Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e449-e457 (doi:10.1542/10.1542/peds.2007-1093)
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ARTICLE

Predictors of Persistent and New-onset Fatigue in Adolescent Girls

Maike ter Wolbeek, PhDa,b, Lorenz J. P. van Doornen, PhDb, Annemieke Kavelaars, PhDa and Cobi J. Heijnen, PhDa

a Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, Utrecht, Netherlands
b Department of Health Psychology, Utrecht University, Utrecht, Netherlands

OBJECTIVE. The purpose of this study was to investigate the stability of fatigue in adolescents and to explore whether psychological, somatic, and lifestyle factors are involved in the onset and persistence of fatigue during adolescence.

METHODS. In this longitudinal study, a total of 653 adolescent girls (aged 14.40 ± 1.45 years) who previously participated in an epidemiological study filled out questionnaires 6 (T2) and 12 (T3) months after the initial assessment (T1). Fatigue severity, depression, anxiety, and chronic fatigue syndrome–related symptoms were assessed. We determined the prevalence of severely fatigued cases at T2 and T3 and evaluated whether persistently fatigued participants initially differed from nonfatigued participants and participants with transient fatigue. We examined which factors predicted the development of new-onset fatigue and investigated whether changes in fatigue covaried with changes in other complaints and changes in lifestyle.

RESULTS. Of all participants who were severely fatigued at T1, 25.7% were persistently fatigued throughout the study. Persistently fatigued participants had higher levels of depression and anxiety at the beginning of the study, were less physically active, and slept shorter. New-onset fatigue was predicted by depression, less physical activity, and more nightlife activities. Interestingly, new onset was not predicted by initial levels of fatigue. Persistently fatigued participants did not differ in initial fatigue severity from short-term fatigued patients. A decrease in fatigue severity was associated with a decrease in depression, anxiety, and chronic fatigue syndrome–related symptoms and, to a lesser extent, with an increase in physical activity and sleep duration.

CONCLUSIONS. The stability of severe fatigue among adolescents is substantial. The involvement in the onset and persistence of fatigue suggests that both preventive and therapeutic strategies with respect to fatigue treatment in adolescents should concentrate on emotional well-being. Moreover, adolescents at risk should be stimulated to spend more time on physical activities and to sleep longer.

Abbreviations: CFS—chronic fatigue syndrome • CIS—Checklist Individual Strength • BDI—Beck Depression Inventory • STAIC—State/Trait Anxiety Inventory for Children

Accepted Jul 20, 2007.


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