Differential associations between fatigue and psychobiological stress measures in women with depression and women with somatic symptom disorder

Abstract

Objective: Medically unexplained fatigue is a burdensome, widespread symptom, and a frequent complaint in depressive disorders (DDs) as well as somatic symptom disorder (SSD). Heightened stress levels are a likely cause of fatigue, although the temporal associations, as well as the role of the stress-reactive hypothalamic-pituitary-adrenal (HPA) axis, are not yet completely understood. We were interested in the differences between DD and SSD regarding general, mental, and physical fatigue, as well as associations between psychobiological stress measures (representing different time frames) and fatigue in these groups.

Methods: Fifty-eight women (29 with DD, 29 with SSD) reported subjective recent fatigue and chronic stress levels, as well as levels of depression and somatic complaints using baseline questionnaires. Furthermore, they completed an ambulatory assessment period comprising measurements of fatigue, subjective stress, and salivary cortisol five times a day for 14 consecutive days. Salivary cortisol was obtained as a measure of within-day HPA axis activity, and hair cortisol concentration was obtained as a measure of accumulated HPA axis activity of the preceding three months.

Results: Women with DD reported higher levels of general and mental fatigue than did women with SSD, which was explained by their higher level of depression. Physical fatigue levels did not differ between groups. In both groups, momentary general, mental, and physical fatigue levels were associated with momentary subjective stress but not with chronic stress. Momentary salivary cortisol levels were positively associated with mental fatigue, while hair cortisol concentration was not.

Conclusions: There are differences in fatigue profiles between DD and SSD, which should be accounted for in future research and practice (e.g., individualized treatment strategies focusing on mental or physical fatigue, depending on which fatigue dimension is prominent).

Keywords: Ambulatory assessment; Cortisol; Depression; Fatigue; Somatic symptom disorder; Stress.