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Senger K, Heider J, Kleinstäuber M, Sehlbrede M, Witthöft M, Schröder A. Network Analysis of Persistent Somatic Symptoms in Two Clinical Patient Samples. Psychosom Med 2022; 84:74-85. [PMID: 34428004 DOI: 10.1097/psy.0000000000000999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous attempts to group persistent somatic symptoms (PSSs) with factor-analytic approaches have obtained heterogeneous results. An alternative approach that seems to be more suitable is the network theory. Compared with factor analysis, which focuses on the underlying factor of symptoms, network analysis focuses on the dynamic relationships and interactions among different symptoms. The main aim of this study is to apply the network approach to examine the heterogeneous structure of PSS within two clinical samples. METHODS The first data set consisted of n = 254 outpatients who were part of a multicenter study. The second data set included n = 574 inpatients, both with somatoform disorders. Somatic symptom severity was assessed with the Screening of Somatoform Disorder (SOMS-7T). RESULTS Results indicate that there are five main symptom groups that were found in both samples: neurological, gastrointestinal, urogenital, cardiovascular, and musculoskeletal symptoms. Although patterns of symptoms with high connection to each other look quite similar in both networks, the order of the most central symptoms (e.g., symptoms with a high connection to other symptoms in the network) differs. CONCLUSIONS This work is the first to estimate the structure of PSS using network analysis. A next step could be first to replicate our findings before translating them into clinical practice. Second, results may be useful for generating hypotheses to be tested in future studies, and the results open new opportunities for a better understanding for etiology, prevention, and intervention research.
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Affiliation(s)
- Katharina Senger
- From the Department of Psychology (Senger, Heider, Schröder), University of Koblenz-Landau, Landau, Germany; Department of Psychology (Kleinstäuber), Emma Eccles Jones College of Education and Health Services, Utah State University, Logan, Utah; Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Centre (Sehlbrede), University of Freiburg, Freiburg im Breisgau; and Division of Clinical Psychology and Psychotherapy (Witthöft), Johannes Gutenberg University of Mainz, Mainz, Germany
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Sitnikova K, Dijkstra-Kersten SMA, Mokkink LB, Terluin B, van Marwijk HWJ, Leone SS, van der Horst HE, van der Wouden JC. Systematic review of measurement properties of questionnaires measuring somatization in primary care patients. J Psychosom Res 2017; 103:42-62. [PMID: 29167047 DOI: 10.1016/j.jpsychores.2017.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/02/2017] [Accepted: 10/09/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this review is to critically appraise the evidence on measurement properties of self-report questionnaires measuring somatization in adult primary care patients and to provide recommendations about which questionnaires are most useful for this purpose. METHODS We assessed the methodological quality of included studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. To draw overall conclusions about the quality of the questionnaires, we conducted an evidence synthesis using predefined criteria for judging the measurement properties. RESULTS We found 24 articles on 9 questionnaires. Studies on the Patient Health Questionnaire-15 (PHQ-15) and the Four-Dimensional Symptom Questionnaire (4DSQ) somatization subscale prevailed and covered the broadest range of measurement properties. These questionnaires had the best internal consistency, test-retest reliability, structural validity, and construct validity. The PHQ-15 also had good criterion validity, whereas the 4DSQ somatization subscale was validated in several languages. The Bodily Distress Syndrome (BDS) checklist had good internal consistency and structural validity. Some evidence was found for good construct validity and criterion validity of the Physical Symptom Checklist (PSC-51) and good construct validity of the Symptom Check-List (SCL-90-R) somatization subscale. However, these three questionnaires were only studied in a small number of primary care studies. CONCLUSION Based on our findings, we recommend the use of either the PHQ-15 or 4DSQ somatization subscale for somatization in primary care. Other questionnaires, such as the BDS checklist, PSC-51 and the SCL-90-R somatization subscale show promising results but have not been studied extensively in primary care.
