Fatigue, burnout, and chronic fatigue syndrome among employees on sick leave: do attributions make the difference?

M J H Huibers¹, A J H M Beurskens¹, J B Prins², IJ Kant¹, E Bazelmans², C P van Schayck³, J A Knottnerus³, G Bleijenberg²

¹ Department of Epidemiology, Maastricht University, Netherlands
² Department of Medical Psychology, UMC Nijmegen, Netherlands
³ Department of General Practice, Maastricht University, Netherlands

Correspondence to:
Correspondence to:
Dr M J H Huibers, Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands;
marcus.huibers{at}hag.unimaas.nl

Background: Persistent fatigue among employees, burnout, and chronic fatigue syndrome (CFS) are three fatigue conditions that share some characteristics in theory. However, these conditions have not been compared in empirical research, despite conceptual similarities.

Methods: This cross sectional study aimed to investigate relations between persistent fatigue, burnout, and CFS by describing the clinical features of a sample of 151 fatigued employees on sick leave. Using validated instruments, subgroups based on research criteria for CFS and burnout within the sample of fatigued employees and a reference group of 97 diagnosed CFS patients were compared. Analyses of covariance were performed.

Results: A total of 66 (43.7%) fatigued employees met research criteria for CFS (except symptom criteria) and 76 (50.3%) met research criteria for burnout. "CFS-like employees" (fatigued employees who met CFS criteria) reported stronger somatic attributions than "non-CFS-like employees". Burnt out CFS-like employees were more depressed and distressed than CFS-like employees who were not burnt out. Burnout cases among the non-CFS-like employees had stronger psychological attributions than fatigued employees who were not burnt out. Compared to diagnosed CFS patients, CFS-like employees merely had a shorter duration of fatigue complaints. Burnt out CFS-like employees had stronger psychological attributions and were more distressed than CFS patients.

Conclusions: Fatigued employees shared many important characteristics with CFS patients, regardless of burnout status, and many fatigued employees met CFS criteria and/or burnout criteria. Differences however concerned the causal attributions that were made. This raises questions about the role of causal attributions: are they modified by fatigue complaints or do they determine illness outcome?

Keywords: clinical features; work; fatigue; burnout; chronic fatigue syndrome; ANCOVA

Abbreviations: ANCOVA, analysis of covariance; BDI, Beck Depression Inventory; CAL, Causal Attributions List; CFS, chronic fatigue syndrome; CIS, Checklist Individual Strength; MBI-GS, Maslach Burnout Inventory-General Survey; OHS, occupational health service; SCL-90, Symptom Checklist 90; SF-36, Short Form Health Survey

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