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Hegedüs L, Van Der Feltz-Cornelis CM, Papini E, Nagy EV, Weetman AP, Perros P. Medically not yet explained symptoms in hypothyroidism. Nat Rev Endocrinol 2024:10.1038/s41574-024-01022-7. [PMID: 39138377 DOI: 10.1038/s41574-024-01022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/15/2024]
Abstract
Persistent symptoms are common in the general population and even more so in people with hypothyroidism. When symptoms are unexplained and brought to medical attention, they can be referred to as medically not yet explained symptoms (MNYES), a term preferred to other descriptors by patients, care-givers and experts. MNYES might be neglected by endocrinologists or misattributed to hypothyroidism. Awareness of MNYES could open up more effective and less harmful interventions for patients who present to endocrinologists with unexplained symptoms than costly over-investigations and over-treatment with thyroid hormones (such as levothyroxine and liothyronine). The role of the endocrinologist is to recognize and acknowledge that MNYES could be underlying a patient's presentation, to communicate effectively with the patient and others involved in the patient's care, to apply a 'two-track approach' in management by paying equal attention to physical and psychosocial contributors, and to collaborate with other relevant health professionals. Categorization of patients into levels of risk for symptom deterioration helps in selecting suitable therapies. Effective management of MNYES demands time, training, expertise and resources.
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Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anthony P Weetman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Petros Perros
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Barrio-Martínez S, Ruiz-Rodríguez P, Medrano LA, Priede A, Muñoz-Navarro R, Moriana JA, Carpallo-González M, Prieto-Vila M, Cano-Vindel A, González-Blanch C. Effect of Reliable Recovery on Health Care Costs and Productivity Losses in Emotional Disorders. Behav Ther 2024; 55:585-594. [PMID: 38670670 DOI: 10.1016/j.beth.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 04/28/2024]
Abstract
Despite the high economic costs associated with emotional disorders, relatively few studies have examined the variation in costs according to whether the patient has achieved a reliable recovery. The aim of this study was to explore differences in health care costs and productivity losses between primary care patients from a previous randomized controlled trial (RCT)-PsicAP-with emotional symptoms who achieved a reliable recovery and those who did not after transdiagnostic cognitive-behavioral therapy (TD-CBT) plus treatment as usual (TAU) or TAU alone. Sociodemographic and cost data were obtained for 134 participants treated at five primary care centers in Madrid for the 12-month posttreatment period. Reliable recovery rates were higher in the patients who received TD-CBT + TAU versus TAU alone (66% vs. 34%, respectively; chi-square = 13.78, df = 1, p < .001). Patients who did not achieve reliable recovery incurred more costs, especially associated with general practitioner consultations (t = 3.01, df = 132, p = .003), use of emergency departments (t = 2.20, df = 132, p = .030), total health care costs (t = 2.01, df = 132, p = .040), and sick leaves (t = 1.97, df = 132, p = .048). These findings underscore the societal importance of achieving a reliable recovery in patients with emotional disorders, and further support the value of adding TD-CBT to TAU in the primary care setting.
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Affiliation(s)
| | | | | | - Amador Priede
- Valdecilla Biomedical Research Institute and Mental Health Centre, Hospital de Laredo
| | | | - Juan Antonio Moriana
- Universidad de Córdoba and Maimónides Institute for Research in Biomedicine of Cordoba
| | | | | | | | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital and Universidad Europea del Atlántico
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3
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Seo JW, Lee J, Jeon S, Hwang Y, Kim J, Lee S, Kim SJ. Fatigue and somatization in shift-workers: Effects of depression and sleep. J Psychosom Res 2023; 173:111467. [PMID: 37619432 DOI: 10.1016/j.jpsychores.2023.111467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE We investigated the differences in fatigue and somatization between shift and non-shift workers and explored the effects of sleep and depression on fatigue and somatization in shift workers. METHODS In total, 4543 shift workers and 2089 non-shift workers completed self-reported questionnaires. The Center for Epidemiologic Studies Depression Scale (CESD), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Somatization subscale of the Symptom Checklist 90-item version (SCL-SOM) were used to measure depression, sleep quality, fatigue, and somatization, respectively. Fatigue and somatization were compared between shift and non-shift workers after controlling for different sets of covariates. RESULTS Compared to non-shift workers, shift workers reported higher FSS (mean difference: 2.19 ± 0.30, p < 0.01) and SCL-SOM (mean difference: 1.77 ± 0.21, p < 0.01) scores after controlling for age, gender, presence of medical illness, occupational category, monthly income, length of service, and weekly working hours. The between-group difference in FSS score was no longer significant after additionally controlling for CES-D (p = 0.15) or PSQI (p = 0.18). The between-group difference in SCL-SOM score showed only non-significant trends after additionally controlling for CES-D (p = 0.09) or PSQI (p = 0.07). The group difference in SCL-SOM scores disappeared after controlling for both CES-D and PSQI scores (p = 0.99). CONCLUSIONS Shift workers had higher fatigue and somatization levels than non-shift workers and the group difference was associated with disturbed sleep and depressed mood in shift workers.
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Affiliation(s)
- Jin Won Seo
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sehyun Jeon
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yunjee Hwang
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jichul Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Somi Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Predictors of Full Recovery in Individuals with Emotional Disorders: One-Year Follow-Up Secondary Analysis of the PsicAP Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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5
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van der Feltz-Cornelis CM, Sweetman J, Edwards M, Gall N, Gilligan J, Hayle S, Kaul A, Moriarty AS, Perros P, Sampford J, Smith N, Elfeddali I, Varley D, Gower J. Identifying the top research priorities in medically not yet explained symptoms (MNYES): a James Lind Alliance priority setting partnership. BMJ Open 2022; 12:e061263. [PMID: 35777869 PMCID: PMC9252198 DOI: 10.1136/bmjopen-2022-061263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study establishes research priorities for medically not yet explained symptoms (MNYES), also known as persistent physical symptoms or medically unexplained symptoms, from the perspective of patients, caregivers and clinicians, in a priority setting partnership (PSP) following the James Lind Alliance (JLA) approach. Research into such symptoms in general has been poorly funded over the years and so far has been primarily researcher-led with minimal input from patients, caregivers and clinicians; and sometimes has been controversial. DESIGN JLA PSP method. The PSP termed these symptoms MNYES. METHODS The study was conducted according to the JLA's detailed methodology for conducting priority setting exercises. It involved five key stages: defining the appropriate term for the conditions under study by the PSP Steering Group; gathering questions on MNYES from patients, caregivers and clinicians in a publicly accessible survey; checking these research questions against existing evidence; interim prioritisation in a second survey; and a final multi-stakeholder consensus meeting to determine the top 10 unanswered research questions using the modified nominal group methodology. RESULTS Over 700 responses from UK patients, caregivers and clinicians were identified in the two surveys and charities contributed from a broad range of medical specialties and primary care. The final top 10 unanswered research questions cover, among others: treatment strategies, personalisation of treatment, collaborative care pathways, training for clinicians and outcomes that matter to patients. INTERPRETATION The top 10 unanswered research questions are expected to generate much needed, relevant and impactful research into MNYES.
