Health-Related Quality of Life in Older Persons with Medically Unexplained Symptoms

doi:10.1016/j.jagp.2016.07.013

The American Journal of Geriatric Psychiatry

Volume 24, Issue 11, November 2016, Pages 1117-1127

https://doi.org/10.1016/j.jagp.2016.07.013 Get rights and content

Objective

Research on health-related quality of life (HRQoL) in older persons with medically unexplained symptoms (MUS) is scarce, and, in contrast with younger patients, interactions with chronic somatic diseases are more complex.

Design

In the current study we compared HRQoL between older persons with MUS and older persons with medically explained symptoms (MES). Our study sample consisted of 118 older MUS-patients and 154 older MES-patients.

Setting/Measurements

The diagnosis of MUS was ascertained by the general practitioner and confirmed by a geriatrician within a multidisciplinary diagnostic assessment. Additional characteristics, including the HRQoL (Short Form-36), were assessed during a home visit. MES-patients received two home visits to assess all measures. Multiple linear regression analyses, adjusted for age, sex, education, cognitive functioning, and psychiatric diagnoses, were performed to assess the relationship between group (MUS/MES) and HRQoL. Analyses were repeated with additional adjustments for somatization and hypochondriacal cognitions.

Results

Older patients with MUS had a significantly lower level of HRQoL compared with older patients with MES. Even after adjustments, the presence of MUS was still associated with both a lower physical and mental HRQoL. These associations disappeared, however, after additional adjustments for somatization and hypochondriacal cognitions. Within the subgroup of MUS-patients, higher levels of hypochondriac anxiety and of somatization were significantly associated with both lower physical and mental HRQoL.

Conclusions

Associations between HRQoL and late-life MUS disappear when corrected for somatization and hypochondriacal cognitions, which is in line with the DSM-5 classification of somatic symptom disorder. Appropriate psychological treatment seems needed to improve HRQoL in older MUS-patients.

Section snippets

Study Design

The Older Persons with Medically Unexplained Symptoms (OPUS) project is a large observational study aiming to explore physical, psychological, and social determinants of late-life MUS in order to develop suitable interventions for this patient group.

As part of this research project, we performed a case-control study in which we compared 118 older (>60 years) patients with chronic MUS (cases) to 154 older persons suffering from MES (comparison group). To compose a diverse research group

Sample Characteristics

Table 1 shows the patient characteristics and levels of HRQoL for older adults with MUS and MES separately. MUS-patients were significantly younger and more often female than MES-patients. Furthermore, older MUS-patients scored approximately 10 points lower on all SF-36 subscales compared with older MES-patients, except for the General Health subscale and Social Functioning subscale. In line with this, MUS-patients reported lower mental and physical HRQoL component scores than MES-patients (

Main Findings

Older persons with medically unexplained symptoms reported decreased levels of mental and physical health-related quality of life when compared with older persons with medically explained symptoms. Interestingly, these associations disappeared when additionally corrected for somatization and hypochondriacal cognitions.

Within the subgroup of older persons with MUS, levels of somatization, hypochondriacal cognitions, and the presence of a primary somatoform disorder according to DSM-IV criteria

