Chronotype and the Big-Five personality traits as predictors of chronic fatigue among patients with sarcoidosis. A cross-sectional study

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Łukasz Mokros
Joanna Miłkowska-Dymanowska
Łukasz Gwadera
Tadeusz Pietras
Wojciech Piotrowski


Fatigue Assessment Scale (FAS), Conscientiousness, Morning affect


Background. Sarcoidosis may seriously hamper patients’ quality of life despite fairly good prognosis.

Objectives. To assess the relationship between the Big Five personality traits, chronotype and severity of fatigue symptoms, in the context of selected clinical variables and general mental health among patients with sarcoidosis.

Methods. The study group comprised 60 patients with a confirmed diagnosis of sarcoidosis. They were asked to share relevant clinical data and complete a set of questionnaires: Fatigue Asessment Scale (FAS), General Health Questionnaire (GHQ-28), the NEO Five Factor Inventory and Composite Scale of Morningness.

Results. In linear regression analysis, FAS score was predicted by female sex, active sarcoidosis status, Morning Affect and Conscientiousness. In principal component analysis, FAS score and all GHQ-28 subscale scores (somatic symptoms, anxiety/insomnia, social dysfunction and depressive symptoms) formed a single component explaining 60% of variance. The factor loading for each variable exceeded 0.6.

Conclusions. The psychological burden appeared to rise with the severity of the fatigue, regardless the inactive/active phase of sarcoidosis. The severity of fatigue may be linked to patient’s poor morning affect. The profile of psychological burden presented by the patients may be associated with their personality and clinical presentation of sarcoidosis.


