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Factors Contributing to Chronic Fatigue After Traumatic Brain Injury

Schnieders, Jessica MD; Willemsen, Dennis MD; de Boer, Hans MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: November/December 2012 - Volume 27 - Issue 6 - p 404–412
doi: 10.1097/HTR.0b013e3182306341
Original Articles

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.

Department of Rehabilitation, Waterland Hospital, Purmerend (Dr Schnieders) and Department of Internal Medicine, Rijnstate Hospital, Arnhem (Drs Willemsen and de Boer), The Netherlands.

Corresponding Author: Jessica Schnieders, MD, Department of Rehabilitation Medicine, Waterland Hospital, Waterlandlaan 250, 1441 RN Purmerend, The Netherlands (

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.