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Chaabouni A, Houwen J, Akkermans R, van Boven K, Walraven I, Blanker MH, Schers H, Hartman TO. Which patients are at risk of developing symptom diagnoses that persist for more than a year in primary care? Development and external validation of a prediction model. J Psychosom Res 2024; 184:111859. [PMID: 39048422 DOI: 10.1016/j.jpsychores.2024.111859] [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: 02/12/2024] [Revised: 07/05/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES To train, test and externally validate a prediction model that supports General Practitioners (GPs) in early identification of patients at risk of developing symptom diagnoses that persist for more than a year. METHODS We retrospectively collected and selected all patients having episodes of symptom diagnoses during the period 2008 and 2021 from the Family Medicine Network (FaMe-Net) database. From this group, we identified symptom diagnoses that last for less than a year and symptom diagnoses that persist for more than a year. Multivariable logistic regression analysis using a backward selection was used to assess which factors were most predictive for developing symptom diagnoses that persist for more than a year. Performance of the model was assessed using calibration and discrimination (AUC) measures. External validation was tested using data between 2018 and 2022 from AHON-registry, a primary care electronic health records data registry including 73 general practices from the north and east regions of the Netherlands and about 460,795 patients. RESULTS From the included 47,870 patients with a symptom diagnosis in the FaMe-Net registry, 12,481 (26.1%) had a symptom diagnosis that persisted for more than a year. Older age (≥ 75 years: OR = 1.30, 95% CI [1.19, 1.42]), having more previous symptom diagnoses (≥ 3: 1.11, [1.05, 1.17]) and more contacts with the GP over the last 2 years (≥ 10 contacts: 5.32, [4.80, 5.89]) were predictive of symptom diagnoses that persist for more than a year with a marginally acceptable discrimination (AUC 0.70, 95% CI [0.69-0.70]). The external validation showed poor performance with an AUC of 0.64 ([0.63-0.64]). CONCLUSION A clinical prediction model based on age, number of previous symptom diagnoses and contacts might help the GP to early identify patients developing symptom diagnoses that persist for more than a year. However, the performance of the original model is limited. Hence, the model is not yet ready for a large-scale implementation.
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Affiliation(s)
- Asma Chaabouni
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Juul Houwen
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands; Scientific Institute for Quality of Healthcare, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Kees van Boven
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marco H Blanker
- Department of Primary & Long-term Care, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Medical Innovation, Radboud University Medical Centre, Nijmegen, the Netherlands
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Haun MW, van Eickels D, Tönnies J, Graue L, Ayoub-Schreifeldt M, Wensing M, Hartmann M, Szecsenyi J, Wild B, Friederich HC. An integrated mental health video consultations model for patients with somatic symptom disorder in primary care: The randomized VISION pilot trial. J Psychosom Res 2024; 182:111801. [PMID: 38761536 DOI: 10.1016/j.jpsychores.2024.111801] [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: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Symptoms of somatic symptom disorder (SSD) are one of the most common reasons for consultations in primary care. However, specialized psychological services are mostly unavailable. This pilot trial aimed to determine the feasibility, acceptability, and safety of the integrated mental health video consultations VISION model for patients with SSD in primary care. METHODS We conducted a parallel group, randomized controlled pilot trial involving fifty-one patients with SSD from ten primary care practices in Germany, who we randomized to the VISION model or enhanced treatment-as-usual (eTAU). The VISION model comprised five video consultations which featured diagnostic clarification, psychoeducation (acknowledging and legitimizing of symptoms), and brief psychological therapy. eTAU included training primary care practice teams on the DSM-5 concept of SSD and on current guideline recommendations for its treatment in primary care. We assessed feasibility as the primary outcome at 6-months, measuring efficiency of recruitment, intervention acceptability, and safety. RESULTS Recruitment was efficient reflected in an overall recruitment yield (number randomized per number screened) of 55% (51/92) and a consent rate (number randomized per number eligible) of 94% (51/54). Acceptability of the intervention was high with 98% (123/125) of the video consultations conducted as planned. No serious adverse events were reported in either group. CONCLUSION An integrated mental health video consultations VISION model for patients with SSD presenting to primary care is feasible, acceptable, and safe. Potential clinical effectiveness of the model should be evaluated in confirmatory trial implementing the multifaceted approach tailored to the individual patient with SSD directly into primary care practice. TRIAL REGISTRATION The trial protocol was registered at German Clinical Trials Register (number: DRKS00026075, https://www.drks.de).
