Fatigue during the COVID-19 pandemic – prevalence and predictors: findings from a prospective cohort study

Abstract

The COVID-19 pandemic and consequent lockdowns had a substantial impact on mental health. Distress and fatigue are highly correlated. However, little is known about the determinants of fatigue in the general population during the pandemic. This study aimed to examine the prevalence and predictors of fatigue during the COVID-19 pandemic in the UK population. Online surveys were completed by a UK community cohort in April 2020 (wave 1), July-September 2020 (wave 2) and November-December 2020 (wave 3). In total, 3097 participants completed the wave 1 survey, and 1385 and 1087 participants (85.4% women) completed wave 2 and 3 surveys respectively. Fatigue was assessed using the Chalder Fatigue Scale at waves 2 and 3. Hair samples were provided by 827 participants (90.6% women) at wave 1 and wave 2, which were analyzed to indicate HairE (stress hormone). The mean total fatigue score during wave 2 was 14.7 (SD = 4.7), significantly higher than pre-pandemic levels observed in the community (mean difference 0.50, p = .003). At wave 2, 614 (44.3%) participants met the case definition for fatigue, only 15.6% of whom indicated that fatigue lasted for more than 6 months (suggesting it had started prior to the pandemic). Predictors of fatigue at wave 3 included being in a risk group, depression and belief in having COVID-19, which explained 23.8% of the variability in fatigue scores. Depression at wave 1 was the only significant predictor of remaining a fatigue case at wave 3. Fatigue was highly prevalent in the UK community during the COVID-19 pandemic and limited people’s daily function. Depression and sociodemographic variables were significant predictors of fatigue.

HIGHLIGHTS

• Fatigue levels between July-December 2020 were higher compared to pre-pandemic levels.

• Predictors of fatigue levels 7-8 months later included being a clinical risk group, depression and belief in having had COVID-19.

• HairE was not associated with fatigue.

• Depression was the only significant predictor of remaining a fatigue case.

Keywords:

• COVID-19 pandemic
• depression
• fatigue
• hair cortisone
• SARS-CoV-2
• stress hormone

Acknowledgements

For the purposes of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Accepted Author Manuscript version arising from this submission.

Author contributions

K.A., R.J., K.V., C.C. and T.C. contributed to the study design. K.A., R.J. and K.V. were responsible for coordination and management of recruitment. K.A. and M.K. conducted the statistical analysis. K.A., M.K., R.J., C.C., K.V. and T.C. interpreted the data. K.A. and M.K. drafted the first version of manuscript. R.J., C.C., K.V. and T.C. substantially contributed to revisions of the final manuscript.

Disclosure statement

TC is the author of self-help books on chronic fatigue for which she has received royalties; has received ad hoc payments for workshops carried out in long-term conditions; has received travel expenses and accommodation costs of attending Conferences; is in receipt of grants from Guy’s and St Thomas’ Charity, NIHR and UKRI.

Data availability statement

Data will be deposited in the University of Nottingham data archive. Access to this dataset will be embargoed for a period of 12 months to permit planned analyses of the dataset. Afterward, it may be shared with the consent of the Chief Investigator.

Additional information

Funding

KA was supported by funding from the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The views expressed are those of the author(s) and not necessarily those of the NIHR, the NHS or the Department of Health. TC and MK are supported by funding from Guy’s and St Thomas’ Charity. The views expressed are those of the author and not necessarily those of Guy’s and St Thomas’ Charity. RJ acknowledges support from the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research Center (BRC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. CC acknowledges support from the National Institute for Health Research (NIHR) Nottingham Biomedical Research Center. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. TC acknowledges the financial support of the Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Center for Mental Health award to the South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry at King’s College London.

Notes on contributors

Michail Kalfas

Michail Kalfas MSc, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK. Michael is interested in ­psychiatric conditions and in the interplay between physical and mental health.

Kieran Ayling

Kieran Ayling PhD, University of Nottingham, Nottingham, UK. Research interests: Interactions between psychological, behavioural, and biological factors as they pertain to health. Teaching: Kieran has supervised academic clinical fellows, MSc. Health Psychology project students and PhD students.

Ru Jia

Ru Jia PhD, Dr Ru Jia is a researcher working on behavioural interventions that help improve population health at the University of Oxford.

Carol Coupland

Carol Coupland PhD, University of Nottingham. Expertise: Medical statistics in primary care, statistical analysis of primary care research databases, design and analysis of epidemiological studies and cluster randomised trials.

Kavita Vedhara

Kavita Vedhara PhD. Health psychologist at Cardiff University with expertise in the inter-relationships between psychological factors and health and disease outcomes. Kavita’s research spans three main areas. The first is concerned with psychological influences on the body and this work has shown that negative moods such as stress and depression can make us more vulnerable to infections, including COVID19; can slow the healing of wounds, such as diabetic foot ulcers; and can also make vaccines work less well. The second area is concerned with psychological influences on behaviour and has explored the factors influencing people’s engagement with health interventions such as screening, mask wearing and vaccinations. The third area is concerned with interventions and how we can ‘harness’ the power of these psychological influences to improve the health and well-being of patients and the public.

Trudie Chalder

Trudie Chalder PhD, King’s College London. Research interests: Epidemiological and aetiological studies of fatigue and distress in adolescents and adults with long term conditions; evaluating efficacy of CBT.