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Saini U, Rosmalen JGM, Oldehinkel AJ, van Loo HM. Connecting the dots: Network structures of internalizing and functional symptoms in a population-based cohort. J Psychosom Res 2024; 187:111932. [PMID: 39298869 DOI: 10.1016/j.jpsychores.2024.111932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/22/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE Comorbidities between internalizing disorders (IDs) and functional disorders (FDs) are well-documented, indicating shared pathways. However, their symptom-level relationships have been largely unexplored. This exploratory study employs a network approach to investigate symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS) to identify bridge symptoms explaining comorbidity between the two domains. METHODS We used cross-sectional data on 72,919 adult subjects from the Lifelines Cohort Study, a Dutch general population sample. A total of 38 symptoms representing diagnostic criteria of IDs and FDs were assessed with validated questionnaires. Network models were estimated using eLasso, based on the Ising model, to identify bridge symptoms. The Network Comparison Test (NCT) was used to test whether there were differences in network structure and strength across sex and age. RESULTS Symptoms were moderately connected, with a network density of 52.7%. ID and FD symptoms clustered in their respective domains, but were connected through the bridge symptoms, fatigue, difficulty concentrating, trouble sleeping, and unrefreshing sleep. Fatigue and difficulty concentrating had the most connections, associated with 86.6% and 78.9% of the other symptoms, respectively. NCTs indicated no differences in network connectivity between females versus males or younger versus older adults (>50 years). CONCLUSIONS ID and FD symptoms are moderately interconnected. Bridge symptoms displaying strong connections to multiple disorders may play a central role in the mechanisms underpinning the comorbidity between IDs and FDs.
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Affiliation(s)
- Urvi Saini
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands.
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Albertine J Oldehinkel
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Hanna M van Loo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
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Thomas NS, Gillespie NA, Kendler KS, Oldehinkel AJ, Rosmalen JGM, van Loo HM. Comorbidity and sex differences in functional disorders and internalizing disorders. Gen Hosp Psychiatry 2024; 90:91-98. [PMID: 39079424 PMCID: PMC11390307 DOI: 10.1016/j.genhosppsych.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/13/2024]
Abstract
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.
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Affiliation(s)
- Nathaniel S Thomas
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Box 980126, Richmond, VA 23298-0126, USA.
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Box 980126, Richmond, VA 23298-0126, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Box 980126, Richmond, VA 23298-0126, USA
| | - Albertine J Oldehinkel
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700, RB, Groningen, Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700, RB, Groningen, Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, P.O. Box 30.001, 9700, RB, Groningen, Netherlands
| | - Hanna M van Loo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700, RB, Groningen, Netherlands
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Kleinstäuber M, Schröder A, Daehler S, Pallesen KJ, Rask CU, Sanyer M, Van den Bergh O, Weinreich Petersen M, Rosmalen JGM. Aetiological Understanding of Fibromyalgia, Irritable Bowel Syndrome, Chronic Fatigue Syndrome and Classificatory Analogues: A Systematic Umbrella Review. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11179. [PMID: 38356902 PMCID: PMC10863637 DOI: 10.32872/cpe.11179] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/27/2023] [Indexed: 02/16/2024] Open
Abstract
Background This umbrella review systematically assesses the variety and relative dominance of current aetiological views within the scientific literature for the three most investigated symptom-defined functional somatic syndromes (FSS) and their classificatory analogues within psychiatry and psychology. Method An umbrella review of narrative and systematic reviews with and without meta-analyses based on a search of electronic databases (PubMed, Web of Science, Embase, PsychINFO) was conducted. Eligible reviews were published in English, focused on research of any kind of aetiological factors in adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and somatic symptom disorder (SSD)/somatoform disorder (SFD). Results We included 452 reviews (132 systematic reviews including meta-analyses, 133 systematic reviews, 197 narrative reviews), of which 132 (29%) focused on two or more of the investigated health conditions simultaneously. Across diagnoses, biological factors were addressed in 90% (k = 405), psychological in 33% (k = 150), social in 12% (k = 54), and healthcare factors in 5% (k = 23) of the reviews. The methodological quality of the included systematic reviews (k = 255) was low (low/critically low: 41% [k = 104]; moderate: 49% [k = 126]; high quality: 10% [k = 25]). The high-quality systematic reviews suggest that deficient conditioned pain modulation, genetic factors, changes in the immune, endocrinological, gastrointestinal, cardiovascular, and nervous system, and psychosocial factors such as sexual abuse and pain catastrophizing increase the risk for FSS. Conclusion Only very few systematic reviews have used comprehensive, biopsychosocial disease models to guide the selection of aetiological factors in FSS research. Future research should strive for higher scientific standards and broaden its perspective on these health conditions.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sarah Daehler