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Affiliation(s)
- Christina Maria van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
- York Biomedical Research Institute, University of York, York, UK
- R&D Department, Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
- Institute of Health Informatics, University College London, London, UK
| | | | - Mark Edwards
- St George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nicholas Gall
- Department of Cardiology, University of London Kings College Hospital, London, UK
| | | | | | - Arvind Kaul
- St George's University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew Stephen Moriarty
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James Sampford
- Liaison team, Tees Esk and Wear Valleys Foundation Trust, York, UK
| | - Natalie Smith
- Department of Health Sciences, University of York, York, UK
| | - Iman Elfeddali
- Tranzo Department, Tilburg University, Tilburg, Netherlands
- Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, The Netherlands
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Sarter L, Heider J, Witthöft M, Rief W, Kleinstäuber M. Using clinical patient characteristics to predict treatment outcome of cognitive behavior therapies for individuals with medically unexplained symptoms: A systematic review and meta-analysis. Gen Hosp Psychiatry 2022; 77:11-20. [PMID: 35390568 DOI: 10.1016/j.genhosppsych.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE For individuals with medically unexplained symptoms (MUS), cognitive behavioral therapy (CBT) is the best-evaluated treatment. This systematic review and meta-analyses identify clinical patient characteristics associated with the treatment outcome of CBT for MUS. METHODS A systematic literature search (PubMed, PsycInfo, Web of Science) resulted in 53 eligible studies; of these 32 studies could be included in meta-analyses. Pooled correlation coefficients between predictors and treatment outcome were calculated with a random-effects model. Moderator analyses were conducted to examine differences between subgroups of MUS and different levels of methodological study quality. RESULTS Meta-analyses demonstrated that individuals with higher symptom intensity (r = 0.38; p < 0.001), lower physical functioning (r = -0.29; p < 0.001), lower emotional and social functioning (r = -0.37; p < 0.001), more potential symptom-related incentives (r = -0.15; p = 0.001), or longer symptom duration (r = 0.10; p = 0.033) at the beginning of treatment reported less change of symptom severity until the end of therapy or higher end-of-treatment symptom severity. The pooled effect sizes did not differ between certain subgroups of MUS or between different levels of methodological quality. CONCLUSION Our findings indicated that clinical characteristics of MUS patients are associated with treatment outcome of CBT. We discuss how the results can be used to optimize and personalize future treatments for MUS.
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Affiliation(s)
- Lena Sarter
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35037 Marburg, Germany.
| | - Jens Heider
- University Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, 76829 Landau, Germany.
| | - Michael Witthöft
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Wallstraße 3, 55122 Mainz, Germany.
| | - Winfried Rief
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35037 Marburg, Germany.
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, USA.
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Chinneimawi E, Nagarajan P, Menon V. Caregiver Burden and Disability in Somatoform Disorder: An Exploratory Study. Indian J Psychol Med 2021; 43:500-507. [PMID: 35210678 PMCID: PMC8826199 DOI: 10.1177/0253717620957563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Very few Indian studies have explored disability among patients with somatoform disorder and the burden experienced by their caregivers. We aimed to assess the levels of disability among patients with somatoform disorder and the levels of burden among their caregivers and compare these parameters against patients with schizophrenia. METHODS Participants included adults with a diagnosis of somatoform disorders (F45.0-F 45.9) (n = 28) or schizophrenia (F20.0-F20.9) (n = 28) diagnosed as per the International Classification of Diseases, Tenth Revision (ICD-10), clinical descriptions, and diagnostic guidelines, as well as their caregivers. The WHO Disability Assessment Schedule 2.0 and Family Burden Interview Schedule were used to assess patient disability and caregiver burden, respectively. Independent Student's t-test or chi-square test was used to compare relevant sociodemographic and clinical parameters. RESULTS Out of 56 patients, the mean (±SD) age of the sample was 38.6 (±10.5) years. Females constituted a slender majority of the sample (n = 29, 51.8%). The mean disability score of patients with somatoform disorders was slightly higher (83.6 ±20.9) than that of patients with schizophrenia (82.3 ±16.7). Similarly, the mean burden score of caregivers of patients with somatoform disorders was nominally higher (18.96 ±9.9) than that of caregivers of patients with schizophrenia (15.7 ±9.7). Neither of these differences approached statistical significance (P > 0.05). CONCLUSION Patients with somatoform disorders experience considerable levels of disability, and their caregivers go through various levels of burden in their daily life that is comparable to schizophrenia.
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Affiliation(s)
| | - Padmavathi Nagarajan
- Dept. of Psychiatric Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pudhucherry, India
| | - Vikas Menon
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pudhucherry, India
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Somatic Symptom Disorder in the Inpatient Setting: The Challenge for Patients and Providers. Harv Rev Psychiatry 2021; 28:404-411. [PMID: 32568933 DOI: 10.1097/hrp.0000000000000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Barrio-Martínez S, Cano-Vindel A, Muñoz-Navarro R, Moriana JA, Ruíz-Rodríguez P, Medrano LA, Ventura L, González-Blanch C. Factors differentiating panic disorder with and without comorbid symptoms of depression. Psychol Psychother 2021; 94:523-540. [PMID: 33993636 DOI: 10.1111/papt.12327] [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: 09/03/2020] [Revised: 01/17/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p < .01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (β = .346; p < .01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not. PRACTITIONER POINTS: Somatic symptoms were associated with a higher probability of be in the PD + MDD group. Cognitive variables do not play a relevant role in the differentiation of both groups. A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group.
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Affiliation(s)
| | | | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Human and Social Sciences, University of Zaragoza, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba/Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
| | | | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | - Ludovica Ventura
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain.,Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
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Fisher K, Griffith LE, Gruneir A, Kanters D, Markle-Reid M, Ploeg J. Functional limitations in people with multimorbidity and the association with mental health conditions: Baseline data from the Canadian Longitudinal Study on Aging (CLSA). PLoS One 2021; 16:e0255907. [PMID: 34379653 PMCID: PMC8357170 DOI: 10.1371/journal.pone.0255907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/26/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Increasing multimorbidity is often associated with declining physical functioning, with some studies showing a disproportionate impact on functioning when mental health conditions are present. More research is needed because most multimorbidity studies exclude mental health conditions. OBJECTIVES This study aims to improve our understanding of the association between functional limitation and multimorbidity, including a comparison of those with multimorbidity that includes versus excludes mental health conditions. METHODS This is a population-based, cross-sectional analysis of data from The Canadian Longitudinal Study on Aging. Functional limitation was defined as the presence of any of 14 activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Multimorbidity, measured by the number of chronic conditions, included mood and anxiety disorders. Logistic regression explored the association between multimorbidity (with and without mental health conditions) and functional limitation. Factor analysis identified common condition clusters to help understand clinical complexity in those with mood/anxiety disorders and the potential influences on functional limitation. RESULTS There were 51,338 participants, with a similar proportion of men and women (49% versus 51%) and 42% age 65 years or older. Fifteen percent (15%) had no chronic conditions and 17% had 5+. Ten percent (10%) reported at least one ADL or IADL limitation. Odds ratios (ORs) for functional limitation increased with multimorbidity and were generally higher for those with versus without mental health conditions (e.g., ORs from 1 to 5+ chronic conditions increased 1.9 to 15.8 for those with mood/anxiety disorders versus 1.8 to 10.2 for those without). Factor analysis showed that mood/anxiety conditions clustered with somatic conditions (e.g., migraines, bowel/gastrointestinal disorders). CONCLUSION This study found higher odds of functional limitation for those with multimorbidity that included versus excluded mental health conditions, at all levels of multimorbidity. It highlights the need for concurrent management of mental and physical comorbidities to prevent functional limitations and future decline. This approach is aligned with the NICE clinical assessment and management guidelines for people with multimorbidity.
