Factors contributing to chronic fatigue after traumatic brain injury

J Head Trauma Rehabil. 2012 Nov-Dec;27(6):404-12. doi: 10.1097/HTR.0b013e3182306341.


Background: The annual incidence of traumatic brain injury in Europe amounts to 235 per 100 000 persons. About two-thirds will develop posttraumatic brain injury chronic fatigue (pTBI-CF).

Aim: To identify the reversible hormonal and nonhormonal causes of pTBI-CF.

Patients and methods: Ninety patients with varying degrees of pTBI-CF underwent endocrine testing and an evaluation of sleep, attention, coping style, daily activity and dependency, physical performance, emotional well-being, and quality of life.

Results: Vitamin D deficiency was found in 65%, poor sleep quality in 54%, anxiety disorders in 36%, growth hormone deficiency in 16%, and gonadal hormone deficiencies in 9%. Fatigue severity was correlated with poor sleep (R = +0.65, P < .0001), serum 25-hydroxy vitamin D levels (R = -0.50, P < .0001), and anxiety (R = +0.50, P < .0001) but not with growth hormone deficiency or gonadal hormone deficiencies. The first 3 factors together explained 59% of the fatigue score variance.

Conclusions: Poor sleep, vitamin D deficiency, and anxiety were the most important factors associated with pTBI-CF. Appropriate treatment of these disorders may help to reduce fatigue in these patients.

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Anxiety Disorders / epidemiology
  • Attention
  • Brain Injuries / complications*
  • Chronic Disease
  • Fatigue / etiology*
  • Growth Hormone / metabolism
  • Humans
  • Male
  • Physical Fitness
  • Quality of Life
  • Risk Factors
  • Sleep Wake Disorders / epidemiology
  • Vitamin D Deficiency / epidemiology


  • Growth Hormone