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany.
| | - Deborah van Eickels
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | - Leike Graue
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | | | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
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Löwe B, Toussaint A, Rosmalen JGM, Huang WL, Burton C, Weigel A, Levenson JL, Henningsen P. Persistent physical symptoms: definition, genesis, and management. Lancet 2024; 403:2649-2662. [PMID: 38879263 DOI: 10.1016/s0140-6736(24)00623-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 03/22/2024] [Indexed: 08/29/2024]
Abstract
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Christopher Burton
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
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Hüfner K, Tymoszuk P, Sahanic S, Luger A, Boehm A, Pizzini A, Schwabl C, Koppelstätter S, Kurz K, Asshoff M, Mosheimer-Feistritzer B, Pfeifer B, Rass V, Schroll A, Iglseder S, Egger A, Wöll E, Weiss G, Helbok R, Widmann G, Sonnweber T, Tancevski I, Sperner-Unterweger B, Löffler-Ragg J. Persistent somatic symptoms are key to individual illness perception at one year after COVID-19 in a cross-sectional analysis of a prospective cohort study. J Psychosom Res 2023; 169:111234. [PMID: 36965396 PMCID: PMC10022460 DOI: 10.1016/j.jpsychores.2023.111234] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Subjective illness perception (IP) can differ from physician's clinical assessment results. Herein, we explored patient's IP during coronavirus disease 2019 (COVID-19) recovery. METHODS Participants of the prospective observation CovILD study (ClinicalTrials.gov: NCT04416100) with persistent somatic symptoms or cardiopulmonary findings one year after COVID-19 were analyzed (n = 74). Explanatory variables included demographic and comorbidity, COVID-19 course and one-year follow-up data of persistent somatic symptoms, physical performance, lung function testing, chest computed tomography and trans-thoracic echocardiography. Factors affecting IP (Brief Illness Perception Questionnaire) one year after COVID-19 were identified by regularized modeling and unsupervised clustering. RESULTS In modeling, 33% of overall IP variance (R2) was attributed to fatigue intensity, reduced physical performance and persistent somatic symptom count. Overall IP was largely independent of lung and heart findings revealed by imaging and function testing. In clustering, persistent somatic symptom count (Kruskal-Wallis test: η2 = 0.31, p < .001), fatigue (η2 = 0.34, p < .001), diminished physical performance (χ2 test, Cramer V effect size statistic: V = 0.51, p < .001), dyspnea (V = 0.37, p = .006), hair loss (V = 0.57, p < .001) and sleep problems (V = 0.36, p = .008) were strongly associated with the concern, emotional representation, complaints, disease timeline and consequences IP dimensions. CONCLUSION Persistent somatic symptoms rather than abnormalities in cardiopulmonary testing influence IP one year after COVID-19. Modifying IP represents a promising innovative approach to treatment of post-COVID-19 condition. Besides COVID-19 severity, individual IP should guide rehabilitation and psychological therapy decisions.
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Affiliation(s)
- Katharina Hüfner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sabina Sahanic
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Luger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Boehm
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Schwabl
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabine Koppelstätter
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Kurz
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Malte Asshoff
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Bernhard Pfeifer
- Division for Health Networking and Telehealth, Biomedical Informatics and Mechatronics, UMIT, Hall in Tyrol, Austria
| | - Verena Rass
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Schroll
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sarah Iglseder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexander Egger
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Innsbruck, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.
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Kitselaar WM, Büchner FL, van der Vaart R, Sutch SP, Bennis FC, Evers AW, Numans ME. Early identification of persistent somatic symptoms in primary care: data-driven and theory-driven predictive modelling based on electronic medical records of Dutch general practices. BMJ Open 2023; 13:e066183. [PMID: 37130660 PMCID: PMC10163476 DOI: 10.1136/bmjopen-2022-066183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE The present study aimed to early identify patients with persistent somatic symptoms (PSS) in primary care by exploring routine care data-based approaches. DESIGN/SETTING A cohort study based on routine primary care data from 76 general practices in the Netherlands was executed for predictive modelling. PARTICIPANTS Inclusion of 94 440 adult patients was based on: at least 7-year general practice enrolment, having more than one symptom/disease registration and >10 consultations. METHODS Cases were selected based on the first PSS registration in 2017-2018. Candidate predictors were selected 2-5 years prior to PSS and categorised into data-driven approaches: symptoms/diseases, medications, referrals, sequential patterns and changing lab results; and theory-driven approaches: constructed factors based on literature and terminology in free text. Of these, 12 candidate predictor categories were formed and used to develop prediction models by cross-validated least absolute shrinkage and selection operator regression on 80% of the dataset. Derived models were internally validated on the remaining 20% of the dataset. RESULTS All models had comparable predictive values (area under the receiver operating characteristic curves=0.70 to 0.72). Predictors are related to genital complaints, specific symptoms (eg, digestive, fatigue and mood), healthcare utilisation, and number of complaints. Most fruitful predictor categories are literature-based and medications. Predictors often had overlapping constructs, such as digestive symptoms (symptom/disease codes) and drugs for anti-constipation (medication codes), indicating that registration is inconsistent between general practitioners (GPs). CONCLUSIONS The findings indicate low to moderate diagnostic accuracy for early identification of PSS based on routine primary care data. Nonetheless, simple clinical decision rules based on structured symptom/disease or medication codes could possibly be an efficient way to support GPs in identifying patients at risk of PSS. A full data-based prediction currently appears to be hampered by inconsistent and missing registrations. Future research on predictive modelling of PSS using routine care data should focus on data enrichment or free-text mining to overcome inconsistent registrations and improve predictive accuracy.
