Symptom clusters and symptom network characteristics in chronic fatigue syndrome patients: a cross-sectional study
- 1School of Nursing, Zhejiang Chinese Medical University , , ,
- 2Department of Nursing, The First Affiliated Hospital, Zhejiang Chinese Medical University , , ,
Abstract
Background: Chronic fatigue syndrome is characterized by multiple co-occurring physical, cognitive, sleep, and emotional symptoms. Traditional symptom cluster analysis identifies patterns of symptom co-occurrence but does not clarify the relative importance of individual symptoms or the connections between symptom clusters. Symptom network analysis may complement this approach by identifying core and bridge symptoms.
Objective: To investigate the symptom clusters and structural characteristics of symptom networks in patients with chronic fatigue syndrome, thereby providing a basis for developing targeted strategies for managing symptoms.
Methods: A convenience sampling method was used to enroll 214 patients with chronic fatigue syndrome. Data were collected using a demographic questionnaire and an adapted version of the Chinese Memorial Symptom Assessment Scale. Data were analyzed using SPSS 27.0. Symptom clusters were extracted using principal component analysis (PCA) with varimax rotation, and a symptom network was constructed in R to calculate expected influence and bridge expected influence, thereby identifying core and bridge symptoms.
Results: The three most common symptoms, in descending order, were fatigue (100.00%), difficulty concentrating (90.7%), and feeling drowsy (86.9%). A total of six symptom clusters were identified: Emotional-Sleep Symptom cluster, Fatigue Symptom cluster, Physical symptom cluster, Self-Image symptom cluster, Gastrointestinal symptom cluster, and Neurological symptom cluster, with a cumulative variance contribution of 63.114%. Fatigue had the highest expected influence (rEI = 1.541), followed by worrying (rEI = 1.169); fatigue (rbEI = 0.430), pain (rbEI = 0.363), and difficulty sleeping (rbEI = 0.309) were the primary bridge symptoms.
Conclusion: Patients with chronic fatigue syndrome exhibit co-occurring symptoms and connections across symptom clusters. Fatigue serves as both a core symptom and a bridging symptom, while worrying, difficulty sleeping, and pain are also critical areas of focus in symptom management. Clinically, fatigue should be prioritized for assessment and management, while concurrently conducting comprehensive evaluations of mood, sleep, and pain. Individualized management plans should be developed based on the characteristics of symptom clusters and symptom networks to alleviate the symptom burden in patients with chronic fatigue syndrome and improve their quality of life.
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BibTeX
@article{zi2026symptom,
title = {{Symptom clusters and symptom network characteristics in chronic fatigue syndrome patients: a cross-sectional study}},
author = {Aiqun Zi and Yihan Zhang and Min Sun and Ting Liu and Yan Xu and Min Xu},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1955021},
url = {https://europepmc.org/article/PMC/PMC13727641},
note = {CC BY},
}
RIS
TY - JOUR
TI - Symptom clusters and symptom network characteristics in chronic fatigue syndrome patients: a cross-sectional study
AU - Aiqun Zi
AU - Yihan Zhang
AU - Min Sun
AU - Ting Liu
AU - Yan Xu
AU - Min Xu
PY - 2026
DA - 2026/10/20
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1955021
UR - https://europepmc.org/article/PMC/PMC13727641
AB - Background: Chronic fatigue syndrome is characterized by multiple co-occurring physical, cognitive, sleep, and emotional symptoms. Traditional symptom cluster analysis identifies patterns of symptom co-occurrence but does not clarify the relative importance of individual symptoms or the connections between symptom clusters. Symptom network analysis may complement this approach by identifying core and bridge symptoms. Objective: To investigate the symptom clusters and structural characteristics of symptom networks in patients with chronic fatigue syndrome, thereby providing a basis for developing targeted strategies for managing symptoms. Methods: A convenience sampling method was used to enroll 214 patients with chronic fatigue syndrome. Data were collected using a demographic questionnaire and an adapted version of the Chinese Memorial Symptom Assessment Scale. Data were analyzed using SPSS 27.0. Symptom clusters were extracted using principal component analysis (PCA) with varimax rotation, and a symptom network was constructed in R to calculate expected influence and bridge expected influence, thereby identifying core and bridge symptoms. Results: The three most common symptoms, in descending order, were fatigue (100.00%), difficulty concentrating (90.7%), and feeling drowsy (86.9%). A total of six symptom clusters were identified: Emotional-Sleep Symptom cluster, Fatigue Symptom cluster, Physical symptom cluster, Self-Image symptom cluster, Gastrointestinal symptom cluster, and Neurological symptom cluster, with a cumulative variance contribution of 63.114%. Fatigue had the highest expected influence (rEI = 1.541), followed by worrying (rEI = 1.169); fatigue (rbEI = 0.430), pain (rbEI = 0.363), and difficulty sleeping (rbEI = 0.309) were the primary bridge symptoms. Conclusion: Patients with chronic fatigue syndrome exhibit co-occurring symptoms and connections across symptom clusters. Fatigue serves as both a core symptom and a bridging symptom, while worrying, difficulty sleeping, and pain are also critical areas of focus in symptom management. Clinically, fatigue should be prioritized for assessment and management, while concurrently conducting comprehensive evaluations of mood, sleep, and pain. Individualized management plans should be developed based on the characteristics of symptom clusters and symptom networks to alleviate the symptom burden in patients with chronic fatigue syndrome and improve their quality of life.
SN - 2296-858X
ER -