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Relations between criteria for somatic symptom disorder and quality of life in asylum seekers living in Germany
2022, Journal of Psychosomatic Research
Citation Excerpt :
While these two concepts overlap to a certain degree, functioning refers to performance in an objective fashion (e.g., having a job) and QoL is a subjective measure [7], defined by an “…individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns, …embedded in a cultural, social and environmental context” [8]. Studies have shown that QoL is influenced by MUS such as dizziness and pain [9,10], and that elderly patients with persistent MUS suffer from lower QoL than patients with medically explained symptoms [11]. A group in which MUS are particularly relevant is asylum seekers and refugees [12].
Asylum seekers often suffer from medically unexplained symptoms that affect their quality of life (QoL). The present study is the first to investigate the extent to which somatic symptoms and the B criteria for the DSM-5 somatic symptom disorder (SSD) are associated with the QoL of asylum seekers living in Germany.
In 144 asylum seekers, somatic symptoms (PHQ-15), B criteria for SSD, symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), post-migration living difficulties (PMLD), and QoL (EUROHIS) were assessed cross-sectionally. Multiple regressions in the total sample and in groups of somatic symptom severity (mild/moderate and severe) were conducted to examine the associations between somatic symptoms and B criteria with QoL.
Sleep problems and pain were the most frequently reported somatic symptoms. Sixteen (11%) participants met one B criterion, 24 (17%) met two, and 84 (58%) met all three criteria. QoL correlated negatively with somatic symptoms (r = −0.56, p < .001) and with the existence of at least one B criterion (r = −0.24, p < .001). In the total sample, stronger depressive and somatic symptoms were related to lower QoL (adjusted R² = 0.53) while the B criteria were not. In persons with severe somatic symptom severity, the B criterion behavior was associated with lower QoL.
In addition to stronger somatic and depressive symptoms, the psychological B criterion behavior seems to play an important role in the lower QoL of asylum seekers with severe somatic symptoms.
Potentially traumatic events, social support and burden of persistent somatic symptoms: A longitudinal study
2022, Journal of Psychosomatic Research
Citation Excerpt :
Often these symptoms are self-limiting with minimal impact on daily life. However, when these symptoms persist, they are associated with substantial psychological distress and functional impairment [1–3]. Patients with persistent somatic symptoms (PSS) -also known as medically unexplained symptoms- often have a high medical care utilization [4,5] and may receive unnecessary and potentially harmful investigations and treatments [6–8].
Psychological trauma is a well-known risk factor for the onset of persistent somatic symptoms (PSS). In contrast, little is known on the relation between potentially traumatic events (PTEs) and the severity of PSS, and on the protective effect of social support. We aimed to: (i) determine whether childhood, adulthood and recent PTEs are associated with burden of PSS over four years of follow-up; (ii) examine associations of multiple and cumulative (in childhood and adulthood) exposure to PTEs with burden of PSS; and (iii) determine whether social support modifies these associations.
Longitudinal data of 322 patients with PSS were analyzed. PTEs (Life Events Questionnaire) and social support (Social Support Scale) were assessed at baseline. Burden of PSS was measured in terms of symptom severity (PHQ-15) and physical functioning (RAND-36 PCS) at six repeated measurements over a four-year interval. Associations were analyzed using longitudinal mixed model analysis.
Patients with multiple childhood PTEs reported higher burden of PSS over four-year time. Adulthood PTEs were associated with burden of PSS in patients with, but not in patients without childhood PTEs. Recent PTEs were not associated with burden over time. Social support did not modify any of the associations.
PTEs are associated with higher burden of PSS over time, in addition to the well-known association with the onset of PSS. PTEs in early life and cumulative exposure to PTEs in childhood and adulthood are associated with higher burden over time in patients with PSS. Social support did not attenuate the associations.
Measuring social support in psychiatric patients and controls: Validation and reliability of the shortened Close Persons Questionnaire
2019, Journal of Psychiatric Research
Citation Excerpt :
As part of this study, 118 older (>= 60 years) persons with MUS and 154 older (>= 60 years) persons with Medically Explained Symptoms (MES) were recruited via advertisements, general practices, and a specialized clinic for treating late-life MUS. A more detailed description of the study sample can be found elsewhere (Hanssen et al., 2016). The data of the three previously described epidemiological studies were used to compose a total study sample.
Although previous studies have underlined the protective role of social support for physical and psychological health, no self-report questionnaires are validated for measuring social support in large-scale psychiatric epidemiological studies. In the current study, we aim to validate the shortened version of the Close Persons Questionnaire (CPQ), a self-report questionnaire that is administered twice to measure social support received from the partner (CPQ-p) as well as from a close friend/family member (CPQ-f). Data of psychiatric patients (n = 1891) and controls (n = 1872) from three Dutch epidemiological studies that assessed determinants of psychopathology were used to validate the shortened CPQ. This included determining factor structure and reliability for the different scales. Using multigroup confirmatory factor analyses, a four-factor model proved to be the best fitting model for both the CPQ-p and CPQ-f. The resulting subscales -emotional support, practical support, negative support experiences, inadequacy of support-showed moderate to good reliability for both the CPQ-p and the CPQ-f, and were all correlated with other social measures in the expected directions. The shortened version of the CPQ proves to be a valid and reliable measure of social support for both psychiatric patients and controls. Further research is needed to assess usability of the shortened version of the CPQ for clinical practice.
