Mental fatigue in individuals with psychiatric disorders: a scoping review

Figures & data

Table 1. Characteristics of selected studies.

Reference	Country	Study Design	Study population (Sample size, n)	Proportion of women (n [%])	Mean age ± standard deviation (Q1-Q3)	Mental Fatigue assessment tools	Mental Fatigue prevalence ± standard deviation (Q1-Q3)	Main Findings Regarding Mental Fatigue
Li et al., 2020	Australia	Cross-sectional	GAD (n = 18)	18 (100%)	19.55 ± 3.86	FES-11	7.67 ± 2.89 early-follicular 7.02 ± 2.45 mid-luteal	In the early follicular phase, mental fatigue was significantly higher in the GAD group compared with HC. Neither oestradiol nor progesterone were significant predictors of mental fatigue.
			HC (n = 20)	20 (100%)	20.95 ± 5.27		3.48 ± 2.10 early-follicular 5.85 ± 4.49 mid-luteal
Wessely and Powell, 1989	UK	Cross-sectional	Unexplained CFS (n = 47)	30 (63%)	37 (35.4-40.3)	Questionnaire constructed for the study (subjective aspects of fatigue, including physical and mental complaints)	5.84 (4.96-6.72)	Mental fatigue was prominent in the CFS and MDD groups, but less in the neuromuscular controls.
			Peripheral neuromuscular fatiguing illnesses (n = 33)	19 (57%)	47 (42.6-52.6)		2.42 (1.46-3.38)
			MDD (n = 26)	15 (56%)	45.04 (39.89-50.19)		5.5 (4.4-6.6)
Jiang et al., 2003	Japan	Cross-sectional	First-year students (n = 162)	120 (75%)	19.4 ± 3.30	FSC	1.0 ± 1.4	Trait and state anxiety had strong positive correlations with mental fatigue. Mental fatigue exhibited a positive correlation with the personality risk factors of harm avoidance and negative correlations with persistence, self-directedness, and cooperativeness
			Fifth-year students (n = 89)	44 (49%)	23.2 ± 1.19		1.3 ± 2.0
			Individuals with psychiatric disorders (n = 101)	66 (65%)	47.15 ± 15.59		4.5 ± 3.4
Kaiya et al., 2008	Japan	Cross-sectional	PD (n = 360)	247 (69%)	36.3 ± 9.6	MFI-20	11.3 ± 3.9	Mental fatigue was significantly higher in males with PD than in the HC group. Although females with PD showed no significant differences in mental fatigue levels when compared with HC.
			HC(n = 1004)	195 (19%)	37.7 ± 9.1		10.6 ± 3.1
Dritsa et al., 2009	Canada	Randomised controlled trial	Postpartum depression (n = 88)	35 (100%)	34.57 ± 3.36	MFI-20	14.52 ± 4.00	Postpartum depression results indicated that low physical fatigue, higher mental fatigue and more severe depressed mood show improvement in mental fatigue with home-based exercise.
				42 (100%)	32.67 ± 4.80		12.60 ± 4.54
Ferentinos et al., 2010	Greece	Cross-sectional	MDD (n = 81)	70 (86%)	48.6 ± 10.6	FQ-14	11.9 ± 3.6	FQ-14 had good internal consistency and test–retest reliability to measure mental fatigue within MDD.
			HC (n = 40)	31 (78%)	44.8 ± 13.2		5.5 ± 2.6
Pasquini et al., 2015	Italy	Cross-sectional	OCD (n = 50)	33 (66%)	29.5 (23.7-41.5)	MFI-20	10.0 (9.0-11.2)	Presence of mental fatigue was associated with lower odds of OCD compared with PD. Individuals with OCD and OCPD co-morbidity reported higher scores of mental fatigue than non-OCPD patients.
			PD (n = 50)	16 (32%)	33.5 (26.5-45.0)		13.0 (9.0-16.0)
Chung et al., 2014	China	Cross-sectional	MDD (n = 137)	109 (79.6%)	49.6 ± 9.6	MFI-20	13.62 ± 3,52	MFI-20 had good internal consistency and test–retest reliability to measure mental fatigue within MDD. Reduction of mental fatigue was associated with improvement on quality of life.
Carney et al., 2014	Canada	Cross-sectional	Insomnia and depression (n = 62)	40 (64.5%)	41.0 ± 11.7	MFI-20	15.10 ± 3.74	Cognitive factors for predicting mental fatigue symptoms severity for MDD and comorbid insomnia were unhelpful beliefs about sleep and symptom-focussed rumination.
Gecaite-Stonciene et al., 2020	Lithuania	Cross-sectional	AMD (n = 91)	66 (77.6%)	39.11 ± 11.2	MFI-20	15.9 ± 3.8	OCPD and mental fatigue had a significant association within individuals with comorbid AMD.

