BRITISH JOURNAL OF PSYCHIATRY (2002), 181, 56^61 Neurasthenia: prevalence, disability and health care feelings of fatigue after minor physical effort;effort; characteristics in the Australian community (b)(b)accompaniedaccompanied by one or more of the following symptoms: muscular aches or pains; dizziness; tension headache; IAN HICKIE, TRACEY DAVENPORT, CATHY ISSAKIDIS and GAVIN ANDREWS sleep disturbance; inability to relax; and irritability; (c)(c)inabilityinability to recover through rest, relaxa- tion or enjoyment; (d)(d)durationduration exceeds 3 months; (e)(e)doesdoes not occur in the presence of organic Background Neurasthenia imposes a Neurasthenia as a diagnostic entity has a mental disorders, affective disorders or panic or generalised anxiety disorder. high burden on primary medical health long and chequered history in psychiatry (Wessely, 1990; Hickie et aletal, 1998). Despite Although the WHO thought neurasthenia care systemssystemsin in allallsocieties. societies. changes in diagnostic fashion, aetiological sufficiently different to other ‘Neurotic, Aims TodetermineTo determine the prevalence of theorising and modes of treatment, people stress-related and somatoform disorders’ who essentially report mental and physical to justify its own category, research groups ICD^10 neurasthenia and associated fatigue, a range of other neuropsycho- have tended to be more conservative. Tradi- comorbidity,disability and health care logical and mood symptoms (e.g. impaired tionally, most psychiatric epidemiologists utilisation.utilisation. concentration and short-term memory, irri- highlight the comorbidity with depressive table mood, non-restorative sleep) as well and anxiety disorders (Wessely, 1990) and MethodMethod Utilisation of a national sample as other non-specific physical symptoms have rejected the utility of differentiating of Australian households previously (e.g. muscle aches and pains, headache, the concept until social covariates, course surveyed using the Composite general malaise) continue to impose a high or response to treatment distinguish it from burden on primary medical health care (say) dysthymia(Goldberg & Bridges, International Diagnostic Interview and systems in all societies (U(Ustun¨ stu¨ n & Sartorius, 1991). Such disorders have not been other measures. 1995; Hickie et aletal, 2001,2001aa).). included in the major North American epidemiological studies of the past decade ResultsResults Prolonged and excessive (Kessler(Kessler et aletal, 1994). A more proactive Classification of neurasthenia fatigue wasreported by1465 people view, however, has argued for evidence (13.29% oftheof the sample).Ofthese,sample).Of these, one in Although the diagnostic concept fell into of independence from depression and nine people meet current ICD ^10 criteria disrepute in the English-speaking world in anxiety at the levels of multivariate the 20th century (being seen more simply for neurasthenia.Comorbidity was modelling of symptom data (Gillespie etet as a variant of depression or anxiety), it alal, 1999), genetic vulnerabilities (Hickie associated with affective, anxiety and persisted in most non-English speaking et aletal, 1999,1999aa), longitudinal course (Hickie physical disorders.Peopledisorders. People with countries. Consequently, the ICD–10 et aletal, 1999,1999bb) and treatment response. neurasthenia alone (550.5% of the (World Health Organization (WHO), Although such studies link neurasthenia 1992) contains a clear definition of the con- population) were less disabled and used more closely with other somatoform dis- cept and the World Psychiatric Association orders, there is evidence that the category less services thanthose with comorbid (WPA) has promoted a renewed diagnostic can be distinguished from entities such as disorders.disorders. and research effort (WPA, 1999). In doing fibromyalgia, irritable bowel, somatic so, the WPA sought to broaden the concept depression and somatic anxiety (Kirmayer Conclusions Fatigue is frequent in the to include cognitive, emotional, somatic, & Robbins, 1991). Australian community andandis is commonin energy and sleep variables that could give Although the nosological debate is people attending generalpractice.general practice. the syndrome specific attributes that are complex, studies in primary care indicate Neurasthenia is disabling and demanding clearly different to the symptoms of depres- that prolonged fatigue syndromes are sive and anxiety disorders (WPA, 1999). of serviceslargely because of its common. Prevalence rates for prolonged The ICD–10 diagnostic criteria for fatigue (typically greater than 1 month) comorbidity with other mental and research (WHO, 1993) are included in the vary from 18 to 37% (Pawlikowska et aletal,, physical disorders.Until a remedy for chapter on ‘Neurotic, stress-related and 1994; Hickie et aletal, 1996, 2001aa), whereas),whereas persistentfatigue is provided, doctors somatoform disorders’ in a subsidiary the WHO Primary Care Study (Sartorius section entitled ‘Other neurotic disorders’, should take an active psychological et aletal, 1993) found that an average of implying a disorder of uncertain lineage. 