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Affiliation(s)
- Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - David Kanters
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Sarter L, Heider J, Kirchner L, Schenkel S, Witthöft M, Rief W, Kleinstäuber M. Cognitive and emotional variables predicting treatment outcome of cognitive behavior therapies for patients with medically unexplained symptoms: A meta-analysis. J Psychosom Res 2021; 146:110486. [PMID: 33879330 DOI: 10.1016/j.jpsychores.2021.110486] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS). We still need a better understanding of what characterizes patients with MUS who benefit more or less from CBT. This systematic review aimed to identify patients' cognitive-emotional characteristics predicting the outcome of CBT for MUS. METHODS A systematic literature search (PubMed, PsycINFO, Web of Science) revealed 37 eligible studies, 23 of these provided data for meta-analyses. Mean correlation coefficients between predictor variables and the outcomes (symptom intensity, physical or social-emotional functioning) were calculated using a random-effects model. Differences between syndromes of MUS were investigated with moderator analyses. RESULTS Meta-analyses showed that patients with a comorbid mood disorder (r = 0.32, p < .01) or anxiety disorder (r = 0.18, p < .01), symptom catastrophizing and worries (r = 0.34, p < .01), tendencies of somatosensory amplification (r = 0.46, p = .04), and low symptom acceptance or self-efficacy (r = 0.25, p < .01) have a less favorable CBT outcome. Moderator analyses revealed that these associations between predictors and treatment outcome are pronounced in patients with chronic fatigue syndrome and irritable bowel syndrome. CONCLUSIONS Our results show that pre-treatment differences in patients' cognitive-emotional characteristics predict patients' outcome in CBT. Patient-tailored CBT could be a promising approach to address MUS patients' widely varying needs more effectively. PROTOCOL REGISTRATION The protocol of this systematic review and meta-analysis was registered in the PROSPERO registry (CRD 42018098649).
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Affiliation(s)
- Lena Sarter
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
| | - Jens Heider
- University Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Landau, Germany.
| | - Lukas Kirchner
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
| | - Sandra Schenkel
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Michael Witthöft
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany.
| | - Winfried Rief
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
| | - Maria Kleinstäuber
- University of Otago, Otago Medical School - Dunedin Campus, Department of Psychological Medicine, Dunedin, New Zealand.
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Kleinstäuber M, Exner A, Lambert MJ, Terluin B. Validation of the Four-Dimensional Symptom Questionnaire (4DSQ) in a mental health setting. PSYCHOL HEALTH MED 2021; 26:1-19. [PMID: 33835880 DOI: 10.1080/13548506.2021.1883685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mental health problems are highly prevalent in primary care. Validated tools to detect mental disorders in general practice are needed. The Four-Dimensional Symptom Questionnaire (4DSQ) was designed to help GPs differentiating between psychological distress and psychopathological conditions (depression, anxiety, somatization). The aim of the current study was to examine psychometric properties of the 4DSQ in a mental health setting. Reliability, factorial, construct, and criterion validity of the English translation of the 4DSQ were analyzed in an American sample of 159 patients attending a psychotherapy outpatient clinic. Measurement equivalence across languages was determined by analyzing differential item functioning (DIF) and differential test functioning (DTF) in the American sample and a Dutch mental health sample, matched by age and sex. A confirmatory factor analysis confirmed all 4DSQ subscales to be unidimensional. All 4DSQ subscales revealed excellent reliability (Cronbach's alpha and McDonald omega ≥.90) and high correlations with a symptom distress subscale of an instrument that is commonly used to monitor psychotherapy progress, the Outcome Questionnaire-45. Eight items were flagged with DIF. The Depression subscale was free of DIF. DTF analyses showed an impact of DIF on scale level for the lower cutoff score of the Distress scale. The 4DSQ Distress score was the best predictor of a mood disorder diagnosis and the Anxiety score outperformed other 4DSQ scales to predict an anxiety disorder. In conclusion, the 4DSQ demonstrates excellent reliability and validity in a mental health setting. Further research is needed to determine reliable cutoff values on 4DSQ subscales to predict psychiatric diagnoses.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.,Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - Anna Exner
- Department of Education Studies and Psychology, University of Siegen, Siegen, Germany
| | | | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Jia S, Zhao W, Zhang Y, Hou L, Xia X, Qiao R, Yue J, Dong B. Multiple Physical Symptoms of Community-Dwelling Older People in Western China: Prevalence and Its Association with Frailty. Gerontology 2021; 67:290-298. [PMID: 33503611 DOI: 10.1159/000513246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/21/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Physical symptoms and frailty are common in older adults. A previous study has reported that multiple somatic symptoms are associated with frailty. In this study, we aimed to describe the picture of physical symptoms in older adults in western China and examine the relationship of multiple physical symptoms and frailty, as well as the sex difference of this relationship. METHODS Cross-sectional analyses were based on the West China Health and Aging Trend (WCHAT) study comprising 4,106 community-dwelling older adults (60-95 years). Frailty was assessed using the physical frailty phenotype (PFP). Participants' experience of 28 different physical symptoms in the past 4 weeks was assessed. Physical symptoms were divided into several categories according to organ systems. Multinomial logistic regression analyses were performed to examine the association between frailty and multiple physical symptoms. RESULTS Nearly half of the subjects reported experiencing at least 1 physical symptom during the past 4 weeks. Musculoskeletal symptoms were the most prevalent symptoms. More than 5 physical symptoms were more likely to be frailty, even when all covariates were controlled. A significant association between multiple musculoskeletal symptoms and frailty also was found after adjusted for all covariates and multiple symptoms of other organ systems. Similar results were obtained for multiple cardiopulmonary symptoms. Furthermore, there were sex differences in these relationships. CONCLUSION Multiple physical symptoms appear to have a detrimental impact on frailty in older adults. Compared with counting total symptoms, multiple symptoms of the same organ system may have a greater impact on frailty. Effective interventions and management of multiple physical symptoms are warranted to prevent frailty.
