Thus far no epidemiological study has been conducted in the general population. Merikangas and Angst (3!> studied a cohort of young adults from a community sample in Zurich, Switzerland, and reported the prevalence of neurasthenia, defined according to the ICD-10 criteria, as 1 per cent across 10 years. The sex ratio across the 10 years of follow-up revealed an equal prevalence among males and females during the initial stages of the study, but females exhibited a l.6-fold greater rate than males during the later stages.

The World Health Organization (WHO) international study(32) of patients with psychological problems seen in primary-care settings reported a prevalence of 1.7 per cent of pure neurasthenia. The prevalence rate increased to 5.4 per cent when the syndrome was diagnosed comorbid with depression or anxiety. The prevalence rate in each centre is shown in Table 1.

Table 1 Prevalence of neurasthenic syndrome among patients contacting general health-care facilities

The differences in the prevalence rate can be due to many factors, including perception of what health services can treat and the existence of alternative sources of care. However, the relatively low prevalence rate in Japan and China compared with other countries seems to stand conventional wisdom on its head.

In agreement with the findings of Merikangas and Angst, (31> the WHO results(32> also point to the fact that the syndrome tends to affect younger patients. The WHO study reported that the majority of the patients were below the age of 45 years.

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