Prevalence and associations of fatigue in psychosis: A systematic review and meta-analysis

TY - JOUR

T1 - Prevalence and associations of fatigue in psychosis

T2 - A systematic review and meta-analysis

AU - Poole-Wright, Kim

AU - Patel, Aakash

AU - Gaughran, Fiona

AU - Murray, Robin

AU - Chalder, Trudie

N1 - Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.

PY - 2025/5

Y1 - 2025/5

N2 - BACKGROUND: There is increasing interest in fatigue in people with psychotic illnesses. This systematic review and meta-analysis reviewed the evidence concerning the prevalence of fatigue and associated factors in adults with psychotic illnesses.METHODS: Embase, PsycINFO, Medline and CINAHL were systematically searched for articles in English published between January 1946 to 9 October 2023. Inclusion criteria was 'fatigue' in adults (≥18 years old) with a confirmed ICD11 or DSM5 diagnosis of a psychotic disorder. Risk of bias was assessed with the JBI and the Newcastle-Ottawa Scale. Pooled proportions for fatigue with 95 % CI were calculated using random effects models. Heterogeneity was assessed using Cochran's Q and I 2 statistic and Egger's tests were conducted for publication bias. RESULTS: A total of 57 articles met the inclusion criteria and 7 articles (n = 1161 participants) were included for the meta-analysis of fatigue. Fatigue prevalence was 55 % (95 % CI: 37-71 %, I 2 = 94 %). A sensitivity analysis of the 6 studies using a valid scale (n = 711 participants) found a fatigue proportion of 59 % (95 % CI: 41-76, I 2 = 93 %). Eighteen studies (n = 4569 participants) were included for an analysis exploring the prevalence of antipsychotic-related fatigue, which was 20.5 % (95 % CI: 11-34 %). We found no significant difference in antipsychotic-related fatigue between studies using a valid scale (27 %, 95 % CI: 14-46, k = 7) and studies using a clinical interview (17 %, 95 % CI: 7-35 %, k = 11) p = 0.302. An Egger's test indicated no publication bias. Quality assessments for included studies revealed that 16 % were at low risk of bias, 9 % at high risk and 75 % at moderate risk. Reported associations with fatigue included sex, age, antipsychotics, distress and depression, sleep, and some negative symptoms. CONCLUSIONS: Our study revealed that a majority of people with psychosis experience fatigue. Antipsychotics, sex, and functioning may contribute to tiredness symptoms, but further research is needed.

AB - BACKGROUND: There is increasing interest in fatigue in people with psychotic illnesses. This systematic review and meta-analysis reviewed the evidence concerning the prevalence of fatigue and associated factors in adults with psychotic illnesses.METHODS: Embase, PsycINFO, Medline and CINAHL were systematically searched for articles in English published between January 1946 to 9 October 2023. Inclusion criteria was 'fatigue' in adults (≥18 years old) with a confirmed ICD11 or DSM5 diagnosis of a psychotic disorder. Risk of bias was assessed with the JBI and the Newcastle-Ottawa Scale. Pooled proportions for fatigue with 95 % CI were calculated using random effects models. Heterogeneity was assessed using Cochran's Q and I 2 statistic and Egger's tests were conducted for publication bias. RESULTS: A total of 57 articles met the inclusion criteria and 7 articles (n = 1161 participants) were included for the meta-analysis of fatigue. Fatigue prevalence was 55 % (95 % CI: 37-71 %, I 2 = 94 %). A sensitivity analysis of the 6 studies using a valid scale (n = 711 participants) found a fatigue proportion of 59 % (95 % CI: 41-76, I 2 = 93 %). Eighteen studies (n = 4569 participants) were included for an analysis exploring the prevalence of antipsychotic-related fatigue, which was 20.5 % (95 % CI: 11-34 %). We found no significant difference in antipsychotic-related fatigue between studies using a valid scale (27 %, 95 % CI: 14-46, k = 7) and studies using a clinical interview (17 %, 95 % CI: 7-35 %, k = 11) p = 0.302. An Egger's test indicated no publication bias. Quality assessments for included studies revealed that 16 % were at low risk of bias, 9 % at high risk and 75 % at moderate risk. Reported associations with fatigue included sex, age, antipsychotics, distress and depression, sleep, and some negative symptoms. CONCLUSIONS: Our study revealed that a majority of people with psychosis experience fatigue. Antipsychotics, sex, and functioning may contribute to tiredness symptoms, but further research is needed.

KW - Humans

KW - Fatigue/epidemiology

KW - Psychotic Disorders/epidemiology

KW - Prevalence

U2 - 10.1016/j.schres.2025.03.027

DO - 10.1016/j.schres.2025.03.027

M3 - Article

C2 - 40174485

SN - 0920-9964

VL - 279

SP - 59

EP - 70

JO - Schizophrenia Research

JF - Schizophrenia Research

ER -