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Affiliation(s)
- Shuli Jia
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Wanyu Zhao
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zhang
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lisha Hou
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Xia
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Runjuan Qiao
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jirong Yue
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, China, .,Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China,
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Kullgren KA, Klein EJ, Sturza J, Hutton D, Monroe K, Pardon A, Sroufe N, Malas N. Standardizing Pediatric Somatic Symptom and Related Disorders Care: Clinical Pathway Reduces Health Care Cost and Use. Hosp Pediatr 2020; 10:867-876. [PMID: 32978209 DOI: 10.1542/hpeds.2020-0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pediatric somatic symptom and related disorders (SSRDs) are common with high health care costs and use because of lack of standardized, evidence-based practice. Our hospital implemented a clinical pathway (CP) for SSRD evaluation and management. Our study objective was to evaluate health care cost and use associated with the organization's SSRD CP in the emergency department (ED) and inpatient settings hypothesizing lower cost and use in the CP group relative to controls. METHODS We conducted a retrospective analysis of costs and use before and after implementation of the SSRD CP. Data were collected from the hospital's electronic health record and the Pediatric Health Information System database. Participants included pediatric patients on the CP ("P" group) and control groups with an SSRD diagnosis and mental health consultation either the year before the CP ("C" group) or during the CP study period ("T" group). Primary outcomes included costs, length of stay, diagnostic testing, imaging, subspecialty consultation, and readmission rates. RESULTS The ED P group had more lower-cost imaging, whereas the inpatient T group greater higher-cost imaging than other groups. The inpatient P group had significantly shorter length of stay, fewer subspecialty consults, and lower costs. There were no significant group differences in readmission rates. The CP reduced median total costs per patient encounter by $51 433 for the inpatient group and $6075 for the ED group. CONCLUSIONS The CP group showed significant reductions in health care cost and use after implementation of a CP for SSRD care. In future work, researchers should explore patient and practitioner experience with the SSRD CP and long-term outcomes.
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15
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Cao L, Luo G, Cao L, Sheng C, Ou J. Somatization disorder mediates the association of depression and anxiety with functional impairment in patients with heart failure. PSYCHOL HEALTH MED 2020; 26:911-916. [PMID: 32703019 DOI: 10.1080/13548506.2020.1799421] [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] [Indexed: 10/23/2022]
Abstract
Previous studies have suggested that depression, anxiety, and somatization disorder are strongly associated with diminished functional status. However, research has not tested the mediational models of how depression and anxiety lead to functional impairment. The aim of this study was to examine whether somatization disorder mediates the association of depression and anxiety with functional impairment in heart failure (HF) patients. The self-reported questionnaires were applied to measure depression, anxiety, and somatization disorder. Functional status was evaluated by the NYHA Class. Ordinal logistic regression analysis was performed to examine the association of depression, anxiety, and somatization disorder with functional status. Mediation analysis was conducted to determine indirect effects. Functional impairment was both related to depression (OR = 2.257, 95% CI = 1.534-3.322, P < 0.001) and elevated somatization severity (OR = 1.042, 95% CI = 1.003-1.082, P = 0.032) in HF patients, whereas anxiety was not associated with functional impairment (OR = 0.659, 95% CI = 0.429-1.012, P > 0.05). Mediation analysis indicated that both depression and anxiety have indirect effects on functional impairment as mediated by somatization disorder in HF patients. Additionally, depression has direct effect on functional impairment of the patients.
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Affiliation(s)
- Lihuan Cao
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Guo Luo
- Cardiac Intensive Care Unit, Department of Cardiology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Lifang Cao
- Department of Cardiology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Chun Sheng
- Xiangya Nursing School, Central South University, Changsha, China
| | - Jinnan Ou
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, China
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16
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Kullgren KA, Shefler A, Malas N, Monroe K, Leber SM, Sroufe N, El Sakr A, Pomeranz E, O'Brien E, Mychaliska KP. Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders. Hosp Pediatr 2020; 10:105-113. [PMID: 31896546 DOI: 10.1542/hpeds.2019-0141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care. Little literature exists to address SSRDs in the inpatient pediatric setting. The purpose of the study was to characterize current SSRD practice, identify problem areas in workflow, and develop a standardized approach to inpatient evaluation and management at a tertiary care academic children's hospital. METHODS A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014. A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice. Lean methodology was used to define current state practice and future state intervention. These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development. RESULTS Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review. Most patients presented with either neurologic or pain-related complaints. The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalization. Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis. Half of patients had comorbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up. CONCLUSIONS In this study, we describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of pediatric SSRDs. This study may serve as a model for similar standardization of SSRD care in other inpatient pediatric medical settings.
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Affiliation(s)
| | - Alanna Shefler
- Medical School, University of Michigan, Ann Arbor, Michigan
| | - Nasuh Malas
- Pediatrics
- Division of Child and Adolescent Psychiatry, Departments of Psychiatry
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GARRUSI B, DANAEI M, ABOOSAEIDI R. The prevalence and predictive factors of somatization and its relationship with anxiety and depression in Iranian population. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E400-E406. [PMID: 31967099 PMCID: PMC6953450 DOI: 10.15167/2421-4248/jpmh2019.60.4.1006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/05/2019] [Indexed: 11/24/2022]
Abstract
Introduction Today mental disorders are important concerns of health care system in all countries. Among different mental disorders; depression, anxiety, and somatization are more frequent. This manuscript was conducted to evaluate the frequency of somatization symptoms, its related factors and the correlation between somatization symptoms and anxiety and depression disorders in Iranian population. Methods The cross-sectional study was conducted in Kerman, Iran, 2017. Participants were selected from patients who referred to the Clinics of Educational Hospitals using convenience sampling method. The PHQ-15 and HADS questionnaire were used to assess the somatization and depression and anxiety, respectively. The univariate and multivariate logistic regression was used to determine the predictive factors of somatization symptoms. The correlations between each PHQ-15 item score and anxiety and depression score were expressed. Results The frequency of mild, moderate and severe levels of somatization was 66.3%, 20.5% and 13.1%, respectively. Considering multivariate logistic regression analysis; age was associated with somatic symptoms, significantly. The risk of somatic symptoms was 3.4 times more in Divorced/Widowed participants than single ones (p-value: 0.035). There were significant positive correlations between anxiety and depression scores. Each additional score of anxiety and depression were associated with 1.14 times more likely (p-value: < 0.001) and 1.11 times less likely (p-value: 0.003) of having somatic symptoms, respectively. Conclusion The burden of somatization, depression and anxiety is high in Iranian population. Psychologists and policy-makers should consider these predictive factors for primary prevention of somatization at the personal and community level, respectively.
