What makes women tired? A community sample

Prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic: a network perspective

Background

The COVID-19 pandemic has greatly affected treatment-seeking behaviors of psychiatric patients and their guardians. Barriers to access of mental health services may contribute to adverse mental health consequences, not only for psychiatric patients, but also for their guardians. This study explored the prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic.

Methods

This multi-center, cross-sectional study was conducted in China. Symptoms of depression and anxiety, fatigue level and quality of life (QOL) of guardians were measured with validated Chinese versions of the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder Scale - 7 (GAD-7), fatigue numeric rating scale (FNRS), and the first two items of the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. Independent correlates of depression were evaluated using multiple logistic regression analysis. Analysis of covariance (ANCOVA) was used to compare global QOL of depressed versus non-depressed guardians. The network structure of depressive symptoms among guardians was constructed using an extended Bayesian Information Criterion (EBIC) model.

Results

The prevalence of depression among guardians of hospitalized psychiatric patients was 32.4% (95% CI: 29.7-35.2%). GAD-7 total scores (OR = 1.9, 95% CI: 1.8-2.1) and fatigue (OR = 1.2, 95% CI: 1.1-1.4) were positively correlated with depression among guardians. After controlling for significant correlates of depression, depressed guardians had lower QOL than non-depressed peers did [F_{(1, 1,101)} = 29.24, p < 0.001]. "Loss of energy" (item 4 of the PHQ-9), "concentration difficulties" (item 7 of the PHQ-9) and "sad mood" (item 2 of the PHQ-9) were the most central symptoms in the network model of depression for guardians.

Conclusion

About one third of guardians of hospitalized psychiatric patients reported depression during the COVID-19 pandemic. Poorer QOL was related to having depression in this sample. In light of their emergence as key central symptoms, "loss of energy," "concentration problems," and "sad mood" are potentially useful targets for mental health services designed to support caregivers of psychiatric patients.

Associations between depressive symptoms and quality of life among residents of Wuhan, China during the later stage of the COVID-19 pandemic: A network analysis

BACKGROUND

Various populations have experienced significant increases in depression and decreased quality of life (QOL) during the coronavirus disease 2019 (COVID-19) pandemic. This network analysis study was designed to elucidate interconnections between particular depressive symptoms and different aspects of QOL and identify the most clinically important symptoms in this network among adults in Wuhan China, the initial epicenter of the COVID-19 pandemic.

METHODS

This cross-sectional, convenience-sampling study (N = 2459) was conducted between May 25 to June 18, 2020, after the lockdown policy had been lifted in Wuhan. Depressive symptoms and QOL were measured with the Patient Health Questionnaire-9 (PHQ-9) and first two items of the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. A network structure was constructed from the extended Bayesian Information Criterion (EBIC) model. Network centrality strength and bridge strength were evaluated along with the stability of the derived network model.

RESULTS

Loss of energy (DEP-4) and Guilt feelings (DEP-6) were the two central symptoms with the highest strength as well as the two most prominent bridge symptoms connecting the clusters of depression and quality of life (QOL) in tandem with the two nodes from the QOL cluster. Network structure and bridge strengths remained stable after randomly dropping 75 % of the sample.

CONCLUSION

Interventions targeting "Loss of energy" and "Guilt feelings" should be evaluated as strategies for reducing depressive symptoms and promoting improved QOL in COVID-19-affected populations.

The backbone symptoms of depression: a network analysis after the initial wave of the COVID-19 pandemic in Macao

Background

The coronavirus disease 2019 (COVID-19) pandemic disrupted the working lives of Macau residents, possibly leading to mental health issues such as depression. The pandemic served as the context for this investigation of the network structure of depressive symptoms in a community sample. This study aimed to identify the backbone symptoms of depression and to propose an intervention target.

Methods

This study recruited a convenience sample of 975 Macao residents between 20th August and 9th November 2020. In an electronic survey, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9). Symptom relationships and centrality indices were identified using directed and undirected network estimation methods. The undirected network was constructed using the extended Bayesian information criterion (EBIC) model, and the directed network was constructed using the Triangulated Maximally Filtered Graph (TMFG) method. The stability of the centrality indices was evaluated by a case-dropping bootstrap procedure. Wilcoxon signed rank tests of the centrality indices were used to assess whether the network structure was invariant between age and gender groups.