5.3% of general practice patients met approachto treatment. The diagnostic criteria for neurasthenia criteria for neurasthenia (range 1.1– can be summarised as follows: Declaration of interest None. 10.5%). All studies have emphasised that the syndrome is associated with disability, (a)(a)either,either, persistent and distressing feel- chronicity, comorbidity and high service ings of exhaustion after minor mental utilisation. The Australian National Survey effort or persistent and distressing of Mental Health and Wellbeing (Andrews(Andrews 56 Downloaded from https://www.cambridge.org/core. 02 Oct 2021 at 17:18:41, subject to the Cambridge Core terms of use. NEURASTHENIA IN AUSTRALIA etet alal, 2001) is the first national Data analysis neurasthenia is not a common mental community based psychiatric survey to Routine data analysis procedures were used disorder.disorder. include a module specifically designed to but, as a result of the complex sample identify people who met criteria for design and weighting, specific software Prevalence ICD–10 neurasthenia. This paper is an was required to estimate standard errors Data on the weighted prevalence of neur- account of the key findings, emphasising (s.e.). The s.e. of prevalence estimates and asthenia are displayed in Table 1, by age not only prevalence rates but also patterns confidence intervals around odds ratios and gender, for people meeting criteria in of comorbidity, disability and health care (ORs) derived from logistic regression the past month (1.2%) and sometimes in utilisation.utilisation. models were estimated using delete-1 the past year (1.5%). Only 20% of people jackknife repeated replication in 30 who met criteria during the year were not design-based subsamples (Kish & Frankel, current cases. The disorder is chronic. The METHOD 1974). These calculations used the female to male ratio was small (1.4 and Sample SUDAAN software package (Shah etetalal,, 1.2) in contrast to what is often believed, 1997).1997). The national survey was conducted by the and different from the pattern seen in Australian Bureau of Statistics under the health care facilities. On further examin- terms of their Act that guarantees the RREESUSULLTTSS ation of the numbers of people in the popu- privacy of respondents. A multi-stage lation who reported fatigue (13.2%), sample of private dwellings in rural and DDiiagnoagnossiiss significantly more females than males said urban Australia was drawn. Each state The criteria for neurasthenia are listed ‘yes’ (14.9% v.v. 11.3%;11.3%; PP550.05).0.05).InIn and territory was stratified and each dwell- above. Criterion A, prolonged and addition, when respondents were asked ing within a stratum had an equal and excessive fatigue, was endorsed by 1465 whether it was clinically significant (601 known probability of selection. In all, people (13.2% of the sample). These said ‘yes’), female rates were still higher 13 624 private dwellings were initially responses were probed to ensure that the but the confidence intervals just overlapped selected in the survey sample, and one adult symptom was clinically significant and (6.3%(6.3% v.v. 4.4%;4.4%; PP440.05). For all other member aged 18 years and over randomly not attributed by the respondent to drugs criteria (B–D) the rates of endorsement selected as the possible respondent. A total or alcohol, physical illness or injury (601 were almost identical for males and of 10 641 people participated, a response persons agreed that this was so). Criterion females. Thus, although more women than rate of 78.1%. The age and gender charac- C requires that the fatigue does not men in the population report fatigue the teristics of the sample were weighted to respond to rest and 318 of the 601 prevalence of neurasthenia is not higher in match the age and gender distribution in participants endorsed this. Criterion D women. The multivariate associations of the national census. requires that the fatigue lasts 3 months demographic variables are shown in or more, and this was so for 186 Table 2 together with those for people participants. Finally we asked about the with any 12-month12-month mental disorder. Both Assessment presence of the Criterion B symptoms, sets of disorders decline with age, both The whole interview was administered 172 of the 186 met this criterion. Thus, are more common among people who from a laptop computer.