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Affiliation(s)
- B. GARRUSI
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - M. DANAEI
- Department of Community Medicine, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Correspondence: Mina Danaei, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Imam Highway, Shahid Bahonar University, Afzalipour Faculty of Medicine, Community and Family Medicine Department, 7616914115 Kerman, Iran - Tel. +98 913 3409727 - Fax +98 34 33257671 - E-mail:
| | - R. ABOOSAEIDI
- Department of Community Medicine, HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Brambila-Tapia AJL, Meda-Lara RM, Palomera-Chávez A, de-Santos-Ávila F, Hernández-Rivas MI, Bórquez-Hernández P, Juárez-Rodríguez P. Association between personal, medical and positive psychological variables with somatization in university health sciences students. PSYCHOL HEALTH MED 2019; 25:879-886. [PMID: 31661972 DOI: 10.1080/13548506.2019.1683869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To measure personal, medical and psychological positive and negative variables and to determine their relation with somatization in a sample of health sciences students. Subjects and methods: A total of 594 (34.43%) of the 1725 health science students of a public university answered an online survey with personal and medical information as well as the following psychological variables: phsychological well-being, five facets mindfulness questionnaire (FFMQ), life satisfaction, depression, and academic stress. Additionally, the presence of 11 somatic symptoms and 11 diseases during the last year was measured. Results: Most students were women (74.06%) who were 19.96 ± 4.28 years old. The global frequency of somatization in the previous year was 66.59%, and the presence of any measured disease 14.75%. With the multivariate analysis, self-acceptance was the most related variable (negatively) with somatization, followed by the sum of diseases, female gender, academic stress, smoking, and depression, in a model with an R-value of 0.634, self-acceptance was also the most related variable (negatively) with depression, being this last the most related variable with academic stress. Conclusions: After analyzing all variables considered in this study, self-acceptance was the most related variable with somatization and depression; this highlights the importance of strengthening the acceptance of the self in the student population in order to prevent these conditions and their consequences.
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Affiliation(s)
| | - Rosa Martha Meda-Lara
- Departamento de Psicología Básica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara , Guadalajara, México
| | - Andrés Palomera-Chávez
- Departamento de Psicología Básica, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara , Guadalajara, México
| | - Fabiola de-Santos-Ávila
- Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara , Guadalajara, México
| | - María Isabel Hernández-Rivas
- Departamento de Odontología para la Preservación de la Salud, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara , Guadalajara, México
| | - Patricia Bórquez-Hernández
- Unidad de Tutoría Académica de la Coordinación de Servicios Académicos, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara , Guadalajara, México
| | - Pedro Juárez-Rodríguez
- Doctorado en Ciencias Biomédicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara , Guadalajara, México
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Patterns of somatic distress among internally displaced persons in Ukraine: analysis of a cross-sectional survey. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1265-1274. [PMID: 30805693 DOI: 10.1007/s00127-019-01652-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/07/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE There are often high rates of mental disorders in low- and middle-income countries during humanitarian crises, but the prevalence of somatic distress (SD) is underreported in the existing health service research. We aim to examine the patterns of SD among internally displaced persons (IDPs) in Ukraine, who were forcibly displaced due to the ongoing conflict in the country's eastern region. METHODS The study design was a cross-sectional survey of 2203 adult IDPs throughout Ukraine. The survey collected data on sociodemographic characteristics, traumatic life events (Life Events Checklist), utilisation of mental health care services, and self-reported outcomes of SD (Patient Health Questionnaire 15), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), and post-traumatic stress (PTSD Checklist). Descriptive and multivariate regression analyses were used. RESULTS Over half of respondents (n = 1142, 55%) were identified as being at risk of SD (PHQ-15 score ≥ 6), and the prevalence of moderate (n = 377, 18%) and high severity SD risk (n = 275, 13%) was substantial. There were significant associations (p < 0.05) between SD and age, female gender, economic status, self-reported depression and post-traumatic stress, and multiple trauma exposures. Being at risk of SD was also significantly associated with increased functional disability. Use of mental health care services was low across this population and only high SD risk seemed to be a reliable predictor of care-seeking behaviour. CONCLUSIONS There is a significant risk of SD among IDPs in Ukraine. Our results illustrate the need for targeted health service research and regional programs to ensure that mental health needs are appropriately met.
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Alamam DM, Moloney N, Leaver A, Alsobayel HI, Mackey MG. Multidimensional prognostic factors for chronic low back pain-related disability: a longitudinal study in a Saudi population. Spine J 2019; 19:1548-1558. [PMID: 31125695 DOI: 10.1016/j.spinee.2019.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability. PURPOSE To examine associations between CLBP-related disability at 12-month follow-up and individual, psychosocial and physical factors at baseline, as well as treatment-related factors between baseline and 12-month follow-up among a Saudi population. Additionally, associations between pain intensity and general perceived efficacy (GPE) at 12 months were examined with the aforementioned factors. DESIGN A prospective cohort study. PARTICIPANTS One hundred Saudi participants over 18 years with a history of LBP greater than 3 months' duration. MAIN OUTCOME MEASUREMENTS The primary outcome variable was CLBP-related disability measured by the Arabic Oswestry disability index. Secondary outcome measures were pain intensity over the prior week measured by the VAS and the participant's global perceptions of recovery (general perceived efficacy [GPE]) at 12 months. METHODS At baseline (n=115), participants completed questionnaires covering demographics, disability, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. They performed standardized physical performance tests, including assessment of pain behaviors using a pain behavior scale. After 12 months, participants (n=100) completed questionnaires on disability, pain intensity, GPE and provided treatment-related information during the previous year. Predictors of disability, pain, and GPE were explored using univariate and multivariate regression analyses. RESULTS The prognostic model for moderate-severe CLBP-related disability at 12 months explained 53.0% of the variance. Higher pain intensity, higher fear-avoidance work, and older age predicted higher disability. Having no additional somatic symptoms predicted lower disability. Pain intensity at 12-month follow-up was explained by higher disability at baseline, while not being in paid employment appeared protective (25.7% of variance explained). As univariate associations were weak between predictor variables and GPE, multivariate analysis was not conducted. CONCLUSION The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.
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Affiliation(s)
- Dalyah M Alamam
- Faculty of Health Sciences, The University of Sydney, Australia; Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Niamh Moloney
- Faculty of Medicine and Health Sciences, Department of Health Professions, Macquarie University, Australia; THRIVE Physiotherapy, Guernsey, Channel Islands
| | - Andrew Leaver
- Faculty of Health Sciences, The University of Sydney, Australia
| | - Hana I Alsobayel
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Martin G Mackey
- Faculty of Health Sciences, The University of Sydney, Australia
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van Westrienen PE, Pisters MF, Veenhof C, de Wit NJ. Identification of patients with moderate medically unexplained physical symptoms in primary care with a five years follow-up. BMC FAMILY PRACTICE 2019; 20:66. [PMID: 31113381 PMCID: PMC6530058 DOI: 10.1186/s12875-019-0950-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/26/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with medically unexplained physical symptoms (MUPS) are common in primary care, with a spectrum from mild to moderate and chronic MUPS. The burden of chronic MUPS is high, and early identification of moderate MUPS patients is important to prevent chronicity. The PRESUME screening method to identify moderate MUPS patients in primary care was developed, but insight in prognostic accuracy is needed. Therefore, our objective is to determine the prognostic accuracy for identification of moderate MUPS patients using the screening method with 5 year follow-up. METHODS The PRESUME screening method consists of three subsequent steps based on consultation frequency, exclusion of medical/psychiatric diagnosis and identification of MUPS. In a random 10% sample of patients from the Julius General Practitioners Network (n = 114.185), patients were identified with mild, moderate or chronic MUPS in 2008 (index year), using routine care data. In 5 years follow-up we calculated predictive values and odds ratio's for sustained MUPS related symptoms. RESULTS In 2008, 789 patients (6.9% of the patient population) were identified as having mild, moderate or chronic MUPS. On average 55.5% of the moderate MUPS patients in 2008, still had MUPS related symptoms or developed chronic MUPS in 5 year follow-up. Positive predictive values for maintaining MUPS related symptoms or worsening was 67% after 1 year, and 48.7% after 5 years for moderate MUPS patients. CONCLUSION The prognostic accuracy of the PRESUME screening method using electronic medical record data for identification of moderate MUPS patients is moderate. However, it might be a useful method to identify patients at increased risk of moderate MUPS, if combined with a validity check by the GP.