Results

Loss of energy, psychomotor problems, and guilt feelings were the symptoms with the highest centrality indices, indicating that these three symptoms were backbone symptoms of depression. The directed graph showed that loss of energy had the highest number of outward projections to other symptoms. The network structure remained stable after randomly dropping 50% of the study sample, and the network structure was invariant by age and gender groups.

Conclusion

Loss of energy, psychomotor problems and guilt feelings constituted the three backbone symptoms during the pandemic. Based on centrality and relative influence, loss of energy could be targeted by increasing opportunities for physical activity.

Fatigue and physical activity: Potential modifiable contributors to parenting sense of competence

OBJECTIVES

Parenting sense of competence, as measured by the Parenting Sense of Competence Scale (PSCS), is defined as one's levels of satisfaction and self-efficacy experienced in the parenting role. Previous studies have identified significant associations among PSCS scores and a host of parenting characteristics predictive of child outcomes. Existing approaches to improving parenting sense of competence focus on developing parenting knowledge and skills; however, other modifiable contributing factors to parenting sense of competence may exist. We examined associations among fatigue, physical activity, and parenting sense of competence in a community sample of female primary caregivers of young children (N=137) recruited from a university-based pediatric primary care clinic.

METHODS

Participants completed measures of child disruptive behavior disorders, parent fatigue, and parent physical activity level. Parenting sense of competence was measured with the 16-item PSCS.

RESULTS

Participants' mean age was 32 years (SD=8 years), and most were non-Hispanic (87%) and White (70%). Multiple linear regression analyses revealed significant independent associations of fatigue (β=-0.19, p=.02) and physical activity level (β=0.20 and β=0.25, p<.05) with parenting sense of competence, controlling for child disruptive behaviors, child age, and socioeconomic status.

CONCLUSIONS

In this non-clinical sample of mothers of young children, the significant relationships among fatigue, physical activity level, and parenting sense of competence could suggest potential targets for preventive intervention.

Cultural Differences in Conceptual Models of Everyday Fatigue

The present study used a qualitative methodology to examine cultural differences in representations of everyday fatigue. Thirty-seven European American women and 36 South Asian immigrant women responded to a vignette describing fatigue. A dimensional model of illness representation was used to develop a coding scheme and analyze the data. Results indicate both similarities and differences in conceptual models of fatigue. European Americans were more likely to medicalize fatigue symptoms and view them as acute, severe and in need of treatment. The social and familial context of women's everyday lives strongly influenced their representations.

Traditional Chinese medicinal herbal tea consumption, self-reported somatization, and alexithymia

INTRODUCTION

Somatic presentations of distress are common cross-culturally, although perhaps more so in Asian cultures. Somatic presentations of distress may be associated with alexithymia, a difficulty in experiencing and expressing emotions. Although the constructs of somatization and alexithymia have been examined in depth both within and across cultures, there is minimal information on culture-specific behaviors utilized to cope with stress in individuals who tend to somaticize distress or are alexithymic. The current report investigates the association between somatization and alexithymia, and a culture-specific behavior of traditional Chinese medicinal herbal tea consumption, in a nonclinical, young adult sample.

METHODS

A sample of 222 undergraduate university students of Chinese ethnicity completed self-report measures of somatization and the related construct of somatosensory amplification, alexithymia, and attitude toward the consumption of herbal tea possessing traditional Chinese medicinal value.

RESULTS

After controlling for gender, alexithymia was significantly correlated with somatization (r[220] = 0.29, P < 0.05) and somatosensory amplification (r[220] = 0.19, P < 0.05). Attitudes toward herbal tea consumption were significantly correlated with somatosensory amplification (r[220] = 0.16, P < 0.05).

DISCUSSION

The connection between alexithymia and somatization was confirmed in the current report in a nonclinical sample. A culture-specific behavior (consumption of traditional Chinese medicinal herbal tea) was significantly associated with somatosensory amplification. Potential etiologies and implications of the current findings are discussed.

