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Raasthøj I, Jarbøl DE, Rasmussen S, Wehberg S, Sætre LMS, Rosendal M, Carstensen TBW. Multiple physical symptoms and coping strategies over the last decade - Knowledge from two Danish population-based cross-sectional studies in 2012 and 2022. J Psychosom Res 2024; 184:111832. [PMID: 38936009 DOI: 10.1016/j.jpsychores.2024.111832] [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: 10/27/2023] [Revised: 03/25/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To compare the prevalence of multiple physical symptoms, coping scores, and associations between multiple physical symptoms and coping in two population-based surveys within a 10-year interval. METHODS A nationwide study on symptoms and healthcare-seeking, the Danish Symptom Cohort, was carried out in 2012 and repeated in 2022. For each survey, 100,000 randomly selected individuals were invited, and individuals aged 20-64 years were eligible for inclusion. Multiple physical symptoms were identified using the 25-item Bodily Distress Syndrome checklist, and coping was assessed with the Brief Approach/Avoidance Coping Questionnaire. Statistical analyses included multinomial and logistic regressions. RESULTS A total of 35,877 were included in 2012 and 18,330 in 2022. Overall, 35.1% reported multiple physical symptoms in 2022 compared with 23.8% in 2012. The mean sum score for approach was lower in 2022 than in 2012 with a statistically significant mean difference of -1.27 (Cohen's d = -0.34), while diversion and resignation scores were significantly higher in 2022 with mean differences of 0.34 (Cohen's d = 0.11) and 0.52 (Cohen's d = 0.17), respectively. Regression analyses showed that lower approach scores and higher diversion and resignation scores were associated with an increased probability of having multiple physical symptoms in 2022, thereby confirming the results from 2012. CONCLUSION Over the decade, symptom reporting may have increased while coping strategies may have changed towards a slightly higher use of avoidance and lower use of approach. It seems relevant to identify modifiable contributing factors in society to prevent an acceleration of symptom reporting and avoidant behavior.
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Affiliation(s)
- Isabella Raasthøj
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Dorte Ejg Jarbøl
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Sanne Rasmussen
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Sonja Wehberg
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Lisa Maria Sele Sætre
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Marianne Rosendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; The Research Unit for General Practice, Aarhus, Denmark.
| | - Tina Birgitte Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Madsen MM, Trolle C, Fynne L, Ørnbøl E, Fink P, Gormsen LK. Can internal medicine specialists diagnose functional somatic disorders (FSDs)? Training and comparison with FSD specialists. PLoS One 2024; 19:e0307057. [PMID: 38995907 PMCID: PMC11244839 DOI: 10.1371/journal.pone.0307057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Functional somatic disorders (FSD) are a common problem across medical settings and remain challenging to diagnose and treat. Many patients with FSD undergo sequential and unnecessary extensive diagnostic work-up, which is costly for society and stressful for patients. Previous studies have shown that the empirically based FSD diagnostic entities are interrater reliable and stable over time. OBJECTIVE The aim of this study was to investigate whether internists who have received adequate training and with sufficient time per patient could diagnose FSD. DESIGN This was a prospective diagnostic accuracy study. The study was conducted from May 2020 to April 2022. PARTICIPANTS The study included 27 consecutive patients referred by their general practitioner to a non-psychiatric diagnostic clinic for assessment of physical symptoms on suspicion of FSD. INTERVENTIONS The internists received a 30-hour training course in the use of a tailored version of the SCAN interview. MAIN MEASURES The main outcome measure was the agreement between the diagnoses of the internists and the reference diagnoses made by specialists in FSD on the basis of the full SCAN interview. KEY RESULTS The interrater agreement between the internists and the FSD experts was substantial for any FSD (kappa = 0.63) as well as multi-organ vs. single-organ FSD (kappa = 0.73), indicating good diagnostic agreement. CONCLUSIONS Internists with proper training and sufficient time (3-4 hours) per patient can proficiently diagnose FSD employing a tailored version of the SCAN interview for use in a non-psychiatric diagnostic setting.
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Affiliation(s)
- Michael Moesmann Madsen
- University Clinic for Innovative Patient Pathways, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
- Silkeborg Psychiatric Center, Central Regional Psychiatry, Silkeborg, Denmark
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Christian Trolle
- University Clinic for Innovative Patient Pathways, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Lotte Fynne
- University Clinic for Innovative Patient Pathways, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Lise Kirstine Gormsen
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Rometsch C, Mansueto G, Maas Genannt Bermpohl F, Martin A, Cosci F. Prevalence of functional disorders across Europe: a systematic review and meta-analysis. Eur J Epidemiol 2024; 39:571-586. [PMID: 38551715 PMCID: PMC11249491 DOI: 10.1007/s10654-024-01109-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2024] [Indexed: 07/16/2024]
Abstract
Functional Disorders (FD) refer to persistent somatic symptoms caused by changes in the functioning of bodily processes. Previous findings suggest that FD are highly prevalent, but overall prevalence rates for FD in European countries are scarce. Therefore, the aim of the present work was to estimate the point prevalence of FD in adult general populations. PubMed and Web of Science were searched from inception to June 2022. A generalized linear mixed-effects model for statistical aggregation was used for statistical analyses. A standardized quality assessment was performed, and PRISMA guidelines were followed. A total of 136 studies were included and systematically synthesized resulting in 8 FD diagnoses. The large majority of studies was conducted in the Northern Europe, Spain, and Italy. The overall point prevalence for FD was 8.78% (95% CI from 7.61 to 10.10%) across Europe, with the highest overall point prevalence in Norway (17.68%, 95% CI from 9.56 to 30.38%) and the lowest in Denmark (3.68%, 95% CI from 2.08 to 6.43%). Overall point prevalence rates for specific FD diagnoses resulted in 20.27% (95% CI from 16.51 to 24.63%) for chronic pain, 9.08% (95% CI from 7.31 to 11.22%) for irritable bowel syndrome, and 8.45% (95% CI from 5.40 to 12.97%) for chronic widespread pain. FD are highly prevalent across Europe, which is in line with data worldwide. Rates implicate the need to set priorities to ensure adequate diagnosis and care paths to FD patients by care givers and policy makers.
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Affiliation(s)
- Caroline Rometsch
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | | | - Alexandra Martin
- School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Tattan M, Ørnbøl E, Wellnitz KB, Hanssen DJC, Dantoft TM, Rosmalen JGM, Fink P, Petersen MW. Factors associated with having previously received a diagnosis of fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome: A cross sectional DanFunD study. J Psychosom Res 2024; 181:111693. [PMID: 38724318 DOI: 10.1016/j.jpsychores.2024.111693] [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: 12/22/2023] [Revised: 03/22/2024] [Accepted: 05/03/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES Fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome are highly prevalent conditions and part of the functional somatic syndromes (FSS) diagnosis, that are classified under the unifying umbrella term functional somatic disorder (FSD). Multiple factors are associated with FSD symptom development; However, few studies have explored these associations in relation to the diagnosis status. This study aims to examine associations with a previously received FSS diagnosis from a physician in participants fulfilling the FSD diagnostic criteria in a population-based sample. METHODS This research employs a comprehensive observational approach using a cross sectional design with data from the DanFunD part two cohort. Information about received FSS diagnoses was obtained from self-reported questionnaires. Participants fulfilling the FSD diagnostic criteria were identified with both self-reported questionnaires and diagnostic interviews. Validated questionnaires were used to assess the examined factors. RESULTS 1704 cases fulfilled the diagnostic criteria for an FSD according to questionnaires or interviews in the DanFunD study. In participants fulfilling the diagnostic criteria, having previously received an FSS diagnosis by a physician was strongly associated with female sex, negative illness perceptions and poor health-related quality of life for questionnaire and interview-based diagnoses. Less consistent associations were observed for lower socioeconomic status, anxiety, and adverse life events. CONCLUSION Previously received FSS diagnoses showed associations with multiple factors with a particular strong association with female sex and poor health related quality of life.
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Affiliation(s)
- Mais Tattan
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, the Netherlands.
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Denise J C Hanssen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Frederiksberg, Capital Region Denmark, Denmark
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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Jespersen CP, Pedersen HF, Kleinstäuber M, Fink P, Wellnitz KB, Ørnbøl E, Schröder A, Agger JL, Vase L, Finnerup NB, Gormsen LK. Efficacy of patient education and duloxetine, alone and in combination, for patients with multisystem functional somatic disorder: Study protocol for the EDULOX trial. Contemp Clin Trials 2024; 141:107524. [PMID: 38604496 DOI: 10.1016/j.cct.2024.107524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Multisystem functional somatic disorder is characterized by specific patterns of persistent physical symptoms with a complex biopsychosocial etiology. The disorder can lead to disability and personal suffering. Current treatment options require specialized settings, therefore patients often wait a long time to receive specific treatment. Patient education is considered important in most treatment programs, but has only been investigated sparsely as a stand-alone treatment. Pharmacological treatment is limited to tricyclic antidepressants in low doses with no antidepressant properties. Duloxetine has been found effective in single organ functional disorders. As a treatment for multisystem functional somatic disorder, duloxetine could reduce symptoms and treat comorbid anxiety and depression. It may furthermore enhance the effect of patient education through a hypothesized effect on cognitive functioning. The purpose of the EDULOX trial is to study psycho-EDUcation and duLOXetine alone and in combination. METHODS This is a nested study design. The parent trial "EDULOX1" (n = 424) will compare a patient education program with enhanced usual care in an open-labelled, randomized controlled trial. In addition to this, eligible participants will furthermore receive either duloxetine or active placebo in the nested, double-blinded, randomized controlled trial, "EDULOX2" (n = 212). Patient and clinician reported outcomes will be collected through questionnaires. CONCLUSION The EDULOX trial may establish evidence for treatments applicable for the majority of patients with multisystem functional somatic disorder. If effective, duloxetine would be a more tolerable pharmacological treatment option that can target comorbid depression and anxiety, and potentially boost the effect of patient education. Trial registration number The study is registered at www. CLINICALTRIALS gov (NCT06232473) and the internal list of research projects at the Region of Central Denmark (Case number 1-16-02-305-23). Approval from the Danish Medical Research Ethics Committees (Case number: 2212291) and the Danish Medicines Agency was obtained under EudraCT Number: 2022-002780-30 and Sponsor's Protocol Code Number: 9515.
