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

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. 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 I2 statistic and Egger's tests were conducted for publication bias. 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 %, I2 = 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, I2 = 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. 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.