LONGITUDINAL-STUDY OF OUTCOME OF CHRONIC FATIGUE SYNDROME

Objective-To examine the predictors of long term outcome for patients with the chronic fatigue syndrome. Design-Cohort study. Subjects-139 s ubjects previously enrolled in two treatment trials; 103 (74%) were re assessed a mean of 3.2 years after start of the trials. Setting-Univer sity hospital referral centre. Main outcome measures-Age at onset, dur ation of illness, psychological and immunological status at initial as sessment. Ongoing symptom severity, levels of disability, and immunolo gical function at follow up. Results-65 subjects had improved but only six reported no current symptoms. An alternative medical diagnosis ha d been made in two and psychiatric illness diagnosed in 20. The assign ment of a primary psychiatric diagnosis at follow up and the strength of the belief that a physical disease process explained all symptoms a t entry to the trials both predicted poor outcome. Age at onset of ill ness, duration of illness, neuroticism, premorbid psychiatric diagnose s, and cell mediated immune function did not predict outcome. Conclusi on-Though most patients with the chronic fatigue syndrome improve, a s ubstantial proportion remain functionally impaired. Psychological fact ors such as illness attitudes and coping style seem more important pre dictors of long term outcome than immunological or demographic variabl es.