth, semi‐structured telephone interviews were conducted with 14 patients and 14 GP s (non‐dyadic), recruited from 19 primary care practices. Methods Interview transcripts were thematically analysed. Initially, patient and GP accounts were analysed separately, before themes were merged to identify shared and independent perspectives. Results Three main themes were identified. Within these, subthemes from patients’, GP s’, or shared patient/ GP perspectives emerged. The main themes encompassed the following: (1) Change from normal – the impact of fatigue; (2) The challenges of managing fatigue; and (3) The consultation GP s’ knowledge was often not reflected in patients’ accounts, even for those reporting positive experiences, suggesting knowledge was not effectively translated. Conclusions Some findings, such as impact, mirror those described in chronic fatigue. New insights into early‐stage fatigue management also arose, including mismatches in patient and GP perceptions on negative tests and not re‐presenting. These highlight the need for better communication and shared understanding. GP s should pre‐emptively present a biopsychosocial model of fatigue and keep communication channels open, particularly in the light of negative physiological tests. Statement of contribution What is already known on this subject? Patients with chronic fatigue retrospectively report lack of understanding from GP s in early stage of illness. Little research has investigated the early stages of the fatigue trajectory. What does this study add? Consequences of an episode of subacute fatigue are similar to those reported for CFS . There is discordance between GP s’ positive view of negative tests and patients’ need for explanation of symptoms. The length of appointments is a significant barrier for creating shared understanding.

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Biopsychosocial risk factors of persistent fatigue after acute infection: A systematic review to inform interventions

Cited by 32 publications

References 42 publications

Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review

Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review

The role of neuro‐immune interactions in cancer‐related fatigue: Biobehavioral risk factors and mechanisms

Subacute fatigue in primary care – two sides of the story

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