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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.
| | - 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.
| | - Lidwine B Mokkink
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - Berend Terluin
- 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.
| | - Harm W J van Marwijk
- Center for Primary Care, Institute of Population Health, University of Manchester, United Kingdom.
| | - 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.
| | - 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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Sekwena EK, Fontaine JRJ. Redefining and assessing emotional understanding based on the componential emotion approach. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317714681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports on a redefinition and a new operationalisation of the construct of emotional understanding based on the componential emotion approach. Emotional understanding was redefined as the ability to understand the likely emotional processes (i.e., appraisals, action tendencies, bodily reactions, expressions, and subjective feelings) that emerge when a person encounters goal-relevant events. In all, 10 emotions were identified to represent the variability in the emotion domain. For each emotion, a scenario was constructed that typically elicits that emotion. For each scenario, participants had to rate the likelihood of five emotions, five appraisals, five action tendencies, five bodily reactions, five expressions, and five subjective feelings. The new instrument, the Components of Emotional Understanding Test–South African Student version, was administered to 132 undergraduate students from diverse cultural backgrounds. Confirmatory factor analysis confirmed the expected one-factorial structure. Emotional understanding correlated positively with verbal cognitive ability, self-report emotional intelligence, and well-being and was negatively correlated with somatic complaints. Moreover, women outscored men, and no difference was observed between respondents with Black African and White cultural backgrounds.
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Affiliation(s)
- Eva Kefilwe Sekwena
- School of Human Resource Sciences, Faculty of Economic and Management Sciences, North-West University, South Africa
- Department of Personnel Management, Work and Organizational Psychology, Ghent University, Belgium
| | - Johnny RJ Fontaine
- School of Human Resource Sciences, Faculty of Economic and Management Sciences, North-West University, South Africa
- Department of Personnel Management, Work and Organizational Psychology, Ghent University, Belgium
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Porsius JT, Martens AL, Slottje P, Claassen L, Korevaar JC, Timmermans DRM, Vermeulen R, Smid T. Somatic symptom reports in the general population: Application of a bi-factor model to the analysis of change. J Psychosom Res 2015; 79:378-83. [PMID: 26526312 DOI: 10.1016/j.jpsychores.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the latent structure of somatic symptom reports in the general population with a bi-factor model and apply the structure to the analysis of change in reported symptoms after the emergence of an uncertain environmental health risk. METHODS Somatic symptoms were assessed in two general population environmental health cohorts (AMIGO, n=14,829 & POWER, n=951) using the somatization scale of the four-dimensional symptom questionnaire (4DSQ-S). Exploratory bi-factor analysis was used to determine the factor structure in the AMIGO cohort. Multi-group and longitudinal models were applied to assess measurement invariance. For a subsample of residents living close to a newly introduced power line (n=224), we compared a uni- and multidimensional method for the analysis of change in reported symptoms after the power line was put into operation. RESULTS We found a good fit (RMSEA=0.03, CFI=0.98) for a bi-factor model with one general and three symptom specific factors (musculoskeletal, gastrointestinal, cardiopulmonary). The latent structure was found to be invariant between cohorts and over time. A significant increase (p<.05) was found only for musculoskeletal and gastrointestinal symptoms after the power line was put into operation. CONCLUSIONS In our study we found that a bi-factor structure of somatic symptoms reports was equivalent between cohorts and over time. Our findings suggest that taking this structure into account can lead to a more informative interpretation of a change in symptom reports compared to a unidimensional approach.
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Affiliation(s)
- Jarry T Porsius
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Astrid L Martens
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands.