Somatic presentations of distress in China

OBJECTIVE

Somatic presentations of distress are common cross-culturally and are thought to predominate in Asian cultures such as that of China. From an etic perspective, researchers utilizing empirically validated standardized assessment measures find that somatic symptoms are no more common in individuals of Chinese descent than they are in individuals of European descent. In contrast, patient presentations are heavily influenced by culture and are associated with patterns of illness behavior. The objective of the current review is to determine the culture-specific factors contributing to somatic presentations and descriptions of distress in China.

METHOD

The current review was based on a literature search of PubMed and PsychInfo using the terms 'China,' 'Asia,' 'somatoform,' 'somatization,' and 'psychogenic.'

RESULTS

Factors contributing to somatic presentations of distress in China include stigma and help-seeking behavior, and assessment approaches that ignore culture-specific patterns of symptom reporting, fail to incorporate somatic metaphor and Chinese conceptualizations of distress that emphasize bodily sensation, and ignore the role that culture-specific normative data and culture specific response patterns may produce on assessment results.

CONCLUSIONS

From an emic perspective, there are numerous factors contributing to the appearance of a predominantly somatic presentation of distress in China. Implications for clinical practice are discussed.

Multidimensional predictors of fatigue among octogenarians and centenarians

BACKGROUND

Fatigue is a common and frequently observed complaint among older adults. However, knowledge about the nature and correlates of fatigue in old age is very limited.

OBJECTIVE

This study examined the relationship of functional indicators, psychological and situational factors and fatigue for 210 octogenarians and centenarians from the Georgia Centenarian Study.

METHODS

Three indicators of functional capacity (self-rated health, instrumental activities of daily living, physical activities of daily living), two indicators of psychological well-being (positive and negative affect), two indicators of situational factors (social network and social support), and a multidimensional fatigue scale were used. Blocked multiple regression analyses were computed to examine significant factors related to fatigue. In addition, multi-group analysis in structural equation modeling was used to investigate residential differences (i.e., long-term care facilities vs. private homes) in the relationship between significant factors and fatigue.

RESULTS

Blocked multiple regression analyses indicated that two indicators of functional capacity, self-rated health and instrumental activities of daily living, both positive and negative affect, and social support were significant predictors of fatigue among oldest-old adults. The multiple group analysis in structural equation modeling revealed a significant difference among oldest-old adults based on residential status.

CONCLUSION

The results suggest that we should not consider fatigue as merely an unpleasant physical symptom, but rather adopt a perspective that different factors such as psychosocial aspects can influence fatigue in advanced later life.

The epidemiology of chronic fatigue, physical illness, and symptoms of common mental disorders: a cross-sectional survey from the second British National Survey of Psychiatric Morbidity

OBJECTIVE

The study aimed to describe the prevalence of chronic fatigue in the general population and to investigate the extent to which its association with physical illness was independent of other symptoms of common mental disorders.

METHODS

Data from the second British National Survey of Psychiatric Morbidity (2000) were analyzed. The survey covered people aged 16 to 74 years living in private households. Chronic fatigue (significant reported fatigue lasting 6 months or more) was ascertained using the revised Clinical Interview Schedule. Information on reported physical illness and sociodemographic factors was considered. Psychiatric symptoms were also assessed using the revised Clinical Interview Schedule.

RESULTS

The prevalence of chronic fatigue was 15.0%, and this showed a significant association with the number of reported physical illnesses (odds ratio [OR] per reported illness, 1.79; 95% confidence interval, 1.68-1.90). It was higher in midlife, in women, in participants with less skilled occupations, and in those with lower educational attainment. Chronic fatigue was strongly associated with the presence of depressive symptoms (OR, 5.37), anxiety-related symptoms (OR, 4.66), and with sleep complaints (OR, 4.41). After adjustment for all sociodemographic and psychiatric factors, the number of reported physical illnesses was less strongly but still significantly associated with chronic fatigue (OR, 1.51; 1.39-1.63).

