Fatigue and psychological distress in the working population: Psychometrics, prevalence, and correlates
Introduction
Community and primary care studies have repeatedly shown that fatigue is a common complaint [1], [2], [3], [4], [5], [6], and that fatigue may accompany physical [1] as well as psychiatric disorders [1], [5], [7]. Fatigue that becomes prolonged is reported to be associated with impairments comparable to chronic medical conditions [7], and may affect the individual's performance and functioning in the occupational as well as in the home setting.
The concept and the assessment of fatigue have been subjects of controversy for many years [8], [9], and there are still more questions than answers with respect to the status of fatigue. For example, is fatigue conceptually, operationally, and etiologically distinct from psychological distress, or is the overlap between the two constructs so large as to throw in doubt the usefulness of having two separate concepts? Is the natural history of the two different? Are different prevention and treatment strategies applicable? At present, these questions cannot be adequately answered. We do know that studies conducted in the general population [3] and in the primary care setting [5] have shown that fatigue is associated with psychological distress, with observed correlations of .62 and .51. However, the relationship between fatigue and psychological distress may vary across different populations. With respect to the working population, previous research of fatigue and psychological distress was restricted to a specific occupational setting [10], with an observed correlation of .54. Hence, one key issue is whether the available measures of fatigue and the existing measures of psychological distress assess highly similar or sufficiently different underlying concepts in the general working population.
The Maastricht Cohort Study of “Fatigue at work” contributes to this research field with a large-scale epidemiological study in a heterogeneous working sample, in which not only the etiological factors in the onset and natural history of fatigue and psychological distress will be investigated but also the measures of fatigue and psychological distress and the constructs themselves will be examined. Within the Maastricht Cohort Study, fatigue is measured with the self-report Checklist Individual Strength (CIS) [11], [12], [13]. The General Health Questionnaire (GHQ) is used to assess psychological distress [14], [15].
In the present study, we used the baseline data from the Maastricht Cohort Study to describe the relationship between fatigue and psychological distress in the working population, to examine associations with demographic and health factors, and to determine the prevalence of fatigue and psychological distress.
Section snippets
Study population
In May 1998, a total of 26,978 male and female employees, aged 18–65 years, from 45 Dutch companies and organizations received a letter at home inviting participation and the baseline questionnaire. The letter explained the purpose and the general outline of the cohort study, described how the data would be used, and guaranteed anonymity of responses. The voluntary nature of participation was emphasized. Nonrespondents received a written reminder 2 weeks later. After 6 weeks, a random sample of
Distribution of fatigue and psychological distress in the working population
A total of 236 CIS questionnaires were excluded because of more than four items missing. The mean CIS total score in the 11,859 complete questionnaires was 57.2 (S.D. 23.7). As shown in Fig. 1, CIS total scores had a continuous distribution, ranging from 20 to 140. Overall, 113 GHQ's were excluded because of more than three items missing. The mean GHQ score in the 11,982 complete questionnaires was 11.6 (S.D. 5.4), with scores from 0 to 36. Similar to fatigue, a continuous distribution was
Discussion
The present study showed that fatigue is continuously distributed in the working population and fairly well associated with psychological distress (r=.62). As other authors of community and primary care studies [2], [3], [6], we found some degree of fatigue in nearly all of the working populations. It has to be noted, however, that while reasonably distributed, there was an excess of the lowest possible fatigue scores, with a small percentage (2%) completely free of symptoms of fatigue (or
Acknowledgements
The Maastricht Cohort Study is part of the Netherlands concerted research action on “Fatigue at work” granted by The Netherlands Organisation for Scientific Research (NWO). The work presented in this paper was and is currently supported by The Netherlands Organisation for Scientific Research (NWO grant no. 580-02.251). We thank Dr. Helga van den Elzen for initiating and establishing this project and Jos Slangen for his work in data management.
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