| | - Pauline Slottje
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Liesbeth Claassen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Tjabe Smid
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; KLM Health Services, Schiphol, The Netherlands
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Khanna P, Agarwal N, Khanna D, Hays RD, Chang L, Bolus R, Melmed G, Whitman CB, Kaplan RM, Ogawa R, Snyder B, Spiegel BM. Development of an online library of patient-reported outcome measures in gastroenterology: the GI-PRO database. Am J Gastroenterol 2014; 109:234-48. [PMID: 24343547 PMCID: PMC4275098 DOI: 10.1038/ajg.2013.401] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/22/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Because gastrointestinal (GI) illnesses can cause physical, emotional, and social distress, patient-reported outcomes (PROs) are used to guide clinical decision making, conduct research, and seek drug approval. It is important to develop a mechanism for identifying, categorizing, and evaluating the over 100 GI PROs that exist. Here we describe a new, National Institutes of Health (NIH)-supported, online PRO clearinghouse-the GI-PRO database. METHODS Using a protocol developed by the NIH Patient-Reported Outcome Measurement Information System (PROMIS(®)), we performed a systematic review to identify English-language GI PROs. We abstracted PRO items and developed an online searchable item database. We categorized symptoms into content "bins" to evaluate a framework for GI symptom reporting. Finally, we assigned a score for the methodological quality of each PRO represented in the published literature (0-20 range; higher indicates better). RESULTS We reviewed 15,697 titles (κ>0.6 for title and abstract selection), from which we identified 126 PROs. Review of the PROs revealed eight GI symptom "bins": (i) abdominal pain, (ii) bloat/gas, (iii) diarrhea, (iv) constipation, (v) bowel incontinence/soilage, (vi) heartburn/reflux, (vii) swallowing, and (viii) nausea/vomiting. In addition to these symptoms, the PROs covered four psychosocial domains: (i) behaviors, (ii) cognitions, (iii) emotions, and (iv) psychosocial impact. The quality scores were generally low (mean 8.88 ± 4.19; 0 (min)-20 (max). In addition, 51% did not include patient input in developing the PRO, and 41% provided no information on score interpretation. CONCLUSIONS GI PROs cover a wide range of biopsychosocial symptoms. Although plentiful, GI PROs are limited by low methodological quality. Our online PRO library (www.researchcore.org/gipro/) can help in selecting PROs for clinical and research purposes.
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Affiliation(s)
- Puja Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nikhil Agarwal
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA,Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ron D. Hays
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA
| | - Lin Chang
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roger Bolus
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Gil Melmed
- Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Cynthia B. Whitman
- UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Robert M. Kaplan
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA
| | - Rikke Ogawa
- Biomedical Library of the Health Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Bradley Snyder
- UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Brennan M.R. Spiegel
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA,Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA,Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
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Abstract
Somatic symptoms are common presentations in health settings. They can manifest as symptoms of another underlying mental disorder or be termed as medically unexplained. When they are medically unexplained they are invariably subsumed under the diagnostic categories of somatoform disorders. They are associated with interference in functioning, poor quality of life and are burdensome on health resources. The measurement of these symptoms is essential for understanding the individual and planning treatment. There are various instruments that have somatic symptoms measurement in their items. The tools have included somatic symptoms measurement in measuring general psychopathology, somatic symptoms as part of anxiety and depression, somatic symptoms specifically, and as a screening instrument for somatoform disorders. The advantages and disadvantages of common measures have been discussed. It appears that no one measure fulfils the essential criteria of an ideal measure for somatic symptoms. The measures of somatic symptoms should also be culturally sensitive and serve diagnostic, prognostic and heuristic purposes. These aspects are highlighted in the review.
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Affiliation(s)
- Santosh K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Beirens K, Fontaine JRJ. Somatic complaint differences between Turkish immigrants and Belgians: do all roads lead to Rome? ETHNICITY & HEALTH 2011; 16:73-88. [PMID: 21170770 DOI: 10.1080/13557858.2010.529113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Turkish immigrants have been found to report more somatic complaints compared to western majority groups. The present study investigates the combination of two cultural explanations (somatization versus psychologization and emotion mediation) with two acculturative explanations (acculturative stress versus acculturative transition) to explain these differences. DESIGN In total, 144 Turkish immigrants, 353 Belgian majority members, and 222 Turkish majority members were asked to report the last three emotional episodes they encountered and to rate them on 24 emotion terms and 17 somatic sensations. RESULTS Turkish majorities scored higher on all somatic factors, anxiety-sadness, and self-conscious emotions followed by Turkish immigrants and Belgian majorities. Furthermore, path analysis showed (partial) mediation effects of anxiety-sadness and self-conscious factors on the differences in the somatic factors between Belgian and Turkish majorities. CONCLUSION These results indicate that the somatic differences do not result from a trade-off between somatization and psychologization, but that emotions mediate differences in somatic processes to a large extent. It was also found that differences between Turkish immigrants and Belgian majority members are to be attributed to acculturative transition, rather than to acculturative stress.
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Affiliation(s)
- Koen Beirens
- Department of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
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