CONCLUSION

Physical illness is strongly associated with chronic fatigue. Symptoms of common mental disorders are also associated with chronic fatigue, but the association between physical illness and chronic fatigue is evident even after adjusting for psychiatric symptoms. The assessment of physically ill people should include chronic fatigue and psychiatric symptoms.

Cultural differences in the experience of everyday symptoms: a comparative study of South Asian and European American women

This paper describes a study of medically ambiguous symptoms in two contrasting cultural groups. The study combined a qualitative, meaning-centered approach with a structured coding system and comparative design. Thirty-six South Asian immigrants and thirty-seven European Americans participated in a semistructured health history interview designed to elicit conceptual models of medically unexplained illness. The groups reported similar symptoms, but the organization of illness episodes and explanatory models associated with these episodes differed sharply. A variety of cultural variables and processes is proposed to account for observed differences, including somatization, the role of local illness categories, and the divergent core conflicts and values associated with gender roles. It is argued that the comparative design of the study provided insights that could not have been achieved through the study of a single group.

An Investigation of the Role of Non–Work-Time Behavior in Buffering the Effects of Work Strain

OBJECTIVE

In this exploratory study, we investigated the extent to which common leisure time behaviors, which generate positive feelings of fulfillment and personal reward, are significant in alleviating work-induced stress between successive work periods. We tested the hypotheses that such activities increase recovery from stress directly, and also by improving sleep quality, thereby alleviating maladaptive outcomes from work strain.

METHOD

An on-line survey study was completed by a heterogeneous sample of 314 workers in diverse occupations, in good health.

RESULTS

Non-work-time behaviors play a significant role in mediating maladaptive outcomes from work strain. Multivariate analysis of these relationships indicates both direct and indirect effects, the latter being associated with mediating sleep quality. Respondents reporting higher levels of active leisure activities, exercise, and creative (hobby) and social activity, reported significantly better sleep, recovery between work periods, and lower chronic maladaptive fatigue symptomology.

CONCLUSION

Active and fulfilling non-work-time behaviors are more significant in maximizing recovery from work strain than is commonly recognized. This effect is arguably due to the downregulation of stress-induced brain arousal, and stimulation of the pleasure-reward brain neurophysiology. Consistent recovery from work strain between work periods may represent a crucial factor in avoiding work-related "loss spirals" leading to maladaptive health outcomes, which can be particularly relevant to workers in inherently stressful occupations.

Beta-blocker medication usage in older women after myocardial infarction

PURPOSE

The purpose of this study was to assess demographic characteristics of women prescribed beta-blocker (beta-blocker) medication and compare to those not using beta-blocker medication, and to determine if there are differences in depression and fatigue among women who used beta-blockers compared to nonusers 6-12 months after myocardial infarction (MI).

DATA SOURCES

This was a descriptive cross-sectional study of 84 women (61 using beta-blockers and 23 not using beta-blockers) aged 65 and older who were 6-12 months post-MI. Women had their height and weight measured and completed a Demographic Health Form, the Geriatric Depression Scale, and the Revised Piper Fatigue Scale (RPFS).

CONCLUSIONS

While most of the women were taking beta-blockers after MI (74%), significantly fewer Black women were taking beta-blockers (chi(2) = 5.086, p = 0.032). Most of the beta-blocker users were overweight or obese. There were no significant differences in age, t(82) = 0.7, p = 0.486; body mass index, t(82) = 0.76, p = 0.445; income, chi(2)(df = 2) = 3.219, p = 0.075; mean depression, t(82) = 1.648, p = 0.103; or fatigue scores, t(82) = 0.993, p = 0.324, between beta-blocker users and nonusers. More of those not taking beta-blockers reported fatigue with significantly higher fatigue in the affective meaning dimension of the RPFS, t(82) = 2.272, p = 0.03.

IMPLICATIONS FOR PRACTICE

beta-Blocker medication continues to be underutilized in older women. Because no difference was noted in fatigue and depression in the two groups, these may mean that these side effects are not barriers in prescribing this medication post-MI. Nurse practitioners are in pivotal positions to monitor the ongoing physiological and psychological sequelae post-MI and implement interventions to improve their outcomes.