Frailty and Somatic Comorbidity in Older Patients With Medically Unexplained Symptoms
2019, Journal of the American Medical Directors Association
Citation Excerpt :
Data of the OPUS study were collected between September 2011 and March 2014. The OPUS study has been described before14,15 but will be summarized below. To recruit patients with MUS in various developmental and severity stages, recruitment took place in the community by advertisements in local newspapers, in primary care, and in secondary healthcare.
To examine the level of frailty and somatic comorbidity in older patients with medically unexplained symptoms (MUS) and compare this to patients with medically explained symptoms (MES).
Cross-sectional, comparative study.
Community, primary care, and secondary healthcare to recruit patients with MUS in various developmental and severity stages and primary care to recruit patients with MES.
In total, 118 patients with MUS and 154 patients with MES, all aged ≥60 years.
Frailty was assessed according to the Fried criteria (gait speed, handgrip strength, unintentional weight loss, exhaustion, and low physical activity), somatic comorbidity according to the self-report Charlson comorbidity index, and the number of prescribed medications.
Although patients with MUS had less physical comorbidity compared with patients with MES, they were prescribed the same number of medications. Moreover, patients with MUS were more often frail compared with patients with MES. Among patients with MUS, physical frailty was associated with the severity of unexplained symptoms, the level of hypochondriacal beliefs, and the level of somatisation.
Despite a lower prevalence of overt somatic diseases, patients with MUS are more frail compared with older patients with MES. These results suggest that at least in some patients age-related phenomena might be erroneously classified as MUS, which may affect treatment strategy.
Functioning and quality of life in patients with somatic symptom disorder: The association with comorbid depression
2019, Comprehensive Psychiatry
Citation Excerpt :
Like previous studies, we found that functioning and QOL are worse in SSD patients than in healthy people. This finding has been reported in studies looking at SSD, somatoform disorders and medically unexplained symptoms [8,19,41] and in samples of elderly people and adolescents as well as general adult samples [10,42]. Patients with functional somatic syndromes (such as fibromyalgia and irritable bowel syndrome) are also often found to have low QOL [43].
Patients with somatic symptoms often have impaired functioning and reduced quality of life (QOL), but the factors identified as responsible for these impairments vary between studies. We examined functioning and QOL in patients with somatic symptom disorder (SSD), exploring their associations with demographic factors, personality traits and psychological features.
The sample comprised 107 SSD patients and 100 healthy controls. Several types of self-report instrument were administered. Group differences were assessed with independent t-tests. We used multiple linear regression to examine relationships between the independent variables and functioning and QOL. Finally, we used structural equation modeling (SEM) to perform path analysis and examine the fit of a model based on the earlier results.
Most function scores were lower in SSD patients than in healthy controls. In SSD patients overall WHO Quality of Life-BREF (WHOQOL-BREF) score was correlated with exercise level and Beck Depression Inventory-II (BDI-II) score. There were also associations between Sheehan Disability Scale (SDS) score and age, novelty seeking, Cognitions About Body and Health Questionnaire (CABAH) score and BDI-II score. Family APGAR score was only related to BDI-II score. Path analysis revealed that BDI-II score was related to all three indices of functioning.
Depression is associated with functioning and QOL in SSD patients.
The Research Ethics Committee of National Taiwan University National Taiwan University Hospital approved this study (approval number: 201507007RINB).
Quality of Life and Experienced Distress of Patients Suspected of having a Rare (Chronic) Health Condition - Initial Findings from the ZSE-DUO Study
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View full text

Health-Related Quality of Life in Older Persons with Medically Unexplained Symptoms

Objective

Design

Setting/Measurements

Results

Conclusions

Section snippets

Study Design

Sample Characteristics

Main Findings

Res Dev Disabil

Am J Geriatr Psychiatry

Gastroenterology

J Psychosom Res

Mayo Clin Proc

J Psychosom Res

J Psychiatr Res

Lancet

Soc Sci Med

Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes

JAMA

Conceptual model of health-related quality of life

J Nurs Scholarsh

NHG Guideline on medically unexplained symptoms (MUS)

Huisarts Wet

Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders

Economics of medically unexplained symptoms: a systematic review of the literature

Psychother Psychosom

Physical functioning in older persons with somatoform disorders: a pilot study

J Am Med Dir Assoc

Review: somatization in the elderly

Int J Geriatr Psychiatry

Quality of life of persons with chronic fatigue syndrome

J Nerv Ment Dis

Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care

BMC Fam Pract

Health-related quality of life and health care costs in severe, refractory Irritable Bowel Syndrome

Ann Intern Med