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | | | - Charlotte U. Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Sanyer
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | | | - Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Judith G. M. Rosmalen
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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4
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Jørgensen T, Dantoft TM, Weinreich Petersen M, Benros ME, Poulsen CH, Falgaard Eplov L, Gormsen L, Frostholm L, Carstensen TBW, Holm Eliasen M, Kårhus LL, Skovbjerg S, Bjerregaard AA, Brix S, Linneberg A, Fink P. Examine the public health impacts of functional somatic disorders using the DanFunD study. Scand J Public Health 2022; 50:988-994. [PMID: 36245407 DOI: 10.1177/14034948221122886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Persistent physical symptoms (e.g. pain, fatigue) are prevalent in the population and some persons may develop a functional somatic disorder (FSD). We still need to explore the limits between general bodily sensations and FSD, and great controversies exist as regard delimitation, occurrence, risk factors, prognosis, and costs of FSD in the general population. This is mainly due to the lack of focused, sufficient powered, population-based epidemiological studies. Material and Methods: The DanFunD study is the largest focused population-based study on FSD and has the potential to answer these crucial questions regarding the FSD disorders. DanFunD has its origin in the Copenhagen area of Denmark and was initiated in 2009 by an interdisciplinary team of researchers including basic scientists, clinical researchers, epidemiologists, and public health researchers. A population-based cohort of nearly 10,000 people have filled in detailed questionnaires, gone through a thorough health examination, and a biobank is established. The cohort was re-examined after five years. Results:The prevalence of FSD in the Danish population is about 10-15% and is twice as common in women as in men. Persons with FSD report impaired daily activities and low self-perceived health, which qualifies FSD as a major public health problem. The research plan to unravel the risk factors for FSD employs a bio-psycho-social approach according to a detailed plan. Preliminary results are presented, and work is in progress. Likewise, plans for assessing prognosis and health care costs are provided. Conclusion: We invite researchers in the field to collaborate on this unique data material.
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Affiliation(s)
- Torben Jørgensen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark.,Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Lise Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Marie Holm Eliasen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Line Lund Kårhus
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Sine Skovbjerg
- Department of Clinical Medicine, The Danish Centre for Mindfulness, Aarhus University, Denmark
| | | | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Denmark
| | - Allan Linneberg
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
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Irritable bowel, chronic widespread pain, chronic fatigue and related syndromes are prevalent and highly overlapping in the general population: DanFunD. Sci Rep 2020; 10:3273. [PMID: 32094442 PMCID: PMC7039919 DOI: 10.1038/s41598-020-60318-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
Prevalence of functional somatic syndromes (FSS) in the general population varies with observed overlap between syndromes. However, studies including a range of FSS are sparse. We investigated prevalence and characteristics of various FSS and the unifying diagnostic construct bodily distress syndrome (BDS), and identified mutual overlap of the FSS and their overlap with BDS. We included a stratified subsample of 1590 adults from a randomly selected Danish general population sample (n = 7493). Telephonic diagnostic interviews performed by three trained physicians were used to identify individuals with FSS and BDS. Prevalence of overall FSS was 9.3%; 3.8% for irritable bowel, 2.2% for chronic widespread pain, 6.1% for chronic fatigue, 1.5% for whiplash associated disorders, and 0.9% for multiple chemical sensitivity. Prevalence of BDS was 10.7% where 2.0% had the multi-organ type. FSS were highly overlapping with low likelihood of having a “pure” type. Diagnostic agreement of FSS and BDS was 92.0%. Multi-syndromatic FSS and multi-organ BDS were associated with female sex, poor health, physical limitations, and comorbidity. FSS are highly prevalent and overlapping, and multi-syndromatic cases are most affected. BDS captured the majority of FSS and may improve clinical management, making the distinction between multi- and mono-syndromatic patients easier.