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Affiliation(s)
- Cecilia Pihl Jespersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Heidi Frølund Pedersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Johanne Liv Agger
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Vase
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Nanna Brix Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Lise Kirstine Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Møllehave LT, Madsen AL, Kampmann FB, Bjerregaard AA, Dantoft TM, Leth-Møller KB, Thysen SM, Schovsbo SU, Jacobsen RK, Aadahl M, Osler M, Jørgensen T, Linneberg A, Kårhus LL. Cohort Profile Update: The Glostrup Population Studies 1964-2024. Int J Epidemiol 2024; 53:dyae051. [PMID: 38734963 DOI: 10.1093/ije/dyae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/22/2024] [Indexed: 05/13/2024] Open
Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anja Lykke Madsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Freja Bach Kampmann
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anne Ahrendt Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Katja Biering Leth-Møller
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Sanne Marie Thysen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Signe Ulfbeck Schovsbo
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rikke Kart Jacobsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Line Lund Kårhus
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Sommen SL, Zhao Z, Segtnan S, Stiansen-Sonerud T, Selvakumar J, Beier Havdal L, Gjerstad J, Wyller VBB, Lund Berven L. Bulk RNA sequencing for analysis of post COVID-19 condition in adolescents and young adults. J Transl Med 2024; 22:312. [PMID: 38532465 PMCID: PMC10964710 DOI: 10.1186/s12967-024-05117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Post COVID-19 condition (PCC) is a complication of SARS-COV-2 infection and can lead to long-term disability. METHODS The present study was designed to analyse the gene expression patterns of PCC through bulk RNA sequencing of whole blood and to explore the potential molecular mechanisms of PCC. Whole blood was collected from 80 participants enrolled in a prospective cohort study following SARS-CoV-2 infected and non-infected individuals for 6 months after recruitment and was used for bulk RNA sequencing. Identification of differentially expressed genes (DEG), pathway enrichment and immune cell deconvolution was performed to explore potential biological pathways involved in PCC. RESULTS We have found 13 differentially expressed genes associated with PCC. Enriched pathways were related to interferon-signalling and anti-viral immune processes. CONCLUSION The PCC transcriptome is characterized by a modest overexpression of interferon-stimulated genes, pointing to a subtle ongoing inflammatory response.
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Affiliation(s)
- Silke Lauren Sommen
- Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, Oslo, Norway
| | - Zhi Zhao
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Tonje Stiansen-Sonerud
- Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway
- Department of Clinical Molecular Biology (EpiGen), University of Oslo and Akershus University Hospital, Lørenskog, Norway
| | - Joel Selvakumar
- Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Beier Havdal
- Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway
| | - Johannes Gjerstad
- Department of Behavioural Sciences, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Vegard Bruun Bratholm Wyller
- Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Lund Berven
- Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway.
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Jørgensen T, Dantoft TM, Petersen MW, Gormsen L, Winter-Jensen M, Fink P, Linneberg A, Benros ME, Eplov LF, Bjerregaard AA, Schovsbo SU, Brinth LS. Is reduced heart rate variability associated with functional somatic disorders? A cross-sectional population-based study; DanFunD. BMJ Open 2024; 14:e073909. [PMID: 38326244 PMCID: PMC10860071 DOI: 10.1136/bmjopen-2023-073909] [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: 03/22/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES It has been hypothesised that functional somatic disorders (FSD) could be initiated by sympathetic predominance in the autonomic nervous system as measured by low heart rate variability (HRV). Earlier studies on the association between HRV and FSD are small case-control studies hampered by selection bias and do not consider the great overlap between the various FSDs. The aim of the present study is to assess any associations between HRV and various FSDs and whether chronic stress confounds such an association. DESIGN A cross-sectional general population-based study. SETTING The Danish Study of Functional Somatic Disorders conducted 2013-2015 in 10 municipalities in the western part of Greater Copenhagen, Denmark. PARTICIPANTS A total of 6891 men and women aged 18-72 years were included in the analyses after exclusion of 602 persons with missing HRV data. Various delimitations of FSD (chronic fatigue, chronic widespread pain, irritable bowel and bodily distress syndrome) were identified by validated questionnaires and diagnostic interviews. HRV parameters in time and frequency domains were calculated from successive beat-to-beat heart rate (HR) data using the 'E-motion' HR monitor device during 7 min of supine rest. Chronic stress was assessed by Cohen's self-perceived stress scale. OUTCOME MEASURES Logistic regression analyses were used to calculate possible associations between the various delimitations of FSD and HRV adjusting for chronic stress. RESULTS Persons with FSD had a slightly higher mean HR and lower HRV as measured by time domain parameters, whereas associations with frequency domain parameters were not consistent. Adjusting for chronic stress attenuated associations slightly. CONCLUSION The study supports a sympathetic predominance in persons with FSD, which could not be entirely explained by chronic stress. However, it is not possible to conclude whether the association is a causal factor to or a consequence of FSD.
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Affiliation(s)
- Torben Jørgensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Lise Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Matilde Winter-Jensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Ahrendt Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Signe Ulfbeck Schovsbo
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Louise Schouborg Brinth
- Department of Imaging and Radiology, Copenhagen University Hospital - North Zealand, Helsingør, Denmark
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9
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Brund RBK, Jensen LS, Gladvind KM, Fonager K. Sociodemographic and hospital characteristics for patients with severe functional disorder receiving specialized treatment at hospital. A regional register-based cross-sectional study from Denmark. J Psychosom Res 2024; 176:111561. [PMID: 38100895 DOI: 10.1016/j.jpsychores.2023.111561] [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: 10/08/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE 10% of all adult Danish citizen has a functional disorder (FD). This study aimed to describe how patients referred to specialized treatment (CFD; Clinic for Functional Disorders) differentiate from those not referred to specialized treatment in terms of sex, comorbidty, different types of hospital contacts and affiliation to labour market 12 and 60 months prior discharged from the hospital with a FD-diagnosis between 2019 and 2021. METHODS The study was a register-based cross-sectional study of patients discharged with a FD in North Denmark Region between 2019 and 2021 (study period). Patients between 18 and 65 years of age with FD were identified in the regional patient administrative system. RESULTS A total of 6831 patients were discharged from the hospital with a FD, of which 160 were referred to CFD. Patients with FD were more likely to be referred to CFD, if they were female, had reduced or no affiliation to the labour market or most hospital contacts were as outpatient. Moreover, an increase in hospital contacts as outpatient and a reduction in affiliation to labour market over time increased the chance of being treated at CFD. CONCLUSION Patients referred to CFD differed from patients not referred to CFD. Patients referred to CFD were to a lesser extent affiliated to the labour market but had more often hospital contacts as outpatient prior to being discharged with FD. In addition, patients referred to CFD increased their contacts to the hospital as outpatient more than those not referred during the preceding 5 years from discharge with FD.
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Affiliation(s)
- René Børge Korsgaard Brund
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Denmark.
| | | | | | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ma D, Cao J, Wei J, Fritzsche K, Toussaint AC, Li T, Zhang L, Zhang Y, Chen H, Wu H, Ma X, Li W, Ren J, Lu W, Leonhart R. The distribution of somatic symptom disorder and bodily distress syndrome in general hospital outpatients in China: A multicenter cross-sectional study. Gen Hosp Psychiatry 2023; 85:171-176. [PMID: 37948794 DOI: 10.1016/j.genhosppsych.2023.10.017] [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: 05/24/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To investigate the distribution of somatic symptom disorder (SSD) and bodily distress syndrome (BDS) and analyze the differences in psychosocial characteristics of patients with the two diagnoses. METHODS A total of 694 general hospital outpatients completed the diagnostic interviews for SSD and BDS, and a set of questionnaires evaluating their psychosocial characteristics. A secondary analysis of these data is done. RESULTS SSD and BDS had a moderate overlap (kappa value = 0.43). Patients who fulfilled both SSD and BDS diagnosis showed significantly higher levels of symptom-related psychological distress (SSD-12), somatic symptom severity (PHQ-15), depression (PHQ-9), and general anxiety (GAD-7), as well as lower mental and physical quality of life (SF-12) compared to patients with neither diagnosis and patients with only one diagnosis. Patients with either diagnosis were associated with significantly higher psychosocial impairments as compared to those with neither diagnosis. Patients who only met SSD had higher SSD-12 scores, whereas those with only BDS had higher PHQ-15 scores (p<0.001). CONCLUSIONS SSD and BDS appear to represent somewhat different psychopathologies, with SSD more associated with psychological distress and BDS associated with greater experience of somatic symptoms. Patients fulfilling both diagnosis show higher symptom severity in various psychosocial aspects.