Psychological distress among marginalized women in the outskirts of beirut: determinants and association with health perception

The objective of this study was to determine the prevalence of psychological distress (PD) and its determinants in under-privileged women in the outskirts of Beirut, Lebanon. A cross-sectional survey of 1,869 ever-married women aged 15-59 was carried out. PD levels were determined using the 12-item General Health Questionnaire (Appendix). Health status, living conditions, social support, and physical symptoms as reported by women were recorded. Logistic regression was used to test the independent effect of each variable on PD. 46.6% of women had PD. Psychologically distressed women had more children, less education, lower income, less social support, an uncomfortable relationship with their husband, participated in the labor force and were more likely to reside in a predominantly Moslem community. Reporting a health or living problem were significant predictors of PD. The presence of limb, back and stomach pain, and headache were associated with PD. Compared to similar populations in other countries, our sample had a high prevalence of mental distress.

Engendering health disparities

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

Do physical leisure time activities prevent fatigue? A 15 month prospective study of nurses' aides

OBJECTIVE

To test the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue.

METHODS

The hypothesis was tested in a sample that was homogeneous with respect to sex and occupation, with a prospective cohort design. Of 6234 vocationally active, female, Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999, 5341 (85.7%) completed a second questionnaire 15 months later. The main outcome measure was the prevalence of persistent fatigue-that is, always or usually feeling fatigued in the daytime during the preceding 14 days.

RESULTS

In participants without persistent fatigue at baseline, reported engagement in physical leisure time activities for 20 minutes or more at least once a week during the three months before baseline was associated with a reduced risk of persistent fatigue at the follow up (odds ratio = 0.70; 95% confidence interval 0.55 to 0.89), after adjustments for age, affective symptoms, sleeping problems, musculoskeletal pain, long term health problems of any kind, smoking, marital status, tasks of a caring nature during leisure time, and work factors at baseline.

CONCLUSION

The study supports the hypothesis that physical leisure time activities reduce the risk of developing persistent fatigue.

Multiple Role Adaptation Among Women Who Have Children and Re-Enter Nursing School in Taiwan

This study assessed multiple role adaptation within maternal and student roles among female RNs who had children and returned to school for baccalaureate degrees in Taiwan. Using Roy's Adaptation Model as the theoretical framework, relationships were explored among demographic (number of children, age of youngest child, employment status), physical (sleep quality, health perception, activity), and psychosocial factors (self-identity, role expectation, role involvement, social support) and multiple role adaptation (role accumulation). The sample included 118 mother-students who had at least one child younger than age 18 and who were studying in nursing programs in Taiwan. The highest correlation was found between activity and role accumulation followed by significant correlations between sleep quality, health perception, maternal role expectation, and age of youngest child and role accumulation. In regression analyses, the complete model explained 46% of the variance in role accumulation. Implications for education and future research are identified.

The impact of insurance lapse among low-income children

Children living in poverty not only have disproportionately more health problems, but also have disproportionately lower health care service utilization. Change, whether in health care delivery system or in family living situation, may interfere with or jeopardize insurance status and thereby influence access to health care services. We hypothesized that children who have maintained Medicaid insurance compared to those who have not will be more likely to have preventive care visits and less likely to have emergency room visits. We further hypothesized that transient situations such as homeless episodes, foster care placement, and living in more than one location in the same 1-year period will contribute to loss in Medicaid coverage. This retrospective cohort study was conducted at an urban children's hospital outpatient clinic at which 210 family respondents were recruited over a 1-year period. An in-person interview containing several standardized instruments was administered to the caregiver. In addition, children's medical records were retrospectively abstracted from point of study entry to first contact. Findings indicated that children who lost Medicaid coverage, compared to others, had significantly fewer preventive care health visits. There were no differences in emergency room visits. Transient situations did not appear to influence preventive or emergency room care. In addition, the change into a managed-care delivery system also increased loss of coverage. Loss of coverage may be a barrier to preventive care services. To ensure optimal preventive care services, the onus is on the providers and plans to facilitate continued insurance coverage.