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Weinreich Petersen M, Schröder A, Jørgensen T, Ørnbøl E, Meinertz Dantoft T, Eliasen M, Wisbech Carstensen T, Falgaard Eplov L, Fink P. Response to Letter to the Editor: A misleading CFS prevalence estimate in DanFunD. Scand J Public Health 2020; 48:579-580. [DOI: 10.1177/1403494819893241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | | | - Marie Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Tina Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | | | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
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7
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Eliasen M, Schröder A, Fink P, Kreiner S, Dantoft TM, Poulsen CH, Petersen MW, Eplov LF, Skovbjerg S, Jørgensen T. A step towards a new delimitation of functional somatic syndromes: A latent class analysis of symptoms in a population-based cohort study. J Psychosom Res 2018; 108:102-117. [PMID: 29602319 DOI: 10.1016/j.jpsychores.2018.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The current delimitation of functional somatic syndromes (FSS) is inconsistent. We aimed to investigate somatic symptom profiles in the general adult population to contribute to a new, data-driven delimitation of FSS. METHODS Information on 31 self-reported somatic symptoms used in the delimitation of various FSS and bodily distress syndrome (BDS) was obtained from the DanFunD study-a population-based cohort study on 9656 adults (participation 33.6%) from Greater Copenhagen, Denmark. Latent class analysis was used to identify symptom profiles. The profiles were described by their relation with sex, age, chronic disease, self-perceived health, symptom impact, self-reported FSS, and BDS case-status. RESULTS Eight symptom profiles were identified. The largest profile had no symptoms (49% of the population). Three profiles were characterized by a few, specific symptoms: muscle and joint pain (17%), gastrointestinal symptoms (6%), and general symptoms (13%). Three profiles had multiple symptoms in specific combinations: musculoskeletal and general symptoms (7%); fatigue, musculoskeletal and gastrointestinal symptoms (3%); and cardiopulmonary, gastrointestinal and general symptoms (3%). Lastly, one profile (2%) had high probability of all symptoms. The last four profiles (15%) were strongly associated with BDS case-status, poor self-perceived health and high impact of symptoms. Analyses excluding persons with multi-symptomatic chronic disease showed similar results. CONCLUSIONS We identified eight symptom profiles characterized by specific combinations of symptoms. Four of these had multiple symptoms from several bodily systems showing large overlap with BDS, possibly indicating subtypes of FSS. The profiles contribute to a new delimitation of FSS by illustrating the importance of specific symptom combinations.
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Affiliation(s)
- Marie Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark.