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Affiliation(s)
- Dandan Ma
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Kurt Fritzsche
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, Germany
| | - Anne Christin Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, China
| | - Yaoyin Zhang
- Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, China
| | - Hua Chen
- Department of Psychological Medicine, Zhong Shan Hospital, Fudan University, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Tongji Hospital, School of Medicine, Tongji University, China
| | - Xiquan Ma
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, China
| | - Wentian Li
- Department of Clinic Psychology, Wuhan Mental Health Centre, Wuhan, China
| | - Jie Ren
- Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd, China
| | - Wei Lu
- Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University, China
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11
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Jacobsen SA, Frostholm L, Buhmann CB, Petersen MW, Ørnbøl E, Dantoft TM, Bjerregaard AA, Eplov LF, Carstensen TBW. Are Sexual Assaults Related to Functional Somatic Disorders? A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6947. [PMID: 37887685 PMCID: PMC10606494 DOI: 10.3390/ijerph20206947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
An increasing number of sexual assaults (SAs) are being reported. This study investigated associations between SA and FSD, conceptualized as bodily distress syndrome (BDS), and five functional somatic syndromes (FSSs): chronic widespread pain (CWP), irritable bowel (IB), chronic fatigue (CF), multiple chemical sensitivity (MCS), and whiplash-associated disorder (WAD). Participants (n = 7493) from the population-based cohort Danish Study of Functional Disorders (DanFunD) completed questionnaires on FSD, emotional distress, SA, and sociodemographics. Risk ratios (RRs) for each FSD and emotional distress were calculated in nine models with SA as the primary exposure using generalized linear models with binomial family and log link and were adjusted for other potential risk factors. The results showed that SA was associated with single-organ FSD (RR = 1.51; 95% CI = 1.22-1.87), multi-organ FSD (RR = 3.51; 95% CI = 1.89-6.49), CWP (RR = 1.28; 95% CI = 0.83-1.98), IB (RR = 2.00; 95% CI = 1.30-3.07), CF (RR = 1.81; 95% CI = 1.42-2.32), WAD (RR = 2.62; 95% CI = 1.37-5.03), MCS (RR = 3.04; 95% CI = 1.79-5.17), emotional distress (RR = 1.75; 95% CI = 1.21-2.54), and health anxiety (RR = 1.65; 95% CI = 1.10-2.46). Overall, SA victims experienced significantly more somatic symptoms than individuals not exposed to SA. Adjusting for physical and emotional abuse did not change the observed associations. Our results suggest a large impact of SA on the overall somatic and mental health of SA victims. Due to the cross-sectional study design, further studies are required.
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Affiliation(s)
- Sofie Abildgaard Jacobsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | | | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, 2000 Frederiksberg, Denmark; (T.M.D.); (A.A.B.)
| | - Anne Ahrendt Bjerregaard
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, 2000 Frederiksberg, Denmark; (T.M.D.); (A.A.B.)
- Department of Epidemiology Research, Statens Serum Institute, 2300 Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health—CORE (Eplov), Mental Health Centre Copenhagen, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, 8200 Aarhus N, Denmark; (L.F.); (M.W.P.); (E.Ø.); (T.B.W.C.)
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
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12
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Tarar ZI, Farooq U, Nawaz A, Gandhi M, Ghouri YA, Bhatt A, Cash BD. Prevalence of Fibromyalgia and Chronic Fatigue Syndrome among Individuals with Irritable Bowel Syndrome: An Analysis of United States National Inpatient Sample Database. Biomedicines 2023; 11:2594. [PMID: 37892968 PMCID: PMC10604744 DOI: 10.3390/biomedicines11102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023] Open
Abstract
Background and Aim: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with other somatic disorders. We studied the prevalence and predictors of fibromyalgia and chronic fatigue syndrome (CFS) in IBS patients. Methods: We used the National Inpatient Sample and included hospitalization of individuals with IBS, using ICD-10 codes, from 2016-2019. The prevalence and predictors of fibromyalgia and CFS in IBS patients were studied. Univariate and multivariate patient- and hospital-level regression models were used to calculate the adjusted odds of fibromyalgia and CFS in the IBS patient population. Results: Of 1,256,325 patients with an ICD-10 code of IBS included in the study, 10.73% (134,890) also had ICD-10 codes for fibromyalgia and 0.42% (5220) for CFS. The prevalence of fibromyalgia and CFS was significantly higher in IBS patients (adjusted odds ratio (AOR) 5.33, 95% confidence interval (CI) 5.24-5.41, p < 0.001, and AOR 5.40, 95% CI 5.04-5.78, p < 0.001, respectively) compared to the general adult population without IBS. IBS-diarrhea, IBS-constipation, and IBS-mixed types were independently associated with increased odds of fibromyalgia and CFS. Increasing age (AOR 1.02, 95% CI 1.01-1.04, p 0.003; AOR 1.02, 95% CI 1.01-1.03, p 0.001), female gender (AOR 11.2, 95% CI 11.1-11.4, p < 0.001; AOR 1.86, 95% CI 1.78-1.93, p < 0.001) and white race (AOR 2.04, 95% CI 1.95-2.12, p < 0.001; AOR 1.69, 95% CI 1.34-2.13, p < 0.001) were independent predictors of increased odds of fibromyalgia and CFS, respectively. Conclusions: It appears that IBS is associated with an increased prevalence of somatic disorders such as fibromyalgia and CFS.
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Affiliation(s)
- Zahid Ijaz Tarar
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Umer Farooq
- Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO 63103, USA;
| | - Ahmad Nawaz
- Division of Gastroenterology and Hepatology, Suny Upstate Medical University, Syracuse, NY 13210, USA
| | - Mustafa Gandhi
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Yezaz A. Ghouri
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Asmeen Bhatt
- Center for Interventional Gastroenterology at UTHealth (iGUT), Division of Elective Surgery, Department of Surgery, University of Texas Health Medical School, Houston, TX 77030, USA
| | - Brooks D. Cash
- Division of Gastroenterology & Hepatology, University of Texas Health-McGovern Medical School and UT Health Science Center at Houston, St. Houston, TX 77054, USA
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13
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Mamo N, van de Klundert M, Tak L, Hartman TO, Hanssen D, Rosmalen J. Characteristics of collaborative care networks in functional disorders: A systematic review. J Psychosom Res 2023; 172:111357. [PMID: 37392482 DOI: 10.1016/j.jpsychores.2023.111357] [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: 03/10/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Functional disorders (FD) are complex conditions, for which multidisciplinary involvement is often recommended. Collaborative care networks (CCN) may unlock the potential of the multidisciplinary team (MDT) in FD care. To understand what characteristics should be part of CCNs in FD, we studied the composition and characteristics of existing CCNs in FD. METHODS We performed a systematic review following PRISMA guidelines. A search of PubMed, WebofScience, PsycInfo, SocINDEX, AMED and CINAHL was undertaken to select studies describing CCNs in FD. Two reviewers extracted characteristics of the different CCNs. Characteristics were classified as relating to structure and processes of networks. RESULTS A total of 62 studies were identified representing 39 CCNs across 11 countries. Regarding structural characteristics, we found that most networks are outpatient, secondary-care based, with teams of between two and 19 members. Medical specialists were most commonly involved and the typical team leads as well as main patient contacts were general practitioners (GPs) or nurses. Regarding processes, collaboration was demonstrated mostly during assessment, management and patient education, less often during rehabilitation and follow-up, mostly using MDT meetings. CCNs provided a wide range of treatment modalities, reflecting a biopsychosocial approach, including psychological therapies, physiotherapy and social and occupational therapy. CONCLUSION CCNs for FD are heterogeneous, showing a wide variety of structures as well as processes. The heterogeneity of results provides a broad framework, demonstrating considerable variation in how this framework is applied in different contexts. Better development of network evaluation, as well as professional collaboration and education processes is needed.
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Affiliation(s)
- Nick Mamo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands.
| | - Manouk van de Klundert
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lineke Tak
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Denise Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands
| | - Judith Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, Netherlands
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14
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Sattel H, Häuser W, Schmalbach B, Brähler E, Henningsen P, Hausteiner-Wiehle C. Functional Somatic Disorders, Their Subtypes, and Their Association With Self-Rated Health in the German General Population. Psychosom Med 2023; 85:366-375. [PMID: 36917486 DOI: 10.1097/psy.0000000000001187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The heterogeneous conceptualizations and classifications of persistent and troublesome physical symptoms impede their adequate clinical management. Functional somatic disorder (FSD) is a recently suggested interface concept that is etiologically neutral and allows for dysfunctional psychobehavioral characteristics as well as somatic comorbidity. However, its prevalence and impact are not yet known. METHODS We analyzed 2379 participants (mean age = 48.3 years, 52.5% female) from a representative German community survey using operationalized FSD criteria. These criteria defined FSD types based on somatic symptom count, type, and severity assessed by the Bodily Distress Syndrome Checklist. In addition, the associations of those types with health concerns, comorbidity, psychological distress, and self-rated health were determined. RESULTS There were four clearly demarcated groups with no relevant bothering symptoms, with one or with few bothering symptoms from one organ system, and with multiple bothering symptoms from at least two organ systems. Psychological distress, health concerns, and comorbidity steadily increased, and self-rated health decreased according to the number and severity of symptoms. Somatic symptom burden, health concerns, and comorbidity independently predicted self-rated health, with no interaction effect between the latter two. CONCLUSIONS Our data support an FSD concept with two severity grades according to persistent and troublesome symptoms in one versus more organ systems. The delimitation of subtypes with psychobehavioral characteristics and/or with somatic comorbidity seems useful, while still allowing the demarcation of a group of participants with high symptom burden but without those additional characteristics.
