Prevalence of functional disorders across Europe: a systematic review and meta-analysis

Study of Rates and Factors Associated to Psychosomatic Syndromes Assessed Using the Diagnostic Criteria for Psychosomatic Research across Different Clinical Settings

INTRODUCTION

Diagnostic Criteria for Psychosomatic Research (DCPR) serve as an instrument for identifying and classifying specific psychosomatic syndromes that are not adequately encompassed in standard nosography. The present study aimed at measuring the prevalence of DCPR syndromes in different clinical settings and exploring factors associated to such diagnoses.

METHODS

A cross-sectional and nationwide study recruited 6,647 patients in different clinical settings: 306 were diagnosed with fibromyalgia (FM), 333 with irritable bowel syndrome, 1,109 with migraine, 2,550 with coronary heart disease (CHD), and 2,349 with type 2 diabetes (T2D). Participants underwent DCPR diagnostic interview and were assessed for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder 7-Item Scale), and subjective well-being (World Health Organization-5 Well-Being Index). The PsychoSocial Index was used to evaluate global well-being, stress, and abnormal illness behavior. The prevalence of DCPR diagnoses was calculated, and factors associated to such diagnoses were analyzed by logistic regression.

RESULTS

Alexithymia (64.47%), irritable mood (20.55%), and demoralization (15.60%) were the most prevalent psychosomatic syndromes, with demoralization being most common in FM (49.02%). The factors associated to DCPR diagnoses encompassed high anxiety or abnormal illness behavior, and poor well-being. Notably, stress was found to be associated specifically to FM and T2D, with OR of 1.24 (95% CI: 1.06-1.46) and 1.26 (95% CI: 1.18-1.36), respectively.

CONCLUSION

DCPR is a clinically helpful complementary assessment tool in need of being widely implemented in clinical settings in order to have a comprehensive picture of the patients.

[Which solution to functional somatic disorder: The ACSEPT program]

BACKGROUND

Functional somatic disorder (FSD) is a prevalent disorder that can be severely disabling for the patient and is associated with major health costs. There are few formalized care programs for these disorders in the country, and their management encounters various difficulties, both in the diagnosis and its announcement and the treatment. Cognitive-behavioural and emotional therapy (CBT) is the standard on psychiatry care, and its efficacy has been demonstrated through several randomised controlled studies on the intensity of physical and psychological symptoms.

INTERVENTION

At Lille's University Hospital Center, we have established the "ACSEPT" care pathway for TSF management which consists of a psychiatric consultation followed by an individual referral, including a treatment using repeated transcranial magnetic stimulation (rTMS) or the integration of a CBT-based psychoeducation group. This group had the particularity of caring for all patients presenting FSD regardless of the associated physical symptoms. Educating medical professionals and conducting FSD research were other goals of ACSEPT.

DISCUSSION/CONCLUSION

ACSEPT allows an improvement in the care offered to these patients with a defined orientation and interdisciplinary, early, organized cares that are repeatable. Our goal is to study the effectiveness of these different interventions in subsequent studies, to continue the development of ACSEPT and to be able to distribute this intervention at the regional level to establish a clear care program allowing early management of these patients.

Comorbidity and sex differences in functional disorders and internalizing disorders

OBJECTIVE

In the current exploratory study we estimate comorbidity rates between FDs [fibromyalgia (FM), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and irritable bowel syndrome (IBS)]-and IDs-[major depressive disorder (MDD) and generalized anxiety disorder (GAD)] by using self-reported diagnostic criteria.

METHOD

We analyzed data from 107,849 participants (mean age = 49.3 (SD = 13.0), 58.6% women) of the Lifelines Cohort Study. Lifelines is a prospective population-based cohort study in the northeast of the Netherlands. Current IDs were assessed using the Mini-International Neuropsychiatric Interview. Current FM, ME/CFS, and IBS were assessed according to the 2010 American College of Rheumatology criteria, the 1994 Centers for Disease Control and Prevention criteria and the ROME IV criteria, respectively. We estimated tetrachoric correlations between diagnoses and tested for sex differences. Additionally, we estimated the ratio of observed-to-expected frequency for combinations of diagnoses.

RESULTS

FDs and IDs are highly comorbid (odds ratios: 3.2-12.6) with associations stronger among men. Participants with at least three disorders/diagnoses were more prevalent than expected by chance.

CONCLUSION

Studies that aim to explain sex differences and the comorbidity of specific combinations of IDs and FDs will be an important contribution to understanding the etiology of these conditions.

The association between violence against women and chronic pain: a systematic review and meta-analysis

Violence against women is a phenomenon that involves at least 35% of women worldwide. Violence can be sexual, physical, and/or psychological, perpetrated by the partner, another family member, or a stranger. Violence is a public health problem because its consequences include higher morbidity, higher mortality, and short and long-term physical and psychological health diseases. Most studies prove an association between any type of violence and some chronic pain diagnoses but no one has done a complete collection of this evidence. This systematic review and meta-analysis aimed to evaluate whether this association is statistically significant, including the largest number of studies. Through the inclusion of 37 articles, the association has been demonstrated. Compared with no history of violence, women who did experience violence showed 2 times greater odds of developing chronic pain. The impact of violence was significant also on fibromyalgia separately, but not on pelvic pain.PROSPERO registrationPROSPERO CRD42023425477.