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Svend Kreiner
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Chalotte Heinsvig Poulsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark; Mental Health Centre Copenhagen, The Capital Region of Denmark, Hellerup, Denmark
| | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Falgaard Eplov
- Mental Health Centre Copenhagen, The Capital Region of Denmark, Hellerup, Denmark
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Faculty of Medicine, Aalborg University, Aalborg, Denmark
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8
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Dantoft TM, Ebstrup JF, Linneberg A, Skovbjerg S, Madsen AL, Mehlsen J, Brinth L, Eplov LF, Carstensen TW, Schroder A, Fink PK, Mortensen EL, Hansen T, Pedersen O, Jørgensen T. Cohort description: The Danish study of Functional Disorders. Clin Epidemiol 2017; 9:127-139. [PMID: 28275316 PMCID: PMC5333638 DOI: 10.2147/clep.s129335] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The Danish study of Functional Disorders (DanFunD) cohort was initiated to outline the epidemiology of functional somatic syndromes (FSS) and is the first larger coordinated epidemiological study focusing exclusively on FSS. FSS are prevalent in all medical settings and can be defined as syndromes that, after appropriate medical assessment, cannot be explained in terms of a conventional medical or surgical disease. FSS are frequent and the clinical importance varies from vague symptoms to extreme disability. No well-described medical explanations exist for FSS, and how to delimit FSS remains a controversial topic. The specific aims with the cohort were to test delimitations of FSS, estimate prevalence and incidence rates, identify risk factors, delimitate the pathogenic pathways, and explore the consequences of FSS. The study population comprises a random sample of 9,656 men and women aged 18–76 years from the general population examined from 2011 to 2015. The survey comprises screening questionnaires for five types of FSS, ie, fibromyalgia, whiplash-associated disorder, multiple chemical sensitivity, irritable bowel syndrome, and chronic fatigue syndrome, and for the unifying diagnostic category of bodily distress syndrome. Additional data included a telephone-based diagnostic interview assessment for FSS, questionnaires on physical and mental health, personality traits, lifestyle, use of health care services and social factors, and a physical examination with measures of cardiorespiratory and morphological fitness, metabolic fitness, neck mobility, heart rate variability, and pain sensitivity. A biobank including serum, plasma, urine, DNA, and microbiome has been established, and central registry data from both responders and nonresponders are similarly available on morbidity, mortality, reimbursement of medicine, heath care use, and social factors. A complete 5-year follow-up is scheduled to take place from year 2017 to 2020, and further reexaminations will be planned. Several projects using the DanFunD data are ongoing, and findings will be published in the coming years.
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Affiliation(s)
| | | | - Allan Linneberg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; Department of Clinical Experimental Research, Rigshospitalet, Glostrup
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup
| | - Anja Lykke Madsen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup
| | - Jesper Mehlsen
- Coordinating Research Centre, Bispebjerg and Frederiksberg Hospital, Frederiksberg
| | - Louise Brinth
- Coordinating Research Centre, Bispebjerg and Frederiksberg Hospital, Frederiksberg
| | - Lene Falgaard Eplov
- Mental Health Centre Copenhagen, Research Unit, Mental Health Services, Capital Region of Denmark, Copenhagen
| | - Tina Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital; Faculty of Health Sciences, University of Aarhus, Aarhus
| | - Andreas Schroder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital; Faculty of Health Sciences, University of Aarhus, Aarhus
| | - Per Klausen Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital; Faculty of Health Sciences, University of Aarhus, Aarhus
| | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research
| | - Torben Jørgensen
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen; Faculty of Medicine, Aalborg University, Aalborg, Denmark
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9
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Tak LM, Kingma EM, van Ockenburg SL, Ormel J, Rosmalen JGM. Age- and sex-specific associations between adverse life events and functional bodily symptoms in the general population. J Psychosom Res 2015; 79:112-6. [PMID: 26052060 DOI: 10.1016/j.jpsychores.2015.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/02/2015] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test age- and sex-specific associations between adverse life events and functional bodily symptoms (FBS) in the general population. METHODS In a population-based cohort, 964 participants (mean age 55 years SD 11, 48% male) completed two measurements waves of the present study. Lifetime exposure to 12 adverse life events was assessed through a modified version of the List of Threatening Experiences. Stress-sensitive personality was assessed with the 12-item neuroticism scale of the Eysenck Personality Questionnaire-Revised. Socio-economic status was retrieved from questionnaires. Participants completed the somatization section of the Composite International Diagnostic Interview to survey the presence of 42 FBS in the previous year. RESULTS Regression analyses, adjusted for age, revealed that lifetime scores of adverse life events were significantly associated with FBS in the previous year, an association that was nearly identical for females (beta=0.18, t=4.07, p<0.01) and males (beta=0.19, t=4.24, p<0.01). This association remained statistically significant when stress-sensitive personality and socio-economic status were added to the model. Associations between adverse life events during childhood and FBS were statistically significant in females (beta=0.13, t=2.90, p=0.04) but not in males (beta=0.06, t=1.24, p=0.22), whereas there was a stronger association with adverse life events during adulthood in males (beta=0.20, t=4.37, p<0.01) compared to females (beta=0.15, t=3.38, p=0.01). Life events in the previous year were not associated with FBS in the previous year. CONCLUSION Adverse life events during lifetime were associated with FBS in the previous year. This association was dependent on age and sex but largely independent of having a stress-sensitive personality or low socio-economic status. Future studies could adopt a life course perspective to study the role of adverse life events in FBS.
