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Atasoy, Seryan; Sattel, Heribert; Hausteiner-Wiehle, Constanze; Rückert-Eheberg, Ina-Maria; Linkohr, Birgit; Heier, Margit; Ladwig, Karl-Heinz; Peters, Annette ORCID logoORCID: https://orcid.org/0000-0001-6645-0985 und Henningsen, Peter (2026): Risk factors for fatigue symptoms in the general population over 7 years: Findings from the Cooperative Health Research in the Region of Augsburg F4 and FF4 studies. In: Journal of Psychosomatic Research, Bd. 202, 112511 [PDF, 1MB]

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Abstract

Background: To examine sex-specific risk factors of elevated fatigue symptoms over 7 years in a large community cohort.

Methods: Data were drawn from 1700 adults (52.3 % women; mean age = 49.6 ± 9.4 years) participating in the KORA F4 study and its 7-year follow-up (FF4) in Augsburg, Germany. Fatigue symptoms (0-12) were assessed at both time points using four items from the Depression and Exhaustion Scale. Sex-stratified generalized estimating equation (GEE) models examined associations with sociodemographic, behavioural, medical (BMI, medical illness, hemoglobin, C-reactive protein, thyroid-stimulating hormone [TSH], Epstein-Barr virus), psychological (depression, anxiety, childhood trauma), and bodily distress factors (somatization, self-rated health, pain, sleep complaints).

Results: Women reported significantly higher fatigue levels than men at both assessments. Cross-sectionally, higher baseline fatigue was associated with physical inactivity, medical illness, and multiple psychological and bodily distress factors. Several associations differed descriptively by sex: psychological distress and medical utilization showed stronger links in women, whereas sociodemographic factors and selected biomarkers were more relevant in men. Longitudinally, fatigue levels were stable over the follow-up, with baseline fatigue emerging as the main predictor of subsequent fatigue (men: OR = 1.65[1.55-1.77]; women: OR = 1.72 [1.59-1.86]). Physical inactivity and somatization predicted fatigue in both sexes. Depression symptoms, childhood trauma, and lower TSH predicted fatigue only in women, whereas sleep complaints were uniquely predictive in men. Medical measures showed limited value.

Conclusion: Baseline fatigue was linked to behavioural, medical, and psychosocial risk profiles, while longitudinal analyses revealed distress and prior fatigue as the key predictors of elevated fatigue symptoms over time.

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