Pooling was not appropriate for CFS.In studies with control groups of patients without the symptom of tiredness , prevalence of somatic disease was identical to those complaining of tiredness .
Depression , however , was more frequent among those with tiredness .
Conclusions Serious somatic disease is rare in patients complaining of tiredness .
Since prevalence is similar in patients without tiredness , the association may not be causal .
Background Tiredness is one of the most frequent complaints in primary care .
Although often self-limiting and frequently associated with psychosocial stress , patients but also their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up .
We conducted a systematic review and meta- analysis of studies reporting on differential diagnosis of fatigue in primary care .
Generalized anxiety disorder and health care use.
OBJECTIVE To examine self-reported health care use and health care-seeking behaviour of patients meeting DSM-IV 's diagnostic criteria for generalized anxiety disorder ( GAD ) . DESIGN Survey of out patients recruited at three different times of the day  using question naires on worry and anxiety ( a six-item screening question naire based on DSM-IV criteria for GAD ) , on perceived health problems , and on health care use and health care-seeking behaviour . The assessment package also included well vali date d assessment instruments for insomnia and depression symptoms .  All patients seeking health care were invited to participate . Participants completed the survey as they waited in the reception area . SETTING Four r and omly selected community-based medical clinics of Quebec city 's metropolitan area . PARTICIPANTS A final sample of 1110 patients among 1878 out patients invited to participate included 219 ( 19.7 % ) who tested positive for GAD . MAIN OUTCOME MEASURES Self-reported worry and anxiety ( based on DSM-IV criteria for GAD ) , self-perceived health problems , health care use and health care-seeking behaviour , insomnia , and symptoms of depression . RESULTS Participants who tested positive on a screening test for GAD reported more annual medical visits ( 5.3 versus 3.4 ) than other patients . Those who reported at least five annual medical visits were nearly four times more likely to have positive results for GAD . Women were 1.6 times more likely to have positive results than men were . Patients who tested positive reported insomnia-type sleep disturbances , depressive symptoms , fatigue , and gastric problems significantly more often than others . Forty-two percent had consulted a family physician in the past year with a complaint of anxiety . Eighty percent of patients who tested positive reported they believed they had an anxiety problem , and this belief predicted positive test results ( odds ratio = 20.3 ) . Yet most reported not having sought other types of medical or psychological care specifically for anxiety in the past year . CONCLUSION Some patients in this sample with symptoms of GAD mainly seek primary care for their symptoms . Questions about excessive worrying and anxiety , as part of routine examination , can increase recognition of GAD
Pooling was not appropriate for CFS.In studies with control groups of patients without the symptom of tiredness , prevalence of somatic disease was identical to those complaining of tiredness .
Depression , however , was more frequent among those with tiredness .
Conclusions Serious somatic disease is rare in patients complaining of tiredness .
Since prevalence is similar in patients without tiredness , the association may not be causal .
Background Tiredness is one of the most frequent complaints in primary care .
Although often self-limiting and frequently associated with psychosocial stress , patients but also their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up .
We conducted a systematic review and meta- analysis of studies reporting on differential diagnosis of fatigue in primary care .