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Affiliation(s)
- Lineke M Tak
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; Dimence, Institute for Mental Health Care, Deventer, The Netherlands.
| | - Eva M Kingma
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Sonja L van Ockenburg
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Johan Ormel
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
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10
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Coenders A, Chapman C, Hannaford P, Jaaniste T, Qiu W, Anderson D, Glogauer M, Goodison-Farnsworth E, McCormick M, Champion D. In search of risk factors for chronic pain in adolescents: a case-control study of childhood and parental associations. J Pain Res 2014; 7:175-83. [PMID: 24707186 PMCID: PMC3971911 DOI: 10.2147/jpr.s48154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives This study was designed to investigate whether an individual and parental history of functional pain syndromes (FPS) is found more often in adolescents suffering from chronic pain than in their pain-free peers. Methods Our case–control study involved 101 adolescents aged 10–18 years. Cases were 45 patients of the Chronic Pain Clinic at Sydney Children’s Hospital with diverse chronic pain disorders. Controls consisted of 56 adolescent volunteers who did not have chronic pain. Adolescents and their parents filled out questionnaires assessing demographic data as well as known and potential risk factors for chronic pain. A history of FPS was assessed by questionnaire, including restless legs syndrome (RLS). Chi-squared tests and t-tests were used to investigate univariate associations between chronic pain in adolescents and lifetime prevalence of FPS. Logistic regression was used to test multivariate associations, while controlling for possible confounders. Results Migraine, non-migraine headaches, recurrent abdominal pain (RAP), and RLS were reported significantly more frequently in cases than controls (P-values of 0.01, <0.001, 0.01, and 0.03, respectively). Parental migraine, RAP, and RLS were also significantly associated with adolescent chronic pain in the multivariate analyses. Individual history of migraine, non-migraine headaches, and RAP, along with parental history of RAP and depression significantly accounted for 36%–49% of variance in chronic pain. Other associations with chronic pain were generally in accordance with previous reports. Discussion It may be helpful when assessing a child who has chronic pain or is at risk of chronic pain, to enquire about these associations. Based on the current findings, an individual history of migraine, non-migraine headaches, and RAP, as well as parental migraine, RAP, and RLS are symptoms that are of particular relevance to assess.
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Affiliation(s)
| | - Cindy Chapman
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Tiina Jaaniste
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
| | - Wen Qiu
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Anderson
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Maline Glogauer
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Marianne McCormick
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
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Zijlema WL, Stolk RP, Löwe B, Rief W, White PD, Rosmalen JGM. How to assess common somatic symptoms in large-scale studies: a systematic review of questionnaires. J Psychosom Res 2013; 74:459-68. [PMID: 23731742 DOI: 10.1016/j.jpsychores.2013.03.093] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/22/2013] [Accepted: 03/23/2013] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Many questionnaires for assessment of common somatic symptoms or functional somatic symptoms are available and their use differs greatly among studies. The prevalence and incidence of symptoms are partially determined by the methods used to assess them. As a result, comparison across studies is difficult. This article describes a systematic review of self-report questionnaires for somatic symptoms for use in large-scale studies and recommends two questionnaires for use in such studies. METHODS A literature search was performed in the databases Medline, PsycINFO and EMBASE. Articles that reported the development, evaluation, or review of a self-report somatic symptom measure were included. Instrument evaluation was based on validity and reliability, and their fitness for purpose in large scale studies, according to the PhenX criteria. RESULTS The literature search identified 40 questionnaires. The number of items within the questionnaires ranged from 5 to 78 items. In 70% of the questionnaires, headaches were included, followed by nausea/upset stomach (65%), shortness of breath/breathing trouble (58%), dizziness (55%), and (low) back pain/backaches (55%). Data on validity and reliability were reported and used for evaluation. CONCLUSION Questionnaires varied regarding usability and burden to participants, and relevance to a variety of populations and regions. Based on our criteria, the Patient Health Questionnaire-15 and the Symptom Checklist-90 somatization scale seem the most fit for purpose for use in large-scale studies. These two questionnaires have well-established psychometric properties, contain relevant symptoms, are relatively short, and are available in multiple languages.