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Affiliation(s)
- Heribert Sattel
- From the Department of Psychosomatic Medicine and Psychotherapy (Sattel, Henningsen, Hausteiner-Wiehle), Technical University of Munich, Munich; Department of Internal Medicine 1 (Häuser), Klinikum Saarbrücken, Saarbrücken; Departments of Medical Psychology and Medical Sociology (Schmalbach) and Psychosomatic Medicine and Psychotherapy (Brähler), University of Mainz, Mainz; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit (Brähler), University of Leipzig Medical Center, Leipzig; and Department of Neurology (Hausteiner-Wiehle), BGTrauma Center Murnau, Murnau, Germany
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15
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Saunders C, Sperling S, Bendstrup E. A new paradigm is needed to explain long COVID. THE LANCET. RESPIRATORY MEDICINE 2023; 11:e12-e13. [PMID: 36620963 DOI: 10.1016/s2213-2600(22)00501-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Chloe Saunders
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Søren Sperling
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
| | - Elisabeth Bendstrup
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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16
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Raasthøj I, Rasmussen S, Carstensen TBW, Wehberg S, Rosendal M, Jarbøl DE. Coping strategies among individuals with multiple physical symptoms: A general population-based cross-sectional study. J Psychosom Res 2023; 165:111140. [PMID: 36621211 DOI: 10.1016/j.jpsychores.2022.111140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Coping has been suggested as a perpetuating factor for physical symptoms. The aim of this study was to examine the use of the coping strategies approach, resignation, and diversion in individuals with multiple physical symptoms according to the construct of Bodily Distress Syndrome (BDS). METHODS This cross-sectional study was part of the nationwide web-based survey Danish Symptom Cohort (DaSC). In total, 100,000 individuals were invited to participate, and individuals eligible for the present study were respondents aged 20-64 years without a current or recent pregnancy. Multiple physical symptoms were identified using the BDS checklist, and coping was assessed by the Brief Approach/Avoidance Coping Questionnaire. Statistical analyses included descriptive statistics and multinomial and logistic regression. RESULTS A total of 35,810 respondents were included in the study, of which 8512 (23.8%) fulfilled the criteria for having multiple physical symptoms. This group of respondents had lower coping scores on approach and higher coping scores on resignation and diversion compared with the non-BDS group. The regression analyses showed that high scores on approach were associated with a lower probability of having multiple symptoms (adjusted OR 0.92, 95% CI: 0.91-0.92), whereas high scores on diversion and resignation were associated with a higher probability of having multiple symptoms (adjusted OR 1.10; 95% CI: 1.09-1.11 and adjusted OR 1.19; 95% CI: 1.18-1.20, respectively). CONCLUSION The study supports the hypothesis that experiencing multiple physical symptoms is associated with certain coping strategies. This is relevant knowledge for health care professionals who will be treating this patient group.
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Affiliation(s)
- Isabella Raasthøj
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Sanne Rasmussen
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Tina Birgitte Wisbech Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Sonja Wehberg
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Marianne Rosendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; The Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
| | - Dorte Ejg Jarbøl
- The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
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17
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Pedersen HF, Lamm TT, Fink P, Ørnbøl E, Frostholm L. Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial. Contemp Clin Trials Commun 2023; 32:101069. [PMID: 36698746 PMCID: PMC9868341 DOI: 10.1016/j.conctc.2023.101069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/15/2022] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Background Functional somatic disorders (FSDs) with symptoms from multiple organs, i.e., multi-system type, are common in the general population and may lead to disability and reduced quality of life. Evidence for efficient treatment programs has been established, however, there is a need for making treatments accessible to a larger group of patients. Internet-delivered therapy has become prevalent and has proven as effective as face-to-face therapy, while providing a flexible and easily accessible treatment alternative. The aim of the current study is to compare the efficacy of the therapist-assisted internet-delivered treatment program One step at a time (OneStep) with the internet-delivered self-help program Get started (GetStarted). Methods A total of 166 participants aged 18-60 years diagnosed with multi-system FSD will be assessed and randomized to either 1) OneStep: a 14-week program consisting of 11 treatment modules based on principles from cognitive behavioural therapy or 2) GetStarted consisting of 1 module on psychoeducation. The primary outcome is physical health, assessed by a Short Form Health Survey (SF-36) aggregate score of the subscales vitality, physical functioning, and bodily pain 3 months after end-of-treatment and self-reported improvement assessed by the Clinical Global Improvement Scale. Secondary outcomes include symptom load, depression, anxiety, and illness worry. Process measures include emotional distress, illness perception, illness behaviour, and symptom interference. Conclusions This study is the first study to test an internet-delivered treatment program for FSD, multi-system type and has the potential to show the importance of making evidence-based internet-delivered treatment for FSD more accessible.
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Affiliation(s)
- Heidi Frølund Pedersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Corresponding author. Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul Jensens Boulevard 11, 8200 Aarhus N, Denmark.
| | - Thomas Tandrup Lamm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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18
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Characteristics of a Danish Post-COVID Cohort Referred for Examination due to Persistent Symptoms Six Months after Mild Acute COVID-19. J Clin Med 2022; 11:jcm11247338. [PMID: 36555954 PMCID: PMC9783804 DOI: 10.3390/jcm11247338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Post-COVID Clinics were recommended for patients with persistent symptoms following COVID-19, but no specific tests were suggested for evaluation. This study aimed to present a post-COVID clinic patient cohort and evaluate the use of a post-COVID symptom questionnaire (PCQ) score. METHODS Patients were referred from a population of approximately 1 million citizens. PCQ and standardized health scales were registered. Descriptive analyses were performed to assess the prevalence of symptoms, and correlation analyses was undertaken to asses convergent and discriminant trends between PCQ scores and health scales. RESULTS Of 547 patients, 447 accepted inclusion. The median age was 47 years and 12% of the patients were hospitalized. At a median of 6.3 (IQR 4.4-9.9) months after the onset of symptoms, 82% of the patients reported both physical exhaustion and concentration difficulties. Functional disability and extreme fatigue were reported as moderate to severe by 33% and 62% of the patients, respectively. The PCQ score correlated significantly with each of the standardized health scales. CONCLUSION Patients referred to a Post-COVID Clinic were previously generally healthy. At the time of diagnosis, they reported multiple symptoms with severely affected health. The PCQ score could be used as valid measure of Post-COVID severity.
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Ma J, Zheng L, Chen R, Ren J, Chen H, Zhang Y, Li W, Ma X, Lu W, Wu H, Fritzsche K, Toussaint AC, Leonhart R, Wei J, Zhang L. A multicenter study of bodily distress syndrome in Chinese outpatient hospital care: prevalence and associations with psychosocial variables. BMC Psychiatry 2022; 22:733. [PMID: 36434598 PMCID: PMC9694831 DOI: 10.1186/s12888-022-04342-y] [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] [Received: 01/17/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Bodily distress syndrome (BDS) is a new, empirical-based diagnosis of functional somatic symptoms. This study aimed to explore the prevalence of BDS and its association with psychosocial variables in a Chinese clinical population. METHODS A multicentre cross-sectional study of 1269 patients was conducted in 9 different Chinese tertiary outpatient hospitals. The BDS was identified by trained interviewers face-to face, based on a brief version of the Schedules for Assessment in Neuropsychiatry (RIFD) and the BDS Checklist-25. Sociodemographic data and further information were characterised from psychometric questionnaires (The Patient Health Questionnaire-15, the Patient Health Questionnaire-9, the General Anxiety Disorder-7, the Whiteley scale-8) . RESULTS Complete data were available for 697 patients. The prevalence of BDS was 26.8% (95% confidence interval (CI): 23.5-30.1). Among the participants, 5.8% (95% CI: 4.1-7.6) fulfilled the criteria for single-organ BDS, while 20.9% (95%CI: 17.9-24.0) had multi-organ BDS. Comparison of the PHQ-15, PHQ-9, GAD-7, and WI-8 scores revealed higher scores on all dimensions for patients with BDS. In a binary logistic regression analysis, BDS was significantly associated with increased health-related anxiety (WI-8) and depression (PHQ-9). The explained variance was Nagelkerke's R2 = 0.42. CONCLUSIONS In China, the BDS is a common clinical condition in tertiary outpatient hospital settings with high prevalence, and is associated with health anxiety and depressive symptoms. In this clinical population, the severe multi-organ subtype of BDS was the most frequent.