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[1] Valeyre D, Prasse A, Nunes H, et al. Sarcoidosis. Lancet (London, England). 2014;383:1155–1167.
[2] Baughman RP, Culver DA, Judson MA. A Concise Review of Pulmonary Sarcoidosis. American Journal of Respiratory and Critical Care Medicine. 2011;183:573–581.
[3] Hinz A, Fleischer M, Brähler E, et al. Fatigue in patients with sarcoidosis, compared with the general population. General hospital psychiatry. 2011;33:462–468.
[4] Górski W, Mokros Ł, Kumor-Kisielewska A, et al. The utility of selected questionnaires in the assessment of fatigue, depression and health quality in post-sarcoidosis fatigue syndrome. Advances in Respiratory Medicine. 2017;85:313–321.
[5] Górski W, Piotrowski WJ. Fatigue syndrome in sarcoidosis. Pneumonologia i alergologia polska. 2016;84:244–250.
[6] de Kleijn WPE, Drent M, De Vries J. Nature of fatigue moderates depressive symptoms and anxiety in sarcoidosis. British Journal of Health Psychology. 2013;18:439–452.
[7] Sharp M, Brown T, Chen E, et al. Psychological burden associated with worse clinical outcomes in sarcoidosis. BMJ Open Respiratory Research. 2019;6:1–8.
[8] Elfferich MDP, De Vries J, Drent M. Type D or “distressed” personality in sarcoidosis and idiopathic pulmonary fibrosis. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG. 2011;28:65–71.
[9] Korenromp IHE, Grutters JC, van den Bosch JMM, et al. Post-inflammatory fatigue in sarcoidosis: personality profiles, psychological symptoms and stress hormones. Journal of psychosomatic research. 2012;72:97–102.
[10] Adan A, Archer SN, Hidalgo MP, et al. Circadian Typology: A Comprehensive Review. Chronobiology International [Internet]. 2012;29:1153–1175. Available from:
[11] Jankowski KS, Díaz-morales JF, Vollmer C, et al. Morningness – eveningness and sociosexuality : Evening females are less restricted than morning ones. Personality and Individual Differences. 2014;68:13–17.
[12] Caci H, Adan A, Bohle P, et al. Transcultural properties of the Composite Scale of Morningness: the relevance of the “morning affect” factor. Chronobiology International. 2005;22:523–540.
[13] Au J, Reece J. The relationship between chronotype and depressive symptoms: A meta-analysis. Journal of Affective Disorders [Internet]. 2017;218:93–104. Available from:
[14] Chrobak AA, Nowakowski J, Zwolińska-Wcisło M, et al. Associations between chronotype, sleep disturbances and seasonality with fatigue and inflammatory bowel disease symptoms. Chronobiology international. 2018;35:1142–1152.
[15] Crouser ED, Maier LA, Baughman RP, et al. Diagnosis and Detection of Sarcoidosis An Official American Thoracic Society Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine. 2020;201:E26–E51.
[16] American Thoracic Society. Statement on Sarcoidosis. American Journal of Respiratory and Critical Care Medicine. 1999;160:736–755.
[17] Anastasi A, Urbina S. Psychological Testing [Internet]. Upper Saddle River, New Jersey: Prentice Hall; 1997. Available from:
[18] de Vries J, Michielsen H, Van Heck GL, et al. Measuring fatigue in sarcoidosis: The Fatigue Assessment Scale (FAS). British Journal of Health Psychology. 2004;9:279–291.
[19] World Association for Sarcoidosis and Other Granulomatous Diseases. Fatigue Assessment Scale (FAS) [Internet]. Available from:
[20] Zawadzki B, Strelau J, Szczepaniak P, et al. Inwentarz osobowosści NEO-FFI Costy i McCrae – Podręcznik. Warszawa: Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego; 1998.
[21] Smith CS, Reilly C, Midkiff K. Evaluation of three circadian rhythm questionnaires with suggestions for an improved measure of morningness. Journal of Applied Psychology. US: American Psychological Association; 1989. p. 728–738.
[22] Jankowski KS. Composite Scale of Morningness: Psychometric properties, validity with Munich ChronoType Questionnaire and age/sex differences in Poland. European Psychiatry [Internet]. 2015;30:166–171. Available from:
[23] Goldberg D, Williams P. A User’s Guide to the General Health Questionnaire. London: GL Assessment Ltd.; 2006.
[24] Makowska Z, Merecz D. Polska adaptacja kwestionariuszy ogólnego stanu zdrowia Davida Goldberga: GHQ-12 i GHQ-28. Ocena zdrowia psychicznego na podstawie badań kwestionariuszami Davida Goldberga Podręcznik dla użytkowników kwestionariuszy GHQ-12 i GHQ-28. Łódź: Oficyna Wydawnicza Instytut Medycy Pracy im. prof. J. Nofera; 2001.
[25] Groll DL, To T, Bombardier C, et al. The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology [Internet]. 2005;58:595–602. Available from:
[26] Bartram B. Using questionnaires. In: Lambert M, editor. Practical Research Methods in Education: An Early Researcher’s Critical Guide. Abingdon, Oxford: Routledge; 2019. p. 1–11.
[27] Jung S. Exploratory factor analysis with small sample sizes: a comparison of three approaches. Behavioural processes [Internet]. 2013/03/26. 2013;97:90–95. Available from:
[28] Strickhouser JE, Zell E, Krizan Z. Does personality predict health and well-being? A metasynthesis. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2017;36:797–810.
[29] Tanaka M, Mizuno K, Fukuda S, et al. Personality and fatigue in medical students. Psychological reports. 2010;106:567–575.
[30] Fernández-Muñoz JJ, Morón-Verdasco A, Cigarán-Méndez M, et al. Disability, quality of life, personality, cognitive and psychological variables associated with fatigue in patients with multiple sclerosis. Acta neurologica Scandinavica. 2015;132:118–124.
[31] Cho PSP, Vasudevan S, Maddocks M, et al. Physical Inactivity in Pulmonary Sarcoidosis. Lung. 2019;197:285–293.
[32] Sutin AR, Stephan Y, Luchetti M, et al. The five-factor model of personality and physical inactivity: A meta-analysis of 16 samples. Journal of Research in Personality. 2016;63:22–28.
[33] Jeon HJ, Bang YR, Park HY, et al. Differential effects of circadian typology on sleep-related symptoms, physical fatigue and psychological well-being in relation to resilience. Chronobiology international. 2017;34:677–686.
[34] Bauducco S, Richardson C, Gradisar M. Chronotype, circadian rhythms and mood. Current Opinion in Psychology. 2020;34:77–83.
[35] Merikanto I, Suvisaari J, Lahti T, et al. Eveningness relates to burnout and seasonal sleep and mood problems among young adults. Nordic Journal of Psychiatry. 2016;70:72–80.
[36] Leger KA, Charles ST, Fingerman KL. Affect variability and sleep: Emotional ups and downs are related to a poorer night’s rest. Journal of psychosomatic research. 2019;124:109758.
[37] Holas P, Kowalski J, Dubaniewicz A, et al. Relationship of emotional distress and physical concerns with fatigue severity in sarcoidosis. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG. 2018;35:160–164.
[38] Bosse-Henck A, Wirtz H, Hinz A. Subjective sleep quality in sarcoidosis. Sleep medicine. 2015;16:570–576.
[39] Hendriks CMR, Saketkoo LA, Elfferich MDP, et al. Sarcoidosis and Work Participation: The Need to Develop a Disease-Specific Core Set for Assessment of Work Ability. Lung. 2019;197:407–413.
[40] Gerke AK, Judson MA, Cozier YC, et al. Disease burden and variability in sarcoidosis. Annals of the American Thoracic Society. 2017;14:S421–S428.
[41] Hendriks C, Drent M, De Kleijn W, et al. Everyday cognitive failure and depressive symptoms predict fatigue in sarcoidosis: A prospective follow-up study. Respiratory Medicine. 2018;138:S24–S30.
[42] Finsterer J, Mahjoub SZ. Fatigue in healthy and diseased individuals. The American journal of hospice & palliative care. 2014;31:562–575.
[43] American Psychiatric Association. Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition. VA, United States: American Psychiatric Association Publishing; 2013.
[44] Bunevicius A, Brozaitiene J, Stankus A, et al. Specific fatigue-related items in self-rating depression scales do not bias an association between depression and fatigue in patients with coronary artery disease. General hospital psychiatry. 2011;33:527–529.
[45] Corfield EC, Martin NG, Nyholt DR. Co-occurrence and symptomatology of fatigue and depression. Comprehensive Psychiatry. 2016;71:1–10.
[46] Talarowska ME, Kowalczyk M, Maes M, et al. Immune to happiness - inflammatory process indicators and depressive personality traits. Archives of Medical Science. 2020;16:848–857.
[47] Dennis PA, Weinberg JB, Calhoun PS, et al. An investigation of vago-regulatory and health-behavior accounts for increased inflammation in posttraumatic stress disorder. Journal of psychosomatic research. 2016;83:33–39.
[48] Smith KJ, Au B, Ollis L, et al. The association between C-reactive protein, Interleukin-6 and depression among older adults in the community: A systematic review and meta-analysis. Experimental Gerontology. 2018;102:109–132.
[49] Seiler A, Murdock KW, Fagundes CP. Impaired mental health and low-grade inflammation among fatigued bereaved individuals. Journal of psychosomatic research. 2018;112:40–46.
[50] Rubio-Rivas M, Franco J, Corbella X. Sarcoidosis presenting with and without Löfgren’s syndrome: Clinical, radiological and behavioral differences observed in a group of 691patients. Joint bone spine. 2020;87:141–147.
[51] Hinz A, Brähler E, Möde R, et al. Anxiety and depression in sarcoidosis: the influence of age, gender, affected organs, concomitant diseases and dyspnea. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG. 2012;29:139–146.