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Affiliation(s)
- Wilma L Zijlema
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Hilderink P, Collard R, Rosmalen J, Oude Voshaar R. Prevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups: a systematic review. Ageing Res Rev 2013; 12:151-6. [PMID: 22575906 DOI: 10.1016/j.arr.2012.04.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/09/2012] [Accepted: 04/23/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review current knowledge regarding the prevalence of somatization problems in later life by level of caseness (somatoform disorders and medically unexplained symptoms, MUS) and to compare these rates with those in middle-aged and younger age groups. METHOD A systematic search of the literature published from 1966 onwards was conducted in the Pubmed and EMBASE databases. RESULTS Overall 8 articles, describing a total of 7 cohorts, provided data of at least one prevalence rate for somatoform disorders or MUS for the middle-aged (50-65 years) or older age (≥65 years) group. Prevalence rates for somatoform disorders in the general population range from 11 to 21% in younger, 10 to 20% in the middle-aged, and 1.5 to 13% in the older age groups. Prevalence rates for MUS show wider ranges, of respectively 1.6-70%, 2.4-87%, and 4.6-18%, in the younger, middle, and older age groups, which could be explained by the use of different instruments as well as lack of consensus in defining MUS. CONCLUSION Somatoform disorders and MUS are common in later life, although the available data suggest that prevalence rates decline after the age of 65 years. More systematic research with special focus on the older population is needed to understand this age-related decline in prevalence rates.
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Kingma EM, de Jonge P, Ormel J, Rosmalen JGM. Predictors of a Functional Somatic Syndrome Diagnosis in Patients with Persistent Functional Somatic Symptoms. Int J Behav Med 2012; 20:206-12. [DOI: 10.1007/s12529-012-9251-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012; 53:575-92. [PMID: 22404290 DOI: 10.1111/j.1469-7610.2012.02535.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. METHOD Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents. RESULTS FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. CONCLUSION Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.
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Affiliation(s)
- John V Campo
- Department of Psychiatry, Professor and chair, The Ohio State University, Columbus, Ohio, USA
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Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biol Psychol 2011; 87:183-94. [PMID: 21315796 DOI: 10.1016/j.biopsycho.2011.02.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/08/2010] [Accepted: 02/03/2011] [Indexed: 01/14/2023]
Abstract
Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is the most investigated biological risk marker in functional somatic disorders (FSDs), such as chronic fatigue syndrome (CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS). Our aim was to assess whether there is an association between basal hypocortisolism and FSD and to identify potential moderators of this association. Meta-analysis on 85 studies revealed that although basal cortisol levels were generally lower in FSD subjects compared to controls, this association did not reach statistical significance (SMD -0.07, 95% CI -0.17 to 0.04, p=0.241). However, when the three FSD were assessed separately, statistically significant basal hypocortisolism was observed in CFS subjects compared to controls (SMD -0.14, 95% CI -0.28 to 0.00, p=0.047), but not in FM or IBS. When all potential moderators were entered into a meta-regression analysis, only type of FSD and female gender were significant independent predictors of basal hypocortisolism. In conclusion, we did not find evidence to consider all three main FSD as hypocortisolemic disorders, as significant reduction in basal cortisol compared to healthy controls was only found in CFS and in females with FM, but not in IBS.
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The genetic, physiological and psychological mechanisms underlying disabling medically unexplained symptoms and somatisation. J Psychosom Res 2010; 68:395-7. [PMID: 20403497 DOI: 10.1016/j.jpsychores.2010.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 01/28/2010] [Accepted: 01/28/2010] [Indexed: 11/21/2022]
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