'Physical or psychological?'– a comparative study of causal 
attribution for chronic fatigue in Brazilian and British primary care patients

Acta Psychiatr Scand. 2008 May 22. [Epub ahead of print]

Cho HJ [1], Bhugra D [2], Wessely S. [3]

Affiliations:
[1] Department of Psychiatry, Federal University of São Paulo, São 
Paulo, Brazil,
[2] Health Services Research Department, Institute of Psychiatry, 
King's College London, London and
[3] Department of Psychological Medicine, Institute of Psychiatry, 
King's College London, London, UK

Corresponding author: Dr Hyong Jin Cho, Department of Psychiatry, 
Federal University of São Paulo, Rua Botucatu 740, CEP 04023-900, São 
Paulo, Brazil.
E-mail: h.cho@iop.kcl.ac.uk

NLM Citation: PMID: 18498433


Abstract

Objective: Causal attribution influences symptom experience, 
help-seeking behaviour and prognosis in chronic fatigue syndrome. We 
compared causal attribution of patients with unexplained chronic 
fatigue (UCF) in Brazil and Britain.

Method: Primary care attenders in São Paulo (n = 3914) and London (n 
= 2459) were screened for the presence of UCF. Those with UCF (São 
Paulo n = 452; London n = 178) were assessed for causal attribution 
(physical vs. psychosocial), perceived chronicity (i.e. reported 
duration of fatigue) and disability.

Results: British UCF patients were more likely to attribute their 
fatigue to physical causes (adjusted odds ratio 1.70, P = 0.037) and 
perceived their fatigue to be more chronic (adjusted beta 0.15, P = 
0.002). There was no significant difference in current disability 
(adjusted beta ?0.01, P = 0.81).

Conclusion: Despite similar disability levels, UCF patients in 
different cultural settings presented different attributions and 
perceptions about their illness. Sociocultural factors may have an 
important role in shaping illness attribution and perception around 
chronic fatigue.