Chronic Fatigue & Ethnicity

Lead Research Organisation: Queen Mary, University of London
Department Name: Unlisted

Abstract

This study investigates fatigue and chronic fatigue like illnesses in six ethnic groups. Previous studies show that chronic fatigue related illnesses are uncommon among ethnic groups. Studies in the US show a higher prevalence of fatigue and associated illnesses among ethnic groups. In the UK we have inadequate information on the largest ethnic groups.
If there are ethnic variations in prevalence, then risk factors may differ across groups, and this may give us clues about how fatigue and related illnesses are influenced by cultural factors, or whether they can be understood as a response to cultural adaptation, isolation, or other stressors such as discrimination. We can also find out if the frequency of service use, and personal explanations that people give for their condition, influence the likelihood of having a fatigue related illness. Therefore, at the moment, we do not know whether the interventions offered should be changed for ethnic groups, or whether ethnic groups present with similar syndromes that are just not recognized, perpetuating disability and a lack of timely intervention. We also do not know whether there are cultural rather than social factors that are neglected, not only in ethnic groups, but also in majority population. For example, coping behaviours such as social support, or exercise, or leisure activities, or religious activities may help some ethnic groups to reduce their risk of fatigue like illness. Findings such as this may help refine or develop future interventions.
The study we propose exploits data that is already collected and is available for further analysis. It is deposited in a data archive which is accessible to the public and research community. Therefore the costs of the work are minimized. We will be able to analyze these data to identify which social, and cultural risk factors are influential related to having fatigue like illnesses, and to common mental health problems. The risk factors can be discerned from the statistical analyses, from the qualitative interviews and transcripts, and from questions about what the subject thought was the cause of fatigue: amongst the explanations is exercise, medication, illness etc. We therefore have a personal view from the subject, alongside statistical information to assess relevance of specific risk factors.

Technical Summary

Chronic fatigue syndrome (CFS) causes significant disability. Early work suggested that CFS was more common in Caucasians than other ethnic groups; recent research casts doubt on this. The Ethnic Minorities Psychiatric Illness Rates in the Community study (EMPIRIC) provides a unique opportunity to answer this question. It included population samples of six ethnic groups: Black Caribbean (N=694), Irish (733), Indian (643), Pakistani (724), Bangladeshi (650), and White British (837). Questions assessed physical health, common mental disorders (CIS-R), physical function (SF-12), emotional strain, social support, work stress, coping and health service use. Ten questions about fatigue assessed duration, intensity, and effort to overcome fatigue; from these a CFS-like illness can be defined. A qualitative component assessed illness models and coping behaviours. The proposed two year quantitative and qualitative investigation of EMPIRIC data will assess ethnic variations of the prevalence of a CFS-like illness, associations with potential risk factors, and coping behaviours.

Publications

10 25 50
 
Title A new dataset linking data from HSE and the EMPIRIC 
Description Linked HSE and EMPIRIC data, we are the only research group to successfully do this, and have data on ethnic groups linked to HSE. 
Type Of Material Database/Collection of Data/Biological Samples 
Provided To Others? No  
Impact Offers prospective analyses for ethnic group comparisons of health models of disease, and service use. 
 
Description Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Primary Audience Health professionals
Results and Impact I presented the findings of the reviews and the modelling at an international 2 day scientific meeting in Moscow. This was a joint meeting held between the World Association of Cultural Psychiatry and The Tomsk Research Institute along with RAMSCI scientists at their Oncological Institute in Moscow. Presentations included oncology, cardiology and psychiatry including liaison psychiatry. Led to much disussion of patient groups in the shaping of medical diagnosis. Findings of a higher risk of CFS among ethnic groups and possibly indigenous peoples was surprising to most of the audience, especially colleagues from the US.

Abstract published in Siberian Journal of Psychiatry and Addiction Psychiatry.
Year(s) Of Engagement Activity 2008
 
Description Presentation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Primary Audience Health professionals
Results and Impact Results of the project were presented to a national research seminar involving interdisciplinary discussion of the findings and studies in other areas

Audience became aware of the racial/cultural differences in the prevalence of CFS and discussion was very constructive
Year(s) Of Engagement Activity 2008
 
Description Presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Primary Audience Health professionals
Results and Impact Presentation of the results of the project to a London wide research institute including multiple disciplines.

Most people in the audience work with people with CFS. Audience became aware of the ethnic/cultural differences in expressions of CFS symptoms and were interested to discuss results even further with the researchers.
Year(s) Of Engagement Activity 2008
 
Description Publications 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? Yes
Primary Audience Health professionals
Results and Impact Two papers are under review,and one in the final stages of preparation. Reviews one paper have been positive and we expect acceptance.

Our work has led to scientific discussion of the basis of a higher risk of CFS in ethnic groups, and the distinction between CF and CFS, and also how little good population evidence actually exists. Also the data we have linked is invaluable as the largest population survyey of ethnic groups with linkage to HSE data. We are preparing applications for CFS and studies of cardiac risk factors for depression and CFS in a large population. Only this linked data base offers such a large sample to test specific hypotheses.
Year(s) Of Engagement Activity 2008
 
Description Resonse to MRC FOI request 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Primary Audience Policymakers/parliamentarians
Results and Impact A response to FOI activity, lead to the answer, and the lay and scientific abstract being loaded onto international websites for patients and the public interested in CFS/ME.

This has not lead to disquiet, unexpectedly but has lead to our studies being awaited and further co-operation from charities to work further with us on future studies.
Year(s) Of Engagement Activity 2008