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Li C, Chen J, Chen Y, Zhang C, Yang H, Yu S, Song H, Fu P, Zeng X. The association between patterns of exposure to adverse life events and the risk of chronic kidney disease: a prospective cohort study of 140,997 individuals. Transl Psychiatry 2024; 14:424. [PMID: 39375339 PMCID: PMC11458756 DOI: 10.1038/s41398-024-03114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 10/09/2024] Open
Abstract
Exposure to adverse life events is linked to somatic disorders. The study aims to evaluate the association between adverse events at varying life stages and the risk of chronic kidney disease (CKD), a condition affecting about 10% population worldwide. This prospective cohort study included 140,997 participants from the UK Biobank. Using survey items related to childhood maltreatment, adulthood adversity and catastrophic trauma, we performed latent class analysis to summarize five distinct patterns of exposure to adverse life events, namely "low-level exposure", "childhood exposure", "adulthood exposure", "sexual abuse" and "child-to-adulthood exposure". We used Cox proportional hazard regression to evaluate the association of patterns of exposure to adverse life events with CKD, regression-based mediation analysis to decompose the total effect, and gene-environment-wide interaction study (GEWIS) to identify interactions between genetic loci and adverse life events. During a median follow-up of 5.98 years, 2734 cases of incident CKD were identified. Compared with the "low-level exposure" pattern, "child-to-adulthood exposure" was associated with increased risk of CKD (hazard ratio 1.37, 95% CI 1.14 to 1.65). BMI, smoking and hypertension mediated 11.45%, 9.79%, and 4.50% of this total effect, respectively. Other patterns did not show significant results. GEWIS and subsequent analyses indicated that the magnitude of the association between adverse life events and CKD differed according to genetic polymorphisms, and identified potential underlying pathways (e.g., interleukin 1 receptor activity). These findings underscore the importance of incorporating an individual's psychological encounters and genetic profiles into the precision prevention of CKD.
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Affiliation(s)
- Chunyang Li
- Department of Nephrology and Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Chen
- Central Laboratory, Sichuan Academy of Medical Science and Sichuan Provincial Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yilong Chen
- Department of Nephrology and Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chao Zhang
- Department of Nephrology and Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huazhen Yang
- Department of Nephrology and Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shaobin Yu
- Department of Nephrology and Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huan Song
- Center of Mental Health, West China Hospital, Sichuan University, Chengdu, China
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Ping Fu
- Department of Nephrology and Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Zeng
- Department of Nephrology and Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China.
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Löwe B, Toussaint A, Rosmalen JGM, Huang WL, Burton C, Weigel A, Levenson JL, Henningsen P. Persistent physical symptoms: definition, genesis, and management. Lancet 2024; 403:2649-2662. [PMID: 38879263 DOI: 10.1016/s0140-6736(24)00623-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 03/22/2024] [Indexed: 08/29/2024]
Abstract
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Christopher Burton
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
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Chaabouni A, Houwen J, Grewer G, Liebau M, Akkermans R, van Boven K, Walraven I, Schers H, Olde Hartman T. The burden of persistent symptom diagnoses in primary care patients: a cross-sectional study. Scand J Prim Health Care 2024; 42:112-122. [PMID: 38189313 PMCID: PMC10851811 DOI: 10.1080/02813432.2023.2293930] [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: 08/24/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION The burden of symptoms is a subjective experience of distress. Little is known on the burden of feeling unwell in patients with persistent symptom diagnoses. The aim of this study was to assess the burden in primary care patients with persistent symptom diagnoses compared to other primary care patients. METHODS A cross-sectional study was performed in which an online survey was sent to random samples of 889 patients with persistent symptom diagnoses (>1 year) and 443 other primary care patients after a transactional identification in a Dutch primary care data registry. Validated questionnaires were used to assess the severity of symptoms (PHQ-15), Symptom Intensity and Symptom Interference questionnaires, depression (PHQ-9), anxiety (GAD-7), quality of life (SF-12 and EQ-5D-5L)) and social functioning (SPF-ILs). RESULTS Overall, 243 patients completed the survey: 178 (73.3%) patients in the persistent symptom diagnoses group and 65 (26.7%) patients in the control group. In the persistent group, 65 (36.5%) patients did not have persistent symptom(s) anymore according to the survey response. Patients who still had persistent symptom diagnoses (n = 113, 63.5%) reported significantly more severe somatic symptoms (mean difference = 3.6, [95% CI: 0.24, 4.41]), depression (mean difference = 3.0 [95% CI: 1.24, 3.61]) and anxiety (mean difference = 2.3 [95% CI: 0.28, 3.10]) and significantly lower physical functioning (mean difference = - 6.8 [95% CI: -8.96, -3.92]). CONCLUSION Patients with persistent symptom diagnoses suffer from high levels of symptoms burden. The burden in patient with persistent symptoms should not be underestimated as awareness of this burden may enhance person-centered care.
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Affiliation(s)
- Asma Chaabouni
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Juul Houwen
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Georg Grewer
- USUMA Markt- und Sozialforschung GmbH, Berlin, Germany
| | - Martin Liebau
- USUMA Markt- und Sozialforschung GmbH, Berlin, Germany
| | - Reinier Akkermans
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kees van Boven
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henk Schers
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Fiedorowicz JG, Guthrie E, Löwe B. Seryan Atasoy, 2023 EAPM Elsevier Young Investigator Award recipient, on stability of somatic symptoms. J Psychosom Res 2023; 173:111497. [PMID: 37743219 DOI: 10.1016/j.jpsychores.2023.111497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Bernd Löwe
- University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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Neuroticism and adverse life events are important determinants in functional somatic disorders: the DanFunD study. Sci Rep 2022; 12:19604. [PMID: 36380136 PMCID: PMC9666664 DOI: 10.1038/s41598-022-24213-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Several psychological factors have been proposed to be associated with functional somatic disorders (FSD). However, large population-based studies investigating the importance of both personality and adverse life events (ALE) are sparse. This study aimed to investigate the association between FSD and neuroticism and the accumulated number of ALE, respectively. This cross-sectional study included a random sample of the adult Danish population (N = 7493). FSD were established by means of self-reported questionnaires and diagnostic interviews. Neuroticism was measured with the Danish version of the short-form NEO Personality Inventory. ALE were measured with the Danish version of the Cumulative Lifetime Adversity Measure. Strong positive associations were found between neuroticism and FSD, and ALE and questionnaire-based FSD. For interview-based FSD, strong positive associations were found for FSD, multi-organ type, and for the subtype of the general symptoms. The level of self-efficacy did not modify these associations, and no moderating effect of neuroticism and ALE in combination on the probability of having FSD was found. FSD were strongly associated with both neuroticism and the accumulated number of ALE, and these associations were not modified by self-efficacy. In combination, neuroticism and ALE did not have a moderating effect on the probability of having FSD.
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Severin Hennemann, 2022 EAPM Elsevier Young Investigator Award Recipient, on Moderators in internet-based treatment for somatic symptom distress. J Psychosom Res 2022; 160:110995. [PMID: 35917631 DOI: 10.1016/j.jpsychores.2022.110995] [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: 11/22/2022]
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