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Affiliation(s)
- Paula Elisabeth van Westrienen
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn Frits Pisters
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
- Physical Therapy Research, department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Nicolaas Johannes de Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Although the self-image distortions and sensitivities of pathological narcissism have been theorized to contribute to somatization, limited empirical research has been devoted to this issue. The present study was developed to test the hypothesis that pathological narcissism contributes to somatic symptoms through increased hypervigiliance to physical sensations. A community sample of 248 adults completed measures of pathological narcissism, somatosensory amplification, somatic symptoms, and depression. Mediation analysis was conducted, controlling for depression, using 99% bootstrapped confidence intervals to examine the indirect effect of pathological narcissism on somatic symptoms via somatosensory amplification. Although pathological narcissism was not directly related to somatic symptoms, a significant indirect effect was observed for pathological narcissism on somatic symptoms via somatosensory amplification. This finding suggests that pathological narcissism contributes to physical hypersensitivity, in turn influencing perceptions of somatic distress. The role of narcissistic dysfunction in somatization indicates the importance of further research and potential clinical consideration.
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González-Blanch C, Fernando Hernández-de-Hita, Muñoz-Navarro R, Ruíz-Rodríguez P, Medrano LA, Moriana JA, Cano-Vindel A. Domain-specific associations between disability and depression, anxiety, and somatization in primary care patients. Psychiatry Res 2018; 269:596-601. [PMID: 30205353 DOI: 10.1016/j.psychres.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/26/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
This study explores the associations between different disability domains and the most prevalent symptoms of mental disorders in primary care patients (i.e. depression, anxiety, and somatization). A total of 1241 participants from 28 primary care centres completed self-report measures of depression, anxiety, and somatization. This same sample also completed the Sheehan Disability Scale (SDS) to assess functional impairment in work, social life, and family life domains. Associations between the symptoms and each disability domain were examined using hierarchical regression analyses. Depression emerged as the strongest predictor of all three disability domains. Somatization was associated only with the work domain, and anxiety was associated only with the family life domain. Clinical symptoms explained a greater proportion of the variance than sociodemographic variables. In primary care patients, depression, anxiety and somatizations were associated with distinct domains of disability. Early provision of effective treatments in the primary care setting may be crucial to reduce the societal burden of common mental disorders.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla- IDIVAL. Santander, Spain.; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain.
| | | | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | | | - Juan Antonio Moriana
- Department of Psychology, University of Córdoba/Maimónides Institute for Research in Biomedicine of Córdoba-IMIBIC/Reina Sofía University Hospital, Spain
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Kealy D, Rice SM, Ogrodniczuk JS, Spidel A. Childhood trauma and somatic symptoms among psychiatric outpatients: Investigating the role of shame and guilt. Psychiatry Res 2018; 268:169-174. [PMID: 30029065 DOI: 10.1016/j.psychres.2018.06.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/25/2018] [Accepted: 06/22/2018] [Indexed: 11/26/2022]
Abstract
Previous research suggests a link between experiences of childhood maltreatment and adult somatic symptom distress. Contributing mechanisms, however, are not yet well understood. It is possible that shame and guilt may function as mediators in the relationship between childhood trauma and adult somatic distress. The present study was developed to investigate the relationship between childhood maltreatment and adult somatic distress, including the potential mediating role of shame and guilt, among psychiatric outpatients. Using data from a sample of 99 Canadian psychiatric outpatients, mediation models with shame and guilt as parallel mediators were evaluated for relationships between childhood emotional abuse, sexual abuse, emotional neglect, and somatic symptoms. Controlling for current depressive symptoms, a significant indirect effect was found for the relationship between emotional abuse and shame, but not guilt, in contributing to somatic symptoms. A similar result was obtained regarding the mediating role of shame in the relationship between emotional neglect and somatic symptoms. Mediation was non-significant regarding childhood sexual abuse, which was directly related to somatic distress after controlling for depressive symptoms. The findings provide further evidence of the link between childhood trauma and somatic symptom distress, with shame as a mechanism for the effects of emotional abuse and neglect.
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Affiliation(s)
- David Kealy
- Department of Psychiatry, University of British Columbia, #420-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada.
| | - Simon M Rice
- Orygen, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, #420-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Alicia Spidel
- White Rock/South Surrey Mental Health and Substance Use Services, 15521 Russell Avenue, White Rock, BC, Canada V4B 2R4
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Sitnikova K, Pret-Oskam R, Dijkstra-Kersten SMA, Leone SS, van Marwijk HWJ, van der Horst HE, van der Wouden JC. Management of patients with persistent medically unexplained symptoms: a descriptive study. BMC FAMILY PRACTICE 2018; 19:88. [PMID: 29914406 PMCID: PMC6006667 DOI: 10.1186/s12875-018-0791-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2013 the Dutch guideline for management of medically unexplained symptoms (MUS) was published. The aim of this study is to assess medical care for patients with persistent MUS as recorded in their electronic medical records, to investigate if this is in line with the national guideline for persistent MUS and whether there are changes in care over time. METHODS We conducted an observational study of adult primary care patients with MUS. Routinely recorded health care data were extracted from electronic medical records of patients participating in an ongoing randomised controlled trial in 30 general practices in the Netherlands. Data on general practitioners' (GPs') management strategies during MUS consultations were collected in a 5-year period for each patient prior. Management strategies were categorised according to the options offered in the Dutch guideline. Changes in management over time were analysed. RESULTS Data were collected from 1035 MUS consultations (77 patients). Beside history-taking, the most frequently used diagnostic strategies were physical examination (24.5%) and additional investigations by the GP (11.1%). Frequently used therapeutic strategies were prescribing medication (24.6%) and providing explanations (11.2%). As MUS symptoms persisted, GPs adjusted medication, discussed progress and scheduled follow-up appointments more frequently. The least frequently used strategies were exploration of all complaint dimensions (i.e. somatic, cognitive, emotional, behavioural and social) (3.5%) and referral to a psychologist (0.5%) or psychiatrist (0.1%). CONCLUSIONS Management of Dutch GPs is partly in line with the Dutch guideline. Medication was possibly prescribed more frequently than recommended, whereas exploration of all complaint dimensions, shared problem definition and referral to mental health care were used less.