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Affiliation(s)
- Jing Ma
- grid.13291.380000 0001 0807 1581Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Linli Zheng
- grid.13291.380000 0001 0807 1581Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Chen
- grid.13291.380000 0001 0807 1581Mental Health Center, West China Hospital, Sichuan University, Chengdu, China ,grid.203458.80000 0000 8653 0555Mental Health Center, University-town Hospital, Chongqing Medical University, Chongqing, China
| | - Jie Ren
- Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd, Jincheng, China
| | - Hua Chen
- grid.8547.e0000 0001 0125 2443Department of Psychological Medicine, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Yaoyin Zhang
- grid.54549.390000 0004 0369 4060Department of Psychosomatic Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wentian Li
- Department of Clinic Psychology, Wuhan Mental Health Centre, Wuhan, China
| | - Xiquan Ma
- grid.24516.340000000123704535Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Lu
- grid.459365.80000 0004 7695 3553Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University, Beijing, China
| | - Heng Wu
- grid.24516.340000000123704535Department of Psychosomatic Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kurt Fritzsche
- grid.7708.80000 0000 9428 7911Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Breisgau, Germany
| | - Anne Christin Toussaint
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Leonhart
- grid.5963.9Institute of Psychology, University of Freiburg, Breisgau, Germany
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lan Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
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20
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Jørgensen T, Dantoft TM, Weinreich Petersen M, Benros ME, Poulsen CH, Falgaard Eplov L, Gormsen L, Frostholm L, Carstensen TBW, Holm Eliasen M, Kårhus LL, Skovbjerg S, Bjerregaard AA, Brix S, Linneberg A, Fink P. Examine the public health impacts of functional somatic disorders using the DanFunD study. Scand J Public Health 2022; 50:988-994. [PMID: 36245407 DOI: 10.1177/14034948221122886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Persistent physical symptoms (e.g. pain, fatigue) are prevalent in the population and some persons may develop a functional somatic disorder (FSD). We still need to explore the limits between general bodily sensations and FSD, and great controversies exist as regard delimitation, occurrence, risk factors, prognosis, and costs of FSD in the general population. This is mainly due to the lack of focused, sufficient powered, population-based epidemiological studies. Material and Methods: The DanFunD study is the largest focused population-based study on FSD and has the potential to answer these crucial questions regarding the FSD disorders. DanFunD has its origin in the Copenhagen area of Denmark and was initiated in 2009 by an interdisciplinary team of researchers including basic scientists, clinical researchers, epidemiologists, and public health researchers. A population-based cohort of nearly 10,000 people have filled in detailed questionnaires, gone through a thorough health examination, and a biobank is established. The cohort was re-examined after five years. Results:The prevalence of FSD in the Danish population is about 10-15% and is twice as common in women as in men. Persons with FSD report impaired daily activities and low self-perceived health, which qualifies FSD as a major public health problem. The research plan to unravel the risk factors for FSD employs a bio-psycho-social approach according to a detailed plan. Preliminary results are presented, and work is in progress. Likewise, plans for assessing prognosis and health care costs are provided. Conclusion: We invite researchers in the field to collaborate on this unique data material.
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Affiliation(s)
- Torben Jørgensen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Michael Eriksen Benros
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark.,Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Chalotte Heinsvig Poulsen
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Centre for Mental Health - CORE, Mental Health Centre Copenhagen, Copenhagen University Hospital, Denmark
| | - Lise Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Tina Birgitte Wisbech Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Marie Holm Eliasen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Line Lund Kårhus
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Sine Skovbjerg
- Department of Clinical Medicine, The Danish Centre for Mindfulness, Aarhus University, Denmark
| | | | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Denmark
| | - Allan Linneberg
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
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21
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Jacobsen SA, Bibby BM, Frostholm L, Petersen MW, Ørnbøl E, Schovsbo SU, Dantoft TM, Carstensen TBW. Development and Validation of the Weighted Index for Childhood Adverse Conditions (WICAC). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013251. [PMID: 36293829 PMCID: PMC9602749 DOI: 10.3390/ijerph192013251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Adverse experiences in childhood are a major public health concern, promoting social inequality in health through biopsychosocial mechanisms. So far, no known measures comprehend the complexity and variations of severity of adverse events. This study aims to develop and validate a new index: the Weighted Index for Childhood Adverse Conditions (WICAC). METHODS The population consists of 7493 randomly invited men and women aged 18-72 years. Data were collected in 2012-2015 as part of the Danish Study of Functional Disorders (DanFunD). Content and construct validation of the WICAC was performed with the hypothesis testing of multiple biopsychosocial outcomes: cardiovascular disease, cancer, poor health, back pain, BMI, obesity, anxiety, depression, low vitality, subjective social status, lower education, smoking, and alcohol consumption. Data were analysed with binominal and linear regression models with risk ratios (RR) and mean differences (MD). RESULTS Content validation is fitting for WICAC. The strongest associations observed were for most severe adversity: Poor Health RR = 2.16 (1.19-2.91), Anxiety RR = 3.32 (2.32-4.74), Heavy Drinking RR = 4.09 (1.85-9.04), and Subjective Social Status MD = -0.481 (-0.721-(-0.241)). Similar results were found for the remaining outcomes. Discriminative validation was undecided. CONCLUSIONS WICAC is an adequate instrument for measuring cumulative adverse life events in childhood and adolescence for research purposes.
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Affiliation(s)
- Sofie A. Jacobsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Correspondence:
| | - Bo M. Bibby
- Department of Public Health, Biostatistics, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
| | - Marie W. Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
| | - Signe U. Schovsbo
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2400 Copenhagen, Denmark
| | - Thomas M. Dantoft
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2400 Copenhagen, Denmark
| | - Tina B. W. Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
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22
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Bjerregaard AA, Petersen MW, Skovbjerg S, Gormsen LK, Cedeño-Laurent JG, Jørgensen T, Linneberg A, Dantoft TM. Physiological Health and Physical Performance in Multiple Chemical Sensitivity-Described in the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159039. [PMID: 35897408 PMCID: PMC9331319 DOI: 10.3390/ijerph19159039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
Multiple chemical sensitivity (MCS) is a multifactorial somatic disorder characterized by physical reactions triggered by even extremely low levels of different airborne chemicals. In most individuals with MCS, these reactions have substantial negative impact on social, occupational, and everyday life often including limited or no engagement in physical activities. The aim of this study was to explore associations between MCS and objective measurements of anthropometry, cardiorespiratory health, and physical performance. From the Danish population-based cohort DanFunD counting 9656 participants aged 18–76 years, 1.95% (n = 188) were categorized as MCS individuals (MCS All). Of those 188, 109 participants were subcategorized as having MCS without functional somatic disorders (FSD) (MCS with no comorbid FSD). The remaining study population without any FSD were regarded controls. We used adjusted multiple linear regression analyses to evaluate associations between MCS and anthropometry, cardiorespiratory fitness, and physical performance. Compared with the general population, MCS All had less optimal body composition, increased risk of obesity, impaired cardiorespiratory fitness, and physical performance which was not seen in MCS with no comorbid FSD. MCS individuals may be inhibited to maintain an active lifestyle which can increase risk of obesity and consequently have negatively impact on general health, which may not be the case among MCS with no comorbid FSD.
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Affiliation(s)
- Anne A. Bjerregaard
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
- Correspondence: or
| | - Marie W. Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 22–23, 8000 Aarhus C, Denmark; (M.W.P.); (L.K.G.)
| | - Sine Skovbjerg
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Hack Kampmanns Plads, 8000 Aarhus C, Denmark;
| | - Lise K. Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 22–23, 8000 Aarhus C, Denmark; (M.W.P.); (L.K.G.)
| | - José G. Cedeño-Laurent
- Department of Exposure Epidemiology and Risk Program, Harvard T.H. Chan School of Public Health, 1350 Massachusetts Ave, Cambridge, MA 02138, USA;
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen, Entrance 5, 2000 Frederiksberg, Denmark; (T.J.); (A.L.); (T.M.D.)
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23
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Häuser W, Andresen V. [Functional gastrointestinal disorders]. Dtsch Med Wochenschr 2022; 147:595-604. [PMID: 35545068 DOI: 10.1055/a-1554-1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Approximately 50 % of chronic gastrointestinal symptoms in primary care can be attributed to functional gastrointestinal disorders (FGID). The most frequent gastrointestinal disorders are functional dyspepsia and irritable bowel syndrome. FGID are heterogenous with regards to the amount of symptoms and associated patient's impairment as well as to the underlying pathophysiological mechanisms. The biopsychosocial model of FGID assumes that biological, psychological and social factors interact in the predisposition to and in the initiation and course of FGID. The Rome Foundation defines FGID as disorders of the brain-gut interaction.Some physicians are hesitant to diagnose FGID due to the lack of specific biomarkers and/or structural changes in the gastrointestinal tract. In addition, some FGID to not respond well to conventional medications. Some patients are reluctant to accept the diagnosis of a FGID because they are afraid that a serious somatic disease has been missed and/or to be diagnosed as mentally ill.The use of interdisciplinary evidence-based guidelines for diagnosis and management of FGID can increase the certainty of diagnosis and the therapeutic options for physicians. In addition, these guidelines include recommendations how to explain the disorder and the management to the patient to establish a trustful doctor-patient relationship.FGID are diagnosed by the history of a typical cluster of symptoms and by guideline - recommended exclusion of somatic gastrointestinal disorders. FGID should be managed according to the main symptoms, the associated impairment and patients' preferences in a graduated approach by education and by dietary, pharmacological and psychological treatments.