Correlates of fatigue in critical care nurses

The purposes of this study were to examine shift-related differences in chronic fatigue and the contributions of sleep quality, anxiety, and depression to chronic fatigue among a random nationwide sample (N = 142) of female critical care nurses. Twenty-three percent of this sample met criteria for clinical depression. Day and night nurses did not differ in their reports of chronic fatigue. Night nurses reported more depression and poorer sleep quality than did day nurses. Regression analyses indicated that among the variables of global sleep quality, depression, and anxiety, depression and sleep quality were the most relevant to the explanation of chronic fatigue. These findings suggest the need for studies of strategies to promote sleep and improve mood in critical care nurses.

Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial

OBJECTIVE

To determine the subjective response to iron therapy in non-anaemic women with unexplained fatigue.

DESIGN

Double blind randomised placebo controlled trial.

SETTING

Academic primary care centre and eight general practices in western Switzerland.

PARTICIPANTS

144 women aged 18 to 55, assigned to either oral ferrous sulphate (80 mg/day of elemental iron daily; n=75) or placebo (n=69) for four weeks.

MAIN OUTCOME MEASURES

Level of fatigue, measured by a 10 point visual analogue scale.

RESULTS

136 (94%) women completed the study. Most had a low serum ferritin concentration; <or= 20 microg/l in 69 (51%) women. Mean age, haemoglobin concentration, serum ferritin concentration, level of fatigue, depression, and anxiety were similar in both groups at baseline. Both groups were also similar for compliance and dropout rates. The level of fatigue after one month decreased by -1.82/6.37 points (29%) in the iron group compared with -0.85/6.46 points (13%) in the placebo group (difference 0.95 points, 95% confidence interval 0.32 to 1.62; P=0.004). Subgroups analysis showed that only women with ferritin concentrations <or= 50 microg/l improved with oral supplementation.

CONCLUSION

Non-anaemic women with unexplained fatigue may benefit from iron supplementation. The effect may be restricted to women with low or borderline serum ferritin concentrations.

Self-care for fatigue in patients With HIV

PURPOSE/OBJECTIVES

To identify when fatigue is reported as a problem by people who are HIV positive, what the perception of fatigue is, and which self-care behaviors are used and with what efficacy.

DESIGN

Multisite descriptive study.

SETTING

University-based AIDS clinics, community-based organizations, and homecare agencies located in cities across the United States, in Norway, and through a university Web site.

SAMPLE

Convenience sample of 422 self-identified people who are HIV positive.

MAIN RESEARCH VARIABLES

Symptom description, symptom relief, symptom help, and self-care strategies.

FINDINGS

The sixth most reported symptom in this study, fatigue, was treated with a variety of self-designed strategies. In only three instances was consultation with a healthcare provider (i.e., physician) or an injection (medication not defined) mentioned. The most frequently used interventions were supplements, vitamins, and nutrition followed by sleep and rest; exercise; adjusting activities, approaches, and thoughts; distraction; and complementary and alternative therapies. In addition to self-designed strategies, the media and friends and family were sources of information.

CONCLUSIONS

Fatigue was reported less frequently in this study than in other HIV-, AIDS-, or cancer-related studies. This may be an artifact of the study design. The use of informal networks for assistance, let alone the prevalence of unrelieved fatigue, indicates the need for more attention to this problem among people with AIDS.

IMPLICATIONS FOR NURSING

Careful assessment of the pattern of fatigue and its onset, duration, intervention, and resolution is required if the varied types of fatigue are to be identified and treated successfully.

Relationship as an inherent component in healthy women's fatigue

The notion of fatigue has remained ambiguous despite more than 100 years of study. Fatigue is recognized as subjective in nature, and it is studied and clinically managed as primarily intrapersonal in scope, with treatment approaches often based in an established, if unfounded, hierarchy of assumptions. When a physiologic cause for fatigue is not identifiable, fatigue complaints often are considered illegitimate. This article builds on data from the literature and from the author's previous work in women's fatigue and relatedness to suggest that interpersonal relationships may serve to exacerbate healthy women's fatigue experiences. The importance of relationship to women's life experience and the inherently relational character of women's fatigue are discussed. The author proposes the importance of including interpersonal experiences as a component of the definition of fatigue for healthy women.

