Somatic symptoms and fatigue in a Norwegian population with high exposure to ticks

Ticks Tick Borne Dis. 2019 Jan;10(1):156-161. doi: 10.1016/j.ttbdis.2018.09.012. Epub 2018 Oct 9.


Background: It is heavily debated whether tick-borne infections cause chronic subjective health complaints. If the hypothesis of a major causal connection is true, one would expect to find more subjective health complaints in a population with high exposure to ticks than in a population with less exposure. In the current study we aimed to assess somatic symptoms and fatigue in a Norwegian population with high exposure to ticks, compare our findings to normative data, and assess predictors of somatic symptom load.

Material and methods: All individuals aged 18-69 years with residential address in Søgne municipality in southern Norway were in the period June 2015 to June 2016 invited to participate in the study. Somatic symptoms were assessed by the Patient Health Questionnaire-15 (PHQ-15) and fatigue by the Fatigue Severity Scale (FSS). A multivariable regression analysis was performed to assess predictors of somatic symptom load.

Results: Out of 7424 invited individuals, 2971 (40.0%) returned the questionnaire. 85.1% of 2950 responders reported exposure to tick-bite. PHQ-15 mean sum score was 5.3, and 16.5% reported moderate to severe somatic symptom load (i.e. ≥ 10). FSS mean score was 3.2, and 29.8% scored above the cut-off value for fatigue (i.e. ≥ 4.0). All gender and age groups in our study population had equal or lower mean sum score on PHQ-15 than reported in Swedish normative data, and lower mean score on FSS than reported in Norwegian normative data. In multivariable regression the following factors were associated with higher somatic symptom load (listed in order of descending beta coefficient): Anxiety and depression, number of other diseases, female gender, younger age, recruitment when visiting general practitioner's office, ≤ 6 years education after primary school, tick-bite earlier in life, erythema migrans earlier in life, less physical activity, and modern health worries.

Conclusion: The study population reported high exposure to tick-bites, but less or equal level of somatic symptoms and less fatigue than found in normative data. There was a weak association between somatic symptom load and exposure to tick-bite and erythema migrans, possibly related to selection bias. Our findings do not support the hypothesis of a major causal connection between tick-borne infections and subjective health complaints.

Keywords: Fatigue; PHQ-15; Subjective health complaints; Tick-bite; Tick-borne infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Animals
  • Erythema Chronicum Migrans / epidemiology*
  • Erythema Chronicum Migrans / etiology
  • Fatigue / epidemiology*
  • Fatigue / etiology
  • Humans
  • Medically Unexplained Symptoms*
  • Middle Aged
  • Multivariate Analysis
  • Norway / epidemiology
  • Regression Analysis
  • Surveys and Questionnaires
  • Tick Bites / complications
  • Tick Bites / epidemiology*
  • Tick-Borne Diseases / complications
  • Tick-Borne Diseases / epidemiology*
  • Ticks / physiology*
  • Young Adult