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24
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Agger JL, Schröder A, Ørnbøl E, Jensen JS, Pedersen HF, Fink P, Gormsen LK. Are study populations in trials of antidepressants and psychotherapy comparable? A retrospective case study of two parallel running trials for multi- organ functional somatic disorder. Psychiatry Res 2022; 311:114474. [PMID: 35276572 DOI: 10.1016/j.psychres.2022.114474] [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: 12/03/2021] [Revised: 01/31/2022] [Accepted: 02/19/2022] [Indexed: 11/19/2022]
Abstract
This study retrospectively compares two previous parallel running, randomized, controlled trials of pharmacotherapy (imipramine) and psychotherapy (acceptance and commitment therapy) for multi-organ functional somatic disorder (FSD). Differences in demographics, psychiatric comorbidity, illness severity, and illness duration associated with eligibility for the two trials and patients' willingness to participate are explored using linear or binary regression models. 418 patients with multi-organ FSD was included. We found that 377 (95%) were eligible for psychotherapy and 257 patients (61%) for pharmacotherapy. Patients eligible for pharmacotherapy were less severely impaired, less often received disability pension, reported shorter illness duration and experienced less psychological distress than patients eligible for psychotherapy. Whilst exclusion criteria for both trials differed markedly, it was not possible to clearly identify patient or illness characteristics associated with patients' willingness to participate. The study showed that trial-specific exclusion criteria led to the selection of less complex and less severely impaired patients in the pharmacological trial in this sample of multi-organ FSD. Our findings have important implications for the interpretation and comparability of RCT results of different treatments in multi-organ FSD and may point to some common flaws in study design and interpretation of pharmacological vs. psychotherapeutic intervention trials in psychiatry.
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Affiliation(s)
- Johanne Liv Agger
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Heidi Frølund Pedersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lise Kirstine Gormsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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25
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Hennemann S, Witthöft M, Kleinstäuber M, Böhme K, Baumeister H, Ebert DD, Probst T. Somatosensory amplification moderates the efficacy of internet-delivered CBT for somatic symptom distress in emerging adults: Exploratory analysis of a randomized controlled trial. J Psychosom Res 2022; 155:110761. [PMID: 35182889 DOI: 10.1016/j.jpsychores.2022.110761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While studies mainly provide positive evidence for the efficacy of internet-delivered cognitive-behavioral therapy (ICBT) for various persistent somatic symptoms, it remains largely unclear for whom these interventions work or not. This exploratory analysis aimed to identify moderators for the outcome between ICBT for somatic symptom distres and a waitlist control group (WL) in a vulnerable target group of emerging adults. METHODS Based on data from a randomized controlled trial on 156 university students with varying degrees of somatic symptom distress who were allocated to either an eight-week, therapist guided ICBT (iSOMA) or to the WL, we examined pretreatment demographic characteristics, health-related variables (e.g., somatic symptom duration), mental distress (e.g., depression, anxiety) and cognitive-emotional factors (emotional reactivity, somatosensory amplification) as candidate moderators of the outcome, somatic symptom distress (assessed by the Patient Health Questionnaire, PHQ-15) from pre- to posttreatment. RESULTS Somatosensory amplification (assessed by the Somatosensory Amplification Scale, SSAS) moderated the outcome in favor of iSOMA (B = -0.17, SE = 0.08, p = 0.031), i.e., higher pretreatment somatosensory amplification was associated with better outcome in the active compared to the control intervention. No significant moderation effects were found among demographic characteristics, health-related variables, or mental distress. CONCLUSION Our findings suggest that an internet-delivered CBT for somatic symptom distress should be preferred over no active treatment particularly in individuals with moderate to high levels of somatosensory amplification, which as a next step should be tested against further treatments and in clinical populations. TRIAL REGISTRATION German Clinical Trials Register (DRKS00014375).
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Affiliation(s)
- Severin Hennemann
- 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
| | - Maria Kleinstäuber
- Utah State University, Emma Eccles Jones College of Education and Human Services, Department of Psychology, Logan (Utah), USA
| | - Katja Böhme
- Johannes Gutenberg University Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Mainz, Germany
| | - Harald Baumeister
- Ulm University, Department of Clinical Psychology and Psychotherapy, Ulm, Germany
| | - David Daniel Ebert
- Technical University of Munich, Department of Sport and Health Sciences, München, Germany
| | - Thomas Probst
- Danube University Krems, Department for Psychotherapy and Biopsychosocial Health, Krems, Austria
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26
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Kane NS, Anastasides N, Litke DR, Helmer DA, Hunt SC, Quigley KS, Pigeon WR, McAndrew LM. Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness. PLoS One 2021; 16:e0259341. [PMID: 34874939 PMCID: PMC8651123 DOI: 10.1371/journal.pone.0259341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Conditions defined by persistent "medically unexplained" physical symptoms and syndromes (MUS) are common and disabling. Veterans from the Gulf War (deployed 1990-1991) have notably high prevalence and disability from MUS conditions. Individuals with MUS report that providers do not recognize their MUS conditions. Our goal was to determine if Veterans with MUS receive an ICD-10 diagnosis for a MUS condition or receive disability benefits available to them for these conditions. METHODS A chart review was conducted with US Veterans who met case criteria for Gulf War Illness, a complex MUS condition (N = 204, M = 53 years-old, SD = 7). Three coders independently reviewed Veteran's medical records for MUS condition diagnosis or service-connection along with comorbid mental and physical health conditions. Service-connection refers to US Veterans Affairs disability benefits eligibility for conditions or injuries experienced during or exacerbated by military service. RESULTS Twenty-nine percent had a diagnosis of a MUS condition in their medical record, the most common were irritable colon/irritable bowel syndrome (16%) and fibromyalgia (11%). Slightly more Veterans were service-connected for a MUS condition (38%) as compared to diagnosed. There were high rates of diagnoses and service-connection for mental health (diagnoses 76% and service-connection 74%), musculoskeletal (diagnoses 86%, service-connection 79%), and illness-related conditions (diagnoses 98%, service-connection 49%). CONCLUSION Given that all participants were Gulf War Veterans who met criteria for a MUS condition, our results suggest that MUS conditions in Gulf War Veterans are under-recognized with regard to clinical diagnosis and service-connected disability. Veterans were more likely to be diagnosed and service-connected for musculoskeletal-related and mental health conditions than MUS conditions. Providers may need education and training to facilitate diagnosis of and service-connection for MUS conditions. We believe that greater acknowledgement and validation of MUS conditions would increase patient engagement with healthcare as well as provider and patient satisfaction with care.
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Affiliation(s)
- Naomi S. Kane
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Nicole Anastasides
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - David R. Litke
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Drew A. Helmer
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- Michael DeBakey VA Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, United States of America
| | - Stephen C. Hunt
- VA Puget Sound Health Care System, Seattle, WS, United States of America
- Department of Medicine, University of Washington, Seattle, WS, United States of America
| | - Karen S. Quigley
- VA Bedford Healthcare System, Center for Health Organization & Implementation Research (CHOIR), Bedford, MA, United States of America
- Department of Psychology, Northeastern University, Boston, MA, United States of America
| | - Wilfred R. Pigeon
- Finger Lakes Healthcare System/VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, United States of America
- Psychiatry Department, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Lisa M. McAndrew
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
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27
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Insulin Resistance Is Associated with Multiple Chemical Sensitivity in a Danish Population-Based Study-DanFunD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312654. [PMID: 34886380 PMCID: PMC8657139 DOI: 10.3390/ijerph182312654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
Multiple chemical sensitivity (MCS) is a multisystem syndrome, and limited knowledge of its pathophysiology exists. Based on the population-based Danish cohort DanFunD, this study investigated metabolic health in people with MCS compared to individuals who did not have MCS. From 9656 cohort participants aged 18–76 years old, 1.95% were categorized as MCS individuals with comorbid functional somatic disorders (MCS +FSD, n = 188), and 1.13% were categorized as MCS without functional somatic disorders (MCS ÷FSD, n = 109). MCS was characterized based on three criteria: the experience of symptoms upon exposure to common odors and airborne chemicals, symptoms related the central nervous systems and others organ symptoms, and significant impact on every day, social, and occupational life. The remaining study population without MCS or any other functional somatic disorders were regarded as controls. We used adjusted multiple linear regression with link-function to evaluate the associations between lipid and glucose metabolism markers and MCS. We also tested the odds ratio of metabolic syndrome in MCS. Results did not point to statistically significant associations between lipid biomarkers or metabolic syndrome and both MCS groups compared to the controls. We found that MCS individuals may be more insulin resistant and that MCS ÷ FSD may have an impaired glucose metabolism when compared to controls.
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28
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Petersen MW, Ørnbøl E, Dantoft TM, Fink P. Assessment of functional somatic disorders in epidemiological research: Self-report questionnaires versus diagnostic interviews. J Psychosom Res 2021; 146:110491. [PMID: 33892205 DOI: 10.1016/j.jpsychores.2021.110491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Self-reported symptom questionnaires are often used for identifying individuals with functional somatic disorders (FSD) in epidemiological research. Studies on their validity in establishing clinically valid cases are, however, lacking. We aimed to compare and dissect the processes of identifying participants with FSD with symptom questionnaires and FSD diagnoses established by diagnostic interviews. METHODS Individuals from the adult Danish population (n = 1590) filled in symptom questionnaires and participated in a diagnostic research interview, performed over telephone by trained family physicians. The two methods were described and compared in different steps: 1) Agreement on presence of symptoms, 2) agreement after FSD symptom pattern criteria had been applied, and 3) agreement on final FSD diagnoses. RESULTS Agreement on symptom presence was high (>82%). Using FSD symptom pattern criteria, the two methods agreed in 30-62% of cases within each category. Discrepancies were mainly due to participants fulfilling symptom patterns in the interview but not in the questionnaires. Agreement between final FSD questionnaire cases and final FSD interview diagnoses was moderate (>68%) with lower FSD prevalence in the interview (26.2% vs 44.5%). Discrepancies were largely explained by the interviewers assessing the symptom patterns to be caused by an alternative physical or mental condition. CONCLUSION Prevalence of final FSD diagnoses were markedly lower in the diagnostic interview compared to self-reported questionnaires cases; mainly because of the clinical evaluation of symptom attribution and impairment. Symptom questionnaires may be valuable as screening tools and as trans-diagnostic comparison while diagnostic interviews are necessary in establishing clinically significant FSD diagnoses.