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Affiliation(s)
- Willeke M Kitselaar
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
- Health, Medical and Neuropsychology unit, Department of Psychology, Leiden University, Leiden, Netherlands
| | - Frederike L Büchner
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
| | - Rosalie van der Vaart
- Health, Medical and Neuropsychology unit, Department of Psychology, Leiden University, Leiden, Netherlands
| | - Stephen P Sutch
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
- HSR, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank C Bennis
- Computer Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Andrea Wm Evers
- Health, Medical and Neuropsychology unit, Department of Psychology, Leiden University, Leiden, Netherlands
| | - Mattijs E Numans
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
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McGhie-Fraser B, Lucassen P, Ballering A, Abma I, Brouwers E, van Dulmen S, Olde Hartman T. Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review of questionnaire measurement instruments. J Psychosom Res 2023; 166:111161. [PMID: 36753936 DOI: 10.1016/j.jpsychores.2023.111161] [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: 10/14/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use. METHODS A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments. RESULTS We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate. CONCLUSION No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.
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Affiliation(s)
- Brodie McGhie-Fraser
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Peter Lucassen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Aranka Ballering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Inger Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Tim Olde Hartman
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
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Lehmann M, Pohontsch NJ, Zimmermann T, Scherer M, Löwe B. Estimated frequency of somatic symptom disorder in general practice: cross-sectional survey with general practitioners. BMC Psychiatry 2022; 22:632. [PMID: 36175883 PMCID: PMC9524044 DOI: 10.1186/s12888-022-04100-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Somatic symptom disorder (SSD) is the successor diagnosis of somatoform disorder in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Relevance and frequency of SSD and its clinical symptoms in general practice are still unknown. We estimate frequencies of patients fulfilling the diagnostic criteria of SSD in general practice. METHODS Mailed and online survey with general practitioners (GP) in Germany using a cross-sectional representative sample from registries of statutory health insurance physicians. GPs estimated percentages of their patients who show the clinical symptoms of SSD according to DSM-5; that is, one or more burdensome somatic symptoms (A criterion), excessive symptom- or illness-related concern, anxiety, or behaviour (B criterion), and persistence of the symptoms over at least 6 months (C criterion). Statistical analysis used means and confidence intervals of estimated patient proportions showing SSD symptoms. Frequency of full-blown SSD was based on the products of these proportions calculated for each GP. RESULTS Responses from 1728 GPs were obtained. GPs saw the clinical symptoms of SSD fulfilled (A and B criteria) in 21.5% (95% CI: 20.6 to 22.3) of their patients. They further estimated that in 24.3% (95% CI: 23.3 to 25.2) of patients, symptoms would persist, yielding a total of 7.7% (95% CI: 7.1 to 8.4) of patients to have a full-blown SSD. CONCLUSIONS We estimate a frequency of 7.7% of patients in general practice to fulfil the diagnostic criteria of SSD. This number may figure as a reference for the yet to be uncovered prevalence of SSD and it indicates a high clinical relevance of the clinical symptoms of SSD in general practice. REGISTRATION German Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS). DRKS-ID DRKS00012942. The date the study was registered: October 2nd 2017. The date the first participant was enrolled: February 9th 2018.
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Affiliation(s)
- Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Nadine Janis Pohontsch
- grid.13648.380000 0001 2180 3484Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Thomas Zimmermann
- grid.13648.380000 0001 2180 3484Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Martin Scherer
- grid.13648.380000 0001 2180 3484Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Bernd Löwe
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Salmon M, Sibeoni J, Harf A, Moro MR, Ludot-Grégoire M. Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur. Front Psychiatry 2022; 13:897002. [PMID: 35958663 PMCID: PMC9358691 DOI: 10.3389/fpsyt.2022.897002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
Aims Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade. Methods This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult. Results The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria. Conclusion This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research. Protocol PROSPERO registration number CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.