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Affiliation(s)
- Kate Sitnikova
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Rinske Pret-Oskam
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Sandra M A Dijkstra-Kersten
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Stephanie S Leone
- Department of Public Mental Health, Trimbos Institute: Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521, VS, Utrecht, the Netherlands
| | - Harm W J van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, BN1 9PH, UK
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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Sharma M, Singh SM, Avasthi A, Varma SC, Sharma A, Suri V. Medically unexplained physical symptoms in patients attending a medical outpatient clinic in a tertiary hospital in North India. Asian J Psychiatr 2018; 32:99-104. [PMID: 29222988 DOI: 10.1016/j.ajp.2017.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/31/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Medically unexplained physical symptoms (MUPS) are commonly seen across health care settings. Earlier studies have focussed on prevalence, cost-utilization and burden. Data from India is scarce. Patients with persistent MUPS have more impairment and psychological distress. This study was designed to assess psychological morbidity, health anxiety (HA), somatic symptom load, disability, quality of life (QOL) in patients with persistent MUPS presenting to a general medical outpatient service and compare it with patients with medically explained physical symptoms (MEPS). METHODS The study was conducted in the outpatient service of the Department of Internal Medicine in a tertiary hospital in North India. Persistent MUPS was defined as physical symptoms of at least 3 months duration leading to dysfunction and with no identifiable medical cause. 70 patients with persistent MUPS and MEPS each were recruited. Psychiatric morbidity was assessed using the Mini International Neuropsychiatric interview, somatic symptom load with Patient Health Questionniare-15 (PHQ-15), HA with Whiteley Index, disability with WHODAS 2.0 and QOL with WHOQOL-Bref. RESULTS Both the groups were comparable on socio-demography and length of symptoms. Prevalence of psychiatric disorders and HA was significantly greater in MUPS. Patients with persistent MUPS had significantly more health care utilization, number and burden of somatic symptoms, greater disability and worse QOL. CONCLUSIONS Patients with persistent MUPS have a different profile when compared to MEPS. There is a need to screen and identify patients with MUPS and manage them keeping in mind the psychological factors and chronic nature and number of symptoms.
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Affiliation(s)
- Mohit Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Shubh Mohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Subhash C Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Aman Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh 16012, India.
| | - Vikas Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh 16012, India.
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Srivastava S, Bhatia MS, Gautam P. 25 Hydroxyvitamin D levels, quality of life, and disability in long-standing patients of somatization. Ind Psychiatry J 2018; 27:87-91. [PMID: 30416297 PMCID: PMC6198590 DOI: 10.4103/ipj.ipj_73_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Somatization disorder is a debilitating condition, in which patients have multiple physical complaints with no explained cause and no relief even after consultations. AIM The present study examined the association of 25-hydroxyvitamin D (25[OH]D) levels, quality of life, disability, and symptom profile in long standing with somatization disorder. METHODS One-hundred three patients of somatization disorder suffering for ≥2 years, visiting psychiatry outpatient clinic during two consecutive summer season (April to June) of 2015-2016 were recruited. Symptom profile was studied using Patient-Health-Questionnaire (PHQ-15) items (somatic symptoms), PHQ-9 items (depressive symptoms), Generalized Anxiety Disorder-7 (GAD-7) item (anxiety symptoms).quality of life was assessed using the World Health Organization Quality of Life BREF 26 item, and disability measure was World Health Organization Disability Assessment Schedule (WHODAS) 2.0. 25(OH) D levels were estimated using chemiluminescence binding assay. RESULTS The poor quality of life in somatization disorder was significantly associated with disability, symptom profile using PHQ-15, PHQ-9, and GAD-7. 25(OH)D levels were deficient in 56.31% of the study population. CONCLUSION The high somatic symptom severity in majority of patients suffering from somatization disorder needs more attention from psychiatrists across cultures so that functional status and quality of life can be improved. Routine estimation of Vitamin D levels and correction of its deficiency may bring about symptomatic relief at an early stage, thereby reducing the morbidity associated with the disorder.
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Affiliation(s)
- Shruti Srivastava
- Department of Psychiatry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Manjeet Singh Bhatia
- Department of Psychiatry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Priyanka Gautam
- Department of Psychiatry, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
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Examining differences in cognitive and affective theory of mind between persons with high and low extent of somatic symptoms: an experimental study. BMC Psychiatry 2017; 17:200. [PMID: 28558727 PMCID: PMC5450064 DOI: 10.1186/s12888-017-1360-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/17/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medically unexplained somatic symptoms are common, associated with disability and strongly related to depression and anxiety disorders. One interesting, but to date rarely tested, hypothesis is that deficits in both theory of mind (ToM) and emotional awareness may undergird the phenomenon of somatization. This study sought to investigate whether or not differences in ToM functioning and self-reported emotional awareness are associated with somatic symptoms in a sample from the general population. METHODS The sample consisted of 50 healthy participants (37 females, 13 males) aged between 22 and 64 years (46.8 ± 11.7) of whom 29 reported a high extent of somatic symptoms (HSR), whereas 21 reported a low extent of somatic symptoms (LSR) based on the 30 highest and lowest percentiles of the Symptom List norms. The participants' affective and cognitive ToM were assessed with two experimental paradigms by experimenters who were blind to the participants' group membership. In addition, self-reports regarding emotional awareness, alexithymia, depressive and anxiety symptoms and current affect were collected. RESULTS In the experimental tasks, HSR showed lower affective ToM than LSR but the groups did not differ in cognitive ToM. Although HSR reported lower emotional awareness than LSR in the self-report measure, this group difference vanished when we controlled for anxiety and depression. Depression, anxiety, emotional awareness and alexithymia were correlated positively. CONCLUSIONS The data supported the hypothesis that deficits in affective ToM are related to somatic symptoms. Neither cognitive ToM nor self-reported emotional awareness were associated with somatic symptoms. Self-reported emotional awareness, alexithymia and symptoms of depression and anxiety shared a considerable amount of variance.
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Van Straaten B, Van der Laan J, Rodenburg G, Boersma SN, Wolf JRLM, Van de Mheen D. Dutch homeless people 2.5 years after shelter admission: what are predictors of housing stability and housing satisfaction? HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:710-722. [PMID: 27189388 DOI: 10.1111/hsc.12361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 06/05/2023]
Abstract
Housing stability is an important focus in research on homeless people. Although definitions of stable housing differ across studies, the perspective of homeless people themselves is generally not included. Therefore, this study explored the inclusion of satisfaction with the participant's current housing status as part of the definition of housing stability and also examined predictors of housing stability with and without the inclusion of homeless person's perspective. Of the initial cohort consisting of 513 homeless participants who were included at baseline in 2011, 324 (63.2%) were also interviewed at 2.5-year follow-up. To determine independent predictors of housing stability, we fitted multivariate logistic regression models using stepwise backward regression. At 2.5-year follow-up, 222 participants (68.5%) were stably housed and 163 participants (51.1%) were stably housed and satisfied with their housing status. Having been arrested (OR = 0.36, 95% CI: 0.20-0.63), a high level of somatisation (physical manifestations of psychological distress) (OR = 0.52, 95% CI: 0.30-0.91) and having unmet care needs (OR = 0.77, 95% CI: 0.60-0.99) were negative predictors of housing stability. Having been arrested (OR = 0.43, 95% CI: 0.25-0.75), high debts (OR = 0.45, 95% CI: 0.24-0.84) and a high level of somatisation (OR = 0.49, 95% CI: 0.28-0.84) were negative predictors of stable housing when satisfaction with the housing status was included. Because inclusion of a subjective component revealed a subgroup of stably housed but not satisfied participants and changed the significant predictors, this seems a relevant addition to the customary definition of housing stability. Participants with characteristics negatively associated with housing stability should receive more extensive and individually tailored support services to facilitate achievement of housing stability.