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Affiliation(s)
- Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark.
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
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29
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Mathisen J, Jensen NK, Bjorner JB, Brønnum-Hansen H, Christensen U, Thielen K, Gadeberg AK, Andersen I. Disability pension among persons with chronic disease: Differential impact of a Danish policy reform. Eur J Public Health 2021; 31:186-192. [PMID: 33398327 DOI: 10.1093/eurpub/ckaa228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2013, Denmark implemented a reform that tightened the criteria for disability pension, expanded a subsidized job scheme ('flexi-job') and introduced a new vocational rehabilitation scheme. The overall aim of the reform was to keep more persons attached to the labour market. This study investigates the impact of the reform among persons with chronic disease and whether this impact differed across groups defined by labour market affiliation and chronic disease type. METHODS The study was conducted as a register-based, nationwide cohort study. The study population included 480 809 persons between 40 and 64 years of age, who suffered from at least one of six chronic diseases. Hazard ratios (HR) and 95% confidence intervals (CI) of being awarded disability pension or flexi-job in the 5 years after vs. the 5 years prior to the reform were estimated. RESULTS Overall, the probability of being awarded disability pension was halved after the reform (HR = 0.49, CI: 0.47-0.50). The impact was largest for persons receiving sickness absence benefits (HR = 0.31, CI: 0.24-0.39) and for persons with functional disorders (HR = 0.38, CI: 0.32-0.44). Also, the impact was larger for persons working in manual jobs than for persons working in non-manual jobs. The probability of being awarded a flexi-job was decreased by one-fourth (HR = 0.76, CI: 0.74-0.79) with the largest impact for high-skilled persons working in non-manual jobs. CONCLUSION Access to disability pension and flexi-job decreased after the reform. This impact varied according to labour market affiliation and chronic disease type.
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Affiliation(s)
- Jimmi Mathisen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Optum Patient Outcomes, Johnston, RI, USA
| | | | - Ulla Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Karsten Thielen
- Unit of Social Medicine, Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark
| | | | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Petersen MW, Schröder A, Eliasen MH, Fink P, Dantoft TM, Jørgensen T. Three different approaches to delimitation of functional somatic disorders: DanFunD. J Psychosom Res 2021; 145:110475. [PMID: 33810860 DOI: 10.1016/j.jpsychores.2021.110475] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The Danish Study of Functional Disorders (DanFunD) approaches functional somatic disorders (FSD) with three delimitations: Five functional somatic syndromes (FSS), Bodily Distress Syndrome (BDS), and eight data-driven symptom profiles (SP). This paper presents each delimitation and discusses optimal approaches for further original research into FSD epidemiology. METHODS A total of 9656 adults from the general Danish population participated in this cross-sectional study. Case assignment of the three FSD delimitations was based on self-reported symptom questionnaires. Overlap of FSS, BDS, and SP and their association with poor self-perceived health were calculated as descriptive statistics and shown with Venn diagrams. Difference in self-perceived health between participants with severe FSD were compared with participants with no FSD and calculated as risk ratios with generalized linear models with binomial family and log link. RESULTS We found pronounced overlaps between any FSS, BDS, and the SP with multiple symptoms as well as for multi-organ BDS and the SP with all symptoms. Symptoms and syndromes related to clusters of musculoskeletal and general symptoms contributed particularly to poor health as did multi-organ BDS and categories of SP with multiple symptoms. CONCLUSION Each of the three delimitations has its strengths and weaknesses, and with this study, we offer a contribution to a more valid delimitation of FSD. Future research within DanFunD and other epidemiological studies may benefit from using more than just one delimitation for capturing the diverse nature of the FSD.
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Affiliation(s)
- Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark.
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
| | - Marie Holm Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen C, Denmark; Faculty of Medicine, Aalborg University, Denmark
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Hüsing P, Löwe B, Olde Hartman TC, Frostholm L, Weigel A. Helpful explanatory models for somatoform symptoms (HERMES): study protocol of a randomised mixed-methods pilot trial. BMJ Open 2021; 11:e044244. [PMID: 33762239 PMCID: PMC7993177 DOI: 10.1136/bmjopen-2020-044244] [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: 11/03/2022] Open
Abstract
INTRODUCTION Persistent somatic symptoms (PSS) are common both in the general population and primary care. They are bothersome in terms of psychological and somatic symptom burden. Health professionals often struggle with communication, as there is a lack of scientifically supported explanatory models for PSS or a focus merely on somatic aspects of the complaints, which both frustrate patients' needs. The objective of the present study is therefore to develop a psychoeducational intervention based on a current evidence-based explanatory model, to examine its feasibility and form the basis for a large-scale randomised controlled trial. METHODS AND ANALYSIS In a randomised controlled mixed-methods pilot trial, 75 adult psychosomatic outpatients with PSS (duration of symptoms ≥6 months) and accompanying psychological (Somatic Symptom B-Criteria Scale total score ≥18) and somatic symptom burden (Patient Health Questionnaire-15 score >10) and no prior psychosomatic treatment will be eligible. Participants will be presented with either the explanatory model without (intervention group 1, n=25) or with elements of personalisation (intervention group 2, n=25). Participants in the control group (n=25) will receive information on current PSS guidelines. Participants will be blinded to group assignment and interventions will be shown on tablet computers at the outpatient clinic. After 1 month, qualitative follow-up telephone interviews will be conducted. As primary outcomes, mean changes in psychological and somatic symptom burden will quantitatively be compared between groups, respectively. Behavioural change mechanisms and feasibility of the three interventions will be evaluated using quantitative and qualitative measures. ETHICS AND DISSEMINATION Ethics approval has been granted by the medical ethics board of the Hamburg Medical Chamber (PV5653). Results from this study will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER DRKS00018803.
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Affiliation(s)
- Paul Hüsing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wertenbruch-Rocke T, Hüsing P, Löwe B, Toussaint A. Application and validation of the bodily distress syndrome checklist in a psychosomatic outpatient sample. Gen Hosp Psychiatry 2021; 69:104-110. [PMID: 33588195 DOI: 10.1016/j.genhosppsych.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The BDS checklist is a self-report measure to assess the most common somatic symptoms in functional somatic syndromes, based on the diagnostic concept of Bodily Distress Syndrome. The aim of the study was to examine the psychometric properties and validity of the BDS checklist in a psychosomatic sample and to investigate whether it is suitable to detect DSM-5 somatic symptom disorders (SSD). METHOD In a cross-sectional study, n = 368 patients from a psychosomatic outpatient clinic completed the BDS checklist and a semi-structured clinical interview on SSD. Item and scale characteristics and measures of reliability and validity were determined. RESULTS The BDS checklist showed good item characteristics and reliability (Cronbach α = 0.89). Factor analysis confirmed four symptom clusters (CFI = 0.95, TLI = 0.95, RMSEA = 0.091, 90% CI = 0.085-0.097). The BDS total score showed significant correlations with other measures of somatic symptom burden (r = 0.79, p < .001), health anxiety (r = 0.46, p < .001), depression (r = 0.45, p < .001), and general anxiety (r = 0.41, p < .001). Higher BDS checklist scores were associated with higher physical and mental health impairment and higher health care use. Diagnostic accuracy regarding somatic symptom disorder was moderate (AUC = 0.72, 95% CI: 0.67-0.77). CONCLUSION Findings of our study indicate that the BDS checklist is a reliable and valid measure to assess the most common somatic symptoms in a psychosomatic setting. It is however not sufficient to detect persons at risk for somatic symptom disorder. A combination with further questionnaires could probably improve diagnostic accuracy.
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Affiliation(s)
- Tina Wertenbruch-Rocke
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany.
| | - Paul Hüsing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Building O25 Martinistrasse 52, 20246 Hamburg, Germany
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Dantoft TM, Nordin S, Andersson L, Petersen MW, Skovbjerg S, Jørgensen T. Multiple chemical sensitivity described in the Danish general population: Cohort characteristics and the importance of screening for functional somatic syndrome comorbidity-The DanFunD study. PLoS One 2021; 16:e0246461. [PMID: 33626058 PMCID: PMC7904225 DOI: 10.1371/journal.pone.0246461] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Multiple chemical sensitivity (MCS) is characterized by widespread symptoms attributed to exposure to airborne chemicals. MCS is categorized as a functional somatic syndrome (FSS), and MCS cases often meet the criteria for other types of FSS, e.g. fibromyalgia. The primary aim was to characterize MCS regarding symptom triggers, symptoms, lifestyle and describe demographics, socioeconomics and lifestyle factors associated with MCS. A secondary aim was to examine the implication of FSS comorbidity. Methods Data were derived from a random sample of the Danish adult population enrolled in the Danish Study of Functional Disorders (DanFunD; n = 9,656). Questionnaire data comprised information used to delimit MCS and four additional types of FSS, as well as data on demographics, socioeconomics and lifestyle. MCS cases (n = 188) was stratified into subgroups; MCS only (n = 109) and MCS with comorbid FSS (n = 73). Information regarding FSS comorbidities were missing for six MCS cases. MCS subgroups and controls without FSS comorbidities (n = 7,791) were compared by means of logistic regression analyses, adjusted for age and sex. Results MCS was associated with female sex, not being in occupation and low social status, but not with age or education. MCS cases reported normal dietary intake and smoking habits and lower alcohol consumption. Additional associations were found between MCS and low rate of cohabitation, sedentarism, daily physically limitations, and poor quality of sleep. However, subgroup analysis revealed that these findings were primarily associated with MCS with comorbid FSS. Conclusions MCS was associated with lower socioeconomic status, physically inactivity and poor quality of sleep. Subgroup analysis revealed that several associations was explained by FSS comorbidity, i.e. MCS cases with no comorbid FSS showed normal rate of cohabitation and did not report physical limitations or difficulties sleeping. Overall, our findings emphasise the importance of screening MCS cases for FSS comorbidity both in epidemiological and clinical settings.
