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Results From a Population-Based Study

Christine Heim, PhD; Dieter Wagner, PhD; Elizabeth Maloney, MS, DrPH; Dimitris A. Papanicolaou, MD; Laura Solomon, MPH; James F. Jones, MD; Elizabeth R. Unger, MD, PhD; William C. Reeves, MD, MSc

Arch Gen Psychiatry. 2006;63:1258-1266.

Context  Chronic fatigue syndrome (CFS) is an important public health problem. The causes of CFS are unknown and effective prevention strategies remain elusive. A growing literature suggests that early adverse experience increases the risk for a range of negative health outcomes, including fatiguing illnesses. Identification of developmental risk factors for CFS is critical to inform pathophysiological research and devise targets for primary prevention.

Objective  To examine the relationship between early adverse experience and risk for CFS in a population-based sample of clinically confirmed CFS cases and nonfatigued control subjects.

Design, Setting, and Participants  A case-control study of 43 cases with current CFS and 60 nonfatigued controls identified from a general population sample of 56 146 adult residents from Wichita, Kan.

Main Outcome Measures  Self-reported childhood trauma (sexual, physical, and emotional abuse and emotional and physical neglect) and psychopathology (depression, anxiety, and posttraumatic stress disorder) by CFS status.

Results  The CFS cases reported significantly higher levels of childhood trauma and psychopathology compared with the controls. Exposure to childhood trauma was associated with a 3- to 8-fold increased risk for CFS across different trauma types. There was a graded relationship between the degree of trauma exposure and CFS risk. Childhood trauma was associated with greater CFS symptom severity and with symptoms of depression, anxiety, and posttraumatic stress disorder. The risk for CFS conveyed by childhood trauma increased with the presence of concurrent psychopathology.

Conclusions  This study provides evidence of increased levels of multiple types of childhood trauma in a population-based sample of clinically confirmed CFS cases compared with nonfatigued controls. Our results suggest that childhood trauma is an important risk factor for CFS. This risk was in part associated with altered emotional state. Studies scrutinizing the psychological and neurobiological mechanisms that translate childhood adversity into CFS risk may provide direct targets for the early prevention of CFS.

Author Affiliations: Viral Exanthems and Herpesvirus Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention (Drs Heim, Wagner, Maloney, Jones, Unger, and Reeves and Ms Solomon), and Departments of Psychiatry and Behavioral Sciences (Dr Heim) and Medicine (Dr Papanicolaou), Emory University School of Medicine, Atlanta, Ga. Dr Papanicolaou is now with Merck & Co, Inc, Rahway, NJ; Ms Solomon is now with the Human Research Protection Office, Office of the Chief Science Officer, Centers for Disease Control and Prevention.

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