GAD: generalised anxiety disorder; HC: healthy controls; MDD: major depressive disorder; CFS: chronic fatigue syndrome; PD: panic disorder; OCD: obsessive-compulsive disorder; AMD: anxiety and mood disorders; FES-11: 11-item Fatigue and Energy Scale; FSC: Fatigue Symptom Checklist; MFI-20: 20-item Multidimensional Fatigue Inventory; FQ-14: 14-item Fatigue Questionnaire.

Figure 1. PRISMA-P 2009 Flow Chart of Study Selection. Query: (‘mental fatigue’ OR ‘mental tiredness’ OR ‘mental exhaustion’). Copyright: © 2009 Moher et al. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. PLoS Med 6(7):e1000097. doi: 10.1371/journal.pmed1000097.

Li, S. H., Lloyd, A. R., & Graham, B. M. (2020). Physical and mental fatigue across the menstrual cycle in women with and without generalised anxiety disorder. Hormones and Behavior, 118, 104667. doi:10.1016/j.yhbeh.2019.104667

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Wessely, S., & Powell, R. (1989). Fatigue syndromes: a comparison of chronic “postviral” fatigue with neuromuscular and affective disorders. Journal of Neurology, Neurosurgery, and Psychiatry, 52(8), 940–948. doi:10.1136/jnnp.52.8.940

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Jiang, N., Sato, T., Hara, T., Takedomi, Y., Ozaki, I., & Yamada, S. (2003). Correlations between trait anxiety, personality and fatigue. Journal of Psychosomatic Research, 55(6), 493–500. doi:10.1016/S0022-3999(03)00021-7

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Kaiya, H., Sugaya, N., Iwasa, R., & Tochigi, M. (2008). Characteristics of fatigue in panic disorder patients. Psychiatry and Clinical Neurosciences, 62(2), 234–237. doi:10.1111/j.1440-1819.2008.01760.x

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Dritsa, M., Dupuis, G., Lowensteyn, I., & Da Costa, D. (2009). Effects of home-based exercise on fatigue in postpartum depressed women: Who is more likely to benefit and why? Journal of Psychosomatic Research, 67(2), 159–163. doi:10.1016/j.jpsychores.2009.01.010

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Ferentinos, P., Kontaxakis, V., Havaki-Kontaxaki, B., Dikeos, D., & Papadimitriou, G. (2010). The Fatigue Questionnaire: Standardization in patients with major depression. Psychiatry Research, 177(1-2), 114–119. doi:10.1016/j.psychres.2009.01.029

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Pasquini, M., Piacentino, D., Berardelli, I., Roselli, V., Maraone, A., Tarsitani, L., & Biondi, M. (2015). Fatigue experiences among OCD outpatients. The Psychiatric Quarterly, 86(4), 615–624. doi:10.1007/s11126-015-9357-3

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Chung, K.-F., Yu, B. Y.-M., Yung, K.-P., Yeung, W.-F., Ng, T. H., & Ho, F. Y.-Y. (2014). Assessment of fatigue using the multidimensional fatigue inventory in patients with major depressive disorder. Comprehensive Psychiatry, 55(7), 1671–1678. doi:10.1016/j.comppsych.2014.06.006

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Carney, C. E., Moss, T. G., Lachowski, A. M., & Atwood, M. E. (2014). Understanding mental and physical fatigue complaints in those with depression and insomnia. Behavioral Sleep Medicine, 12(4), 272–289. doi:10.1080/15402002.2013.801345

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Gecaite-Stonciene, J., Fineberg, N. A., Podlipskyte, A., Neverauskas, J., Juskiene, A., Mickuviene, N., & Burkauskas, J. (2020). Mental fatigue, but not other fatigue characteristics, as a candidate feature of obsessive compulsive personality disorder in patients with anxiety and mood disorders: An exploratory study. International Journal of Environmental Research and Public Health, 17(21), 8132. doi:10.3390/ijerph17218132

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