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Affiliation(s)
- Barbara Van Straaten
- Erasmus Medical Centre, Rotterdam, the Netherlands
- IVO Addiction Research Institute, Rotterdam, the Netherlands
| | - Jorien Van der Laan
- Department of Primary and Community Care, Impuls - Netherlands Center for Social Care Research, Radboud University Medical Center, Nijmegen, the Netherlands
- Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Gerda Rodenburg
- Erasmus Medical Centre, Rotterdam, the Netherlands
- IVO Addiction Research Institute, Rotterdam, the Netherlands
| | - Sandra N Boersma
- Department of Primary and Community Care, Impuls - Netherlands Center for Social Care Research, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith R L M Wolf
- Department of Primary and Community Care, Impuls - Netherlands Center for Social Care Research, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dike Van de Mheen
- Erasmus Medical Centre, Rotterdam, the Netherlands
- IVO Addiction Research Institute, Rotterdam, the Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
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Abstract
Somatic symptom disorder (SSD) is a common disorder encountered in pediatric medicine. It involves the presentation of physical symptoms that are either disproportionate or inconsistent with history, physical examination, laboratory, and other investigative findings. SSDs result in significant impairment with considerable increase in healthcare utilization, school absenteeism, and the potential for unnecessary diagnostic evaluation and treatment intervention. Patients and families often feel dismissed and may worry that a serious condition has been missed. Primary care providers are frequently frustrated due to a lack of a successful approach to patients and families impacted by SSD. The result is often a cycle of disability, frustration and missed opportunities for collaboration towards enhanced patient functionality. This review summarizes the current evidence-based understanding, as well as insights from clinician experience, on the evaluation and management of pediatric SSD.
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Weiss FD, Rief W, Kleinstäuber M. Health care utilization in outpatients with somatoform disorders: Descriptives, interdiagnostic differences, and potential mediating factors. Gen Hosp Psychiatry 2017; 44:22-29. [PMID: 28041572 DOI: 10.1016/j.genhosppsych.2016.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Somatoform disorders are characterized by increased health care utilization producing high health costs. The aim of this study was to assess facets of and interdiagnostic differences in health care use in somatoform disorders and to examine health anxiety, symptom-related disability, depression, and phobic anxiety as potential mediating factors of the relationship between somatization and health care use. METHOD An outpatient sample of N=254 patients with somatoform disorders was investigated by analyzing different facets of their health care use over the last 12months. Multiple mediation analyses were applied. RESULTS Participants reported a mean of 28.02 doctor visits over the last year. Patients fulfilling criteria of DSM-IV somatization disorder had a significantly higher number of doctor visits than patients with undifferentiated somatoform, and somatoform pain disorder, all p≤.006. In most health care use variables, patients with comorbid mental disorders did not differ from patients without comorbidities. The mediation model on the effect of all mediator variables on the relationship between somatization and health care use reached significance (b=0.32, 95% CI: 0.0576, 0.6435). Surprisingly, specific mediator effects were found for health anxiety (b=0.06, 95% CI: 0.0004, 0.1505) and disability (b=0.18, 95% CI: 0.0389, 0.3530), but not for depression and phobic anxiety. CONCLUSIONS Health anxiety and symptom-related disability should be further considered when investigating potential etiological factors of increased health care use.
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Affiliation(s)
- Frauke Dorothee Weiss
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany
| | - Maria Kleinstäuber
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany.
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Yamanashi H, Shimizu Y, Koyamatsu J, Nobuyoshi M, Nagayoshi M, Kadota K, Tamai M, Maeda T. Multiple somatic symptoms and frailty: cross-sectional study in Japanese community-dwelling elderly people. Fam Pract 2016; 33:453-60. [PMID: 27130337 DOI: 10.1093/fampra/cmw028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical frailty is relevant to adverse outcomes, but appropriate procedures for screening populations are lacking. We hypothesized that frailty is associated with multiple somatic symptoms because frail elderly people might have several somatic symptoms attributed to deterioration of multiple organs. OBJECTIVE To examine the association between multiple somatic symptoms and frailty. METHODS We conducted a cross-sectional study and enrolled 1818 participants aged ≥60 years from Japanese national medical check-up in 2015. Frailty status was categorized into frail, pre-frail or non-frail based on the definition of the Fried frailty phenotype model. Sixteen self-reported subjective somatic symptoms were recorded at the timing of medical check-up. Odds ratio (OR) and 95% confidence interval (CI) of frail or pre-frail were analyzed using number of somatic symptoms. RESULTS Out of total of 1818 subjects, 44 (2.4%) frail subjects, 635 (34.9%) pre-frail subjects and 1139 (62.7%) non-frail subjects were detected. More than two somatic symptoms were significantly associated with the frail phenotype (OR 6.20, 95% CI 2.95, 13.03, P < 0.001) and were associated with the pre-frail phenotype (OR 2.06, 95% CI 1.69, 2.51, P < 0.001). Associations remained significant after multi-adjustment for age, sex, past medical cardiovascular diseases and depressive mood The number of somatic symptoms ≥2 was thought to be the optimal cut-off point to predict frail with a sensitivity of 79.6%, specificity of 61.5%. CONCLUSIONS Our study shows that multiple somatic symptoms are independently associated with frailty. Using more than two multiple somatic symptoms as a prescreening tool for frailty may be appropriate.
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Affiliation(s)
- Hirotomo Yamanashi
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto, Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki and
| | | | | | - Masaharu Nobuyoshi
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto
| | | | | | - Mami Tamai
- Department of Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Maeda
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto, Department of Community Medicine and
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Kealy D, Tsai M, Ogrodniczuk JS. Pathological narcissism and somatic symptoms among men and women attending an outpatient mental health clinic. Int J Psychiatry Clin Pract 2016; 20:175-8. [PMID: 27335122 DOI: 10.1080/13651501.2016.1199811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore the relationship between types of pathological narcissism and somatic symptoms among psychiatric outpatients. METHODS Patients (N = 95) completed measures of somatic symptoms, narcissistic grandiosity and vulnerability, and psychiatric symptoms. Relationships among variables were analysed using t-tests and correlations, controlling for psychiatric distress. RESULTS Somatic symptoms were positively associated with two types of narcissistic dysfunction. Among women there was a positive association between somatic symptoms and narcissistic vulnerability, but not grandiosity. Among men, somatic symptoms were positively associated with narcissistic grandiosity, but not vulnerability. CONCLUSIONS The connection between narcissistic pathology and somatic symptom severity appears to differ based on gender. Further research is needed to confirm and extend this preliminary finding.
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Affiliation(s)
- David Kealy
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada
| | - Michelle Tsai
- b Surrey Mental Health & Substance Use Services , Fraser Health Authority , Surrey , Canada
| | - John S Ogrodniczuk
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada
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