Predictors of fatigue in healthy young adults: moderating effects of cigarette smoking and gender

Fatigue is a common complaint of patients seen in primary care. Factors that contribute to fatigue in a patient population include poor health status, psychological stress, poor nutrition, and pregnancy. Less well understood are factors that contribute to fatigue among healthy, nonpregnant individuals. Within the framework of the theory of unpleasant symptoms, 40 healthy young smoking and nonsmoking adults between the ages of 18 and 35 were evaluated to determine self-report level of fatigue and contributing physiological, psychological, and situational factors. Results indicate that while self-report of fatigue did not vary in this population based on gender, subjects who were moderate to heavy cigarette smokers were significantly more fatigued than were nonsmokers (F = 10.24, df = 1, 38, P < 0.01), with the effect being specific to male smokers. Self-report of fatigue did not correlate with body mass index, baseline inflammatory or immune status, or blood pressure. Positive psychological and situational predictors of fatigue included depression (r = 0.556, P < 0.001), state anxiety (r = 0.569, P < 0.001), sleep quality (r = -0.399, P < 0.05), and sleep quantity (r = -0.411, P < 0.05). These results suggest that psychological and situational factors are key contributors to fatigue in young adults and that smoking is a risk factor for fatigue in men.

Attributions of cause and recurrence in long-term breast cancer survivors

Women are bombarded with information about the purported causes and the prevention of breast cancer. This survey sought to determine to what women survivors of breast cancer attributed the cause and lack of recurrence of their breast cancer, and whether these views were associated with specific health behaviors.

METHODS

Women who had survived breast cancer without recurrence for at least 2 years were surveyed by mail about their views on the cause and lack of recurrence of their breast cancer. They were also asked to estimate their personal risk of cancer recurrence, report on their health behaviors, describe what advice they would give to women newly diagnosed with breast cancer, and what they would change if they had to relive their breast cancer experience.

RESULTS

378 (75.6%) women breast cancer survivors responded who had been recurrence free for a mean of 8.6+/-11.8 years. Women (n=322) who responded to the question about the cause of breast cancer attributed it to stress (42.2%), genetics (26.7%), environment (25.5%), hormones (23.9%), don't know (16.5%), diet (15.5%), and breast trauma (2.8%). Women (n=330) who responded to the question about what prevented cancer recurrence attributed it to positive attitude (60.0%), diet (50.0%), healthy lifestyle (40.3%), exercise (39.4%), stress reduction (27.9%), prayer (26.4%), complementary therapies (11.2%), don't know (5.1 %), luck (3.9%), and tamoxifen (3.9%). Most women felt their recurrence risk was average (44.8%), or below average (35.8%). Some attributions of breast cancer cause or lack of recurrence were associated with specific health behaviors. The majority of women survivors would advise other women with breast cancer to be positive, and if they had to relive their cancer experience they would take more control of their treatment.

DISCUSSION

Despite lack of evidence substantiating stress as a cause of breast cancer, many breast cancer survivors believed stress caused their cancer. An even higher percentage of survivors believed their positive attitude had prevented breast cancer recurrence and they would advise other women with breast cancer accordingly. Attribution beliefs clearly affected survivors' health behaviors.

CONCLUSION

Healthcare providers should consider the personal beliefs of patients about cancer cause and recurrence, which may be at variance with scientific evidence. This may assist in framing the management of patients in personally meaningful ways, which may increase health behaviors, adherence, satisfaction and quality of life. Whether it will increase survival remains unknown.

Differential diagnosis of fatigue in women

The incidence of fatigue among women has been reported to be higher than among men. Life events such as childbirth, menopause, and socially imposed roles may confer unique vulnerability. Effective treatment of fatigue is dependent on accurate diagnosis. The mechanisms of fatigue are not well understood, but physiologically based fatigue can be differentiated from psychogenic fatigue. Such differentiation helps to direct and enhance the effectiveness of interventions.