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Affiliation(s)
- Mathilde Salmon
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Aurélie Harf
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
| | - Maude Ludot-Grégoire
- APHP, Hôpital Cochin, Maison de Solenn, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
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9
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Klastrup LK, Rosendal M, Rask MT, Christensen KS, Rask CU. Functional somatic symptoms in youths in general practice: A cross-sectional study on prevalence, clinical management and perceived burden. J Psychosom Res 2022; 156:110765. [PMID: 35276589 DOI: 10.1016/j.jpsychores.2022.110765] [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: 08/05/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Functional somatic symptoms (FSS) may progress into a functional disorder if poorly managed, which may have serious implications. This cross-sectional study describes the management of youths compared to adults in general practice and estimates the prevalence of FSS in youths in this setting by comparing consultation-related aspects between youths with FSS and 1) youths with a specific diagnosis and 2) adults with FSS. METHODS We used data from a Danish survey (2008-2009), including 3295 face-to-face consultations between GPs and patients aged 15-64 years. Patients were divided into youths (15-24 years) and adults (25-64 years) and then into subgroups according to the GPs' classifications: 1) specific diagnosis, 2) resolving symptom and 3) FSS. Logistic regression analysis was used for all comparisons, and estimates were adjusted for gender, concomitant chronic disorder and GP cluster. RESULTS The GPs more frequently ensured continuity of care in adults (AOR:0.75, 95%CI:0.61-0.92, p < 0.01) and perceived youths as less time consuming (AOR:0.58, 95%CI: 0.43-0.77, p < 0.01) and less burdensome (AOR:0.60; 95%CI: 0.45-0.81, p < 0.01) compared to adults. FSS prevalence was 4.4% in youths and 9.0% in adults. However, GPs perceived youths with FSS as more burdensome (AOR:7.77, 95%CI:2.93-20.04, p < 0.01) and more time consuming (AOR:3.98, 95%CI:1.42-11.12, p < 0.01) than youths with a specific diagnosis. No significant differences were found between youths and adults with FSS, respectively, in regards to perceived burden and consultation time. CONCLUSION The results indicate age-related variations in the prevalence and clinical management of FSS in general practice. The GPs perceived both youths and adults with FSS time consuming, which underlines a need for supportive management strategies.
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Affiliation(s)
- L K Klastrup
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark.
| | - M Rosendal
- Research Clinic for Functional Disorders, Aarhus University Hospital, Denmark; Research Unit for General Practice, Aarhus, Denmark.
| | - M T Rask
- Research Clinic for Functional Disorders, Aarhus University Hospital, Denmark.
| | - K S Christensen
- Research Unit for General Practice, Aarhus, Denmark; Department of Public Health, Aarhus University, Denmark.
| | - C U Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
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Koly KN, Christopher E, Ahmed S, Baskin C, Saba J, Islam MS, Tariq MR, Alam SF, Sultana MS, Mushtaq M, Ahmed HU. Mental health training needs of physicians in Bangladesh: Views from stakeholders. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Barriers and facilitators to implementing interventions for medically unexplained symptoms in primary and secondary care: A systematic review. Gen Hosp Psychiatry 2021; 73:101-113. [PMID: 34763113 DOI: 10.1016/j.genhosppsych.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/20/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To integrate existing literature on barriers and facilitators to implementing interventions for Medically Unexplained Symptoms (MUS) in primary and secondary care. METHOD Systematic review following PRISMA guidelines. A search of PsychINFO/Pubmed/Web of Science was performed to select studies focusing on MUS-interventions and implementation. All included papers were checked for quality and bias. A narrative synthesis approach was used to describe the included papers by implementation level, ranging from the specific intervention to the broader economic/political context. RESULTS 20 (quantitative/qualitative/mixed design) papers were included, but the quantitative studies especially, lacked methodological quality, with possible publication bias as a result. Results showed that the intervention needs to be acceptable and in line with daily practice routines. The professional's attitude and skills are important for implementation success, as well as for overcoming problems in the professional-patient interaction. If patients stick to finding a somatic cause, this hampers implementation. A lack of time is a frequently mentioned barrier at the organizational level. Barriers/facilitators at the social context level and at the economic/political level were barely reported on in the included papers. CONCLUSION Results were integrated into an existing implementation model, as an example of how MUS-interventions can be successfully implemented in practice.
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Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment. Healthcare (Basel) 2021; 9:healthcare9091128. [PMID: 34574901 PMCID: PMC8465276 DOI: 10.3390/healthcare9091128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957–2020. Search terms included “somatic symptoms disorder”, “sleep disorders”, “insomnia”, “somatoform”, “somatization”, “therapeutic”, “psychotherapy”, and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4–48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.
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