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Affiliation(s)
- Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Frederiksberg, Capital Region Denmark
- * E-mail:
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sine Skovbjerg
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Aarhus, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospital, Frederiksberg, Capital Region Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Rask MT, Jakobsen PR, Clemensen J, Rosendal M, Frostholm L. Development of an eHealth programme for self-management of persistent physical symptoms: a qualitative study on user needs in general practice. BMC FAMILY PRACTICE 2021; 22:33. [PMID: 33550988 PMCID: PMC7869449 DOI: 10.1186/s12875-021-01380-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
Background Persistent physical symptoms (PPS) are estimated to be present in 17% of patients in general practice. Hence, general practitioners (GPs) play a key role in both the diagnostic assessment and the management of PPS. However, research indicates a need to improve their strategies to support self-help in patients, and eHealth tools may serve as an opportunity. This study aimed to explore patients’ and GPs’ needs related to self-management of PPS. The study was designed to inform the future development of eHealth interventions in this field. Methods This qualitative study was based on 20 semi-structured interviews (6 GPs and 14 patients with PPS). Interviews were audiotaped, transcribed verbatim and analysed through a five-step thematic analysis approach. First, we conducted an inductive analysis to identify and explore emerging subthemes. Second, using a deductive mapping strategy, we categorised the derived subthemes according to the COM-B behaviour change model and its three domains: capability, opportunity and motivation. Results We identified eleven subthemes in the patient interviews and seven subthemes in the GP interviews. Several unmet needs emerged. First, we identified a need to consider PPS early in the illness trajectory by taking a bio-psycho-social approach. Second, both patients and GPs need better skills to manage uncertainty. Third, hope is important for the patients. Fourth, patients need guidance from their GP in how to self-manage their PPS. Conclusions This study provides important insight into key issues and needs related to capability, opportunity and motivation that should be addressed in the design of future eHealth self-management interventions targeting patients with PPS in general practice in order to support and improve care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01380-5.
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Affiliation(s)
- Mette Trøllund Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark.
| | - Pernille Ravn Jakobsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark.,University College Southern Denmark, Lembckesvej 3-7, 6100, Haderslev, Denmark
| | - Jane Clemensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Kløvervænget 23, 5000, Odense, Denmark
| | - Marianne Rosendal
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark.,Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 8000, Aarhus C, Denmark
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Häuser W, Hausteiner-Wiehle C, Henningsen P, Brähler E, Schmalbach B, Wolfe F. Prevalence and overlap of somatic symptom disorder, bodily distress syndrome and fibromyalgia syndrome in the German general population: A cross sectional study. J Psychosom Res 2020; 133:110111. [PMID: 32305723 DOI: 10.1016/j.jpsychores.2020.110111] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To study the prevalence and clinical characteristics of Somatic Symptom Disorder (SSD), Bodily Distress Syndrome (BDS) and fibromyalgia syndrome (FMS) and their overlap in the general German population. METHODS A cross-sectional nationally representative population survey was performed. 2531 participants (mean age 48.8 ± 17.85 years, 53.3% women) completed the Somatic Symptom Scale SSS-8, the Bodily Distress Syndrome (BDS) 25 checklist, the Whiteley Index 7 (WI-7), the self-administered comorbidity questionnaire and the Michigan Body Map. Case definitions of SSD, BDS and FMS were assigned using established criteria. RESULTS 4.5% of participants met the criteria of SSD (SSS - 8 at least one item "bothered very much" and WI- 7 total score ≥ 1). 9.6% met the criteria of single-organ BDS and 1.3% of multi-organ BDS. Prevalence of FMS according to 2016 criteria was 3.4%. 82.3% of FMS cases met any BDS criteria.28.1% of FMS cases satisfied SSD criteria. 28.8% of any BDS cases met the criteria of SSD. 75.1% of SSD cases met the criteria of any BDS. FMS cases reported the highest amount of somatic and psychological symptom burden and health anxieties. There were no differences in age and gender between any BDS and SSD cases. SSD cases reported worse general health and more fibromyalgia-related variables than any BDS cases. CONCLUSIONS In the general population, there is a substantial overlap between FMS and BDS, but not of FMS and SSD, and not of SSD and any BDS. Case definitions of the three disorders partially captured different groups in the general population.
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Affiliation(s)
- Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany; Department Internal Medicine 1, Klinikum Saarbrücken, Saarbrücken, Germany.
| | - Constanze Hausteiner-Wiehle
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany; Department of Neurology, Trauma Center Murnau, Murnau, Germany
| | - Peter Henningsen
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, München, Germany
| | - Elmar Brähler
- Department Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bjarne Schmalbach
- Department Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Irritable bowel, chronic widespread pain, chronic fatigue and related syndromes are prevalent and highly overlapping in the general population: DanFunD. Sci Rep 2020; 10:3273. [PMID: 32094442 PMCID: PMC7039919 DOI: 10.1038/s41598-020-60318-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022] Open
Abstract
Prevalence of functional somatic syndromes (FSS) in the general population varies with observed overlap between syndromes. However, studies including a range of FSS are sparse. We investigated prevalence and characteristics of various FSS and the unifying diagnostic construct bodily distress syndrome (BDS), and identified mutual overlap of the FSS and their overlap with BDS. We included a stratified subsample of 1590 adults from a randomly selected Danish general population sample (n = 7493). Telephonic diagnostic interviews performed by three trained physicians were used to identify individuals with FSS and BDS. Prevalence of overall FSS was 9.3%; 3.8% for irritable bowel, 2.2% for chronic widespread pain, 6.1% for chronic fatigue, 1.5% for whiplash associated disorders, and 0.9% for multiple chemical sensitivity. Prevalence of BDS was 10.7% where 2.0% had the multi-organ type. FSS were highly overlapping with low likelihood of having a “pure” type. Diagnostic agreement of FSS and BDS was 92.0%. Multi-syndromatic FSS and multi-organ BDS were associated with female sex, poor health, physical limitations, and comorbidity. FSS are highly prevalent and overlapping, and multi-syndromatic cases are most affected. BDS captured the majority of FSS and may improve clinical management, making the distinction between multi- and mono-syndromatic patients easier.
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Quarato M, De Maria L, Caputi A, Cavone D, Cannone ESS, Mansi F, Gatti MF, Vimercati L. A case report of idiopathic environmental intolerance: A controversial and current issue. Clin Case Rep 2020; 8:79-85. [PMID: 31998492 PMCID: PMC6982481 DOI: 10.1002/ccr3.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
In this case of idiopathic environmental intolerance, a little known disease characterized by many symptoms of irritation due to exposure to several toxic compounds, genetic analysis could be helpful in case of differential diagnosis issue.
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Affiliation(s)
- Marco Quarato
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Luigi De Maria
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Antonio Caputi
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Domenica Cavone
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Enza Sabrina Silvana Cannone
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Francesca Mansi
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Maria Franca Gatti
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
| | - Luigi Vimercati
- Interdisciplinary Department of MedicineOccupational Medicine “B. Ramazzini”University of Bari Medical SchoolBariItaly
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Petersen MW, Schröder A, Jørgensen T, Ørnbøl E, Dantoft TM, Eliasen M, Thuesen BH, Fink P. The unifying diagnostic construct of bodily distress syndrome (BDS) was confirmed in the general population. J Psychosom Res 2020; 128:109868. [PMID: 31759195 DOI: 10.1016/j.jpsychores.2019.109868] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Bodily distress syndrome (BDS) has been shown to encompass a range of functional somatic syndromes (FSS) such as irritable bowel syndrome (IBS), fibromyalgia (FM), and chronic fatigue syndrome (CFS) in clinical samples. This study aimed to explore symptom clusters and test classification of individuals with illness similar to the BDS criteria in a general population sample. METHODS A stratified subsample of 1590 individuals from the DanFunD part two cohort was included. Symptoms were assessed with the Research Interview for Functional somatic Disorders, performed by trained physicians. In 44 symptoms pooled from criteria of IBS, FM, CFS, and BDS, symptom clusters were explored with explorative factor analysis. Confirmation of symptom clusters of BDS in the previously described 25- and 30-item BDS checklists was performed with confirmatory factor analysis. Classification of individuals into illness groups was investigated with latent class analysis. RESULTS Four symptom clusters (cardiopulmonary, gastrointestinal, musculoskeletal, general symptoms/fatigue) corresponding to the BDS subtypes and their corresponding FSS were identified and confirmed. A three-class model including 25 BDS items had the best fit for dividing participants into classes of illness: One class with low probability, one class with medium probability, and one class with high probability of having ≥4 symptoms in all symptom clusters. CONCLUSION The BDS concept was confirmed in the general population and constitutes a promising approach for improved FSS classification. It is highly clinical relevant being the only diagnostic construct defining the complex multi-organ type.
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Affiliation(s)
- Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark.
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen C, Denmark; Faculty of Medicine, Aalborg University, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Marie Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Betina H Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark
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