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International Journal of Behavioral Medicine

Erschienen in:

01.06.2013

Multiple Somatic Symptoms Predict Impaired Health Status in Functional Somatic Syndromes

verfasst von: F. H. Creed, B. Tomenson, C. Chew-Graham, G. J. Macfarlane, I. Davies, J. Jackson, A. Littlewood, J. McBeth

Erschienen in: International Journal of Behavioral Medicine | Ausgabe 2/2013

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Abstract

Background

The relationship between functional somatic syndromes and multiple somatic symptoms is unclear.

Purpose

We assessed whether the number of somatic symptoms is a predictor of health status in three functional somatic syndromes (FSS).

Methods

In a population-based study of 990 UK adults we assessed chronic widespread pain (CWP), chronic fatigue (CF) and irritable bowel syndrome (IBS) by questionnaire and medical record data. We assessed health status (Short Form 12 and EQ-5D), number of somatic symptoms (Somatic Symptom Inventory) and anxiety/depression (Hospital Anxiety and Depression Scale) both at baseline and at follow-up 1 year later.

Results

The proportion of people with an FSS who also have multiple somatic symptoms (52–55 %) was similar in the three functional syndromes. The presence of multiple somatic symptoms was associated with more impaired health status both at baseline and at follow-up. This finding was not explained by severity of FSS. In the absence of multiple somatic symptoms, the health status of the FSS was fair or good. In multiple regression analysis, the number of somatic symptoms, the presence of a functional syndrome (CWP or CF) and anxiety/depression were predictors of EQ-5D thermometer at follow-up after adjustment for confounders.

Conclusions

Multiple somatic symptoms in people with an FSS are associated with impaired health status and this cannot be explained by more severe functional syndrome or the presence of anxiety and depression.

Clark C, Goodwin L, Stansfeld SA, Hotopf M, White PD. Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort. Br J Psychiatry. 2011;199:323–9.PubMedCrossRef

Clauw DJ, Arnold LM, McCarberg BH. The science of fibromyalgia. Mayo Clin Proc. 2011;86(9):907–11.PubMedCrossRef

Sharpe M. Chronic fatigue syndrome: neurological, mental or both. J Psychosom Res. 2011;70(6):498–9.PubMedCrossRef

Brandt LJ, Bjorkman D, Quigley E, et al. Evidence-based position statement on the management of irritable bowel syndrome in North America. Am J Gastroenterol. 2002;97(11 Suppl):S1–5.

Elsenbruch S. Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms. Brain Behav Immun. 2011;25(3):386–94.PubMedCrossRef

Wessely S, White PD. There is only one functional somatic syndrome. Br J Psychiatry. 2004;185:95–6.PubMedCrossRef

Kato K, Sullivan P, Evengard B, Pedersen N. A population-based twin study of functional somatic syndromes. Psychol Med. 2009;39:487–505.CrossRef

Kato K, Sullivan PF, Pedersen N. Latent class analysis of functional somatic symptoms in a population-based sample of twins. J Psychosom Res. 2010;68:447–53.PubMedCrossRef

Knudsen AK, Henderson M, Harvey SB, Chalder T. Long-term sickness absence among patients with chronic fatigue syndrome. Br J Psychiatry. Sep 8. [Epub ahead of print]. 2011.

10.

White PD. Chronic fatigue syndrome: is it one discrete syndrome or many? Implications for the "one versus many" functional somatic syndromes debate. J Psychosom Res. 2010;68:455–9.PubMedCrossRef

11.

Creed F, Fernandes L, Guthrie E, et al. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome [see comment]. Gastroenterology. 2003;124(2):303–17.PubMedCrossRef

12.

White P, Goldsmith K, Johnson A, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011;377(9768):823–36.PubMedCrossRef

13.

Creed FH, Kroenke K, Henningsen P, Gudi A, White P. Evidence-based treatment. In: Creed FH, Henningsen P, Fink P, editors. Medically unexplained symptoms, somatisation and bodily distress: developing better clinical services. Cambridge: Cambridge University Press; 2011.CrossRef

14.

Gupta A, Silman AJ, Ray D, et al. The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study. Rheumatology. 2007;46(4):666–71.PubMedCrossRef

15.

Creed FH, Barsky A, Leiknes KA. Epidemiology: prevalence, causes and consequences. Medically unexplained symptoms, somatisation and bodily distress: developing better clinical services. Cambridge: Cambridge University Press; 2011. p. 42.CrossRef

16.

Nicholl BI, Halder SL, Macfarlane GJ, et al. Psychosocial risk markers for new onset irritable bowel syndrome—results of a large prospective population-based study. Pain. 2008;137(1):147–55.PubMedCrossRef

17.

Hotopf M, Mayou R, Wadsworth M, et al. Temporal relationships between physical symptoms and psychiatric disorder. Results from a national birth cohort. Br J Psychiatry. 1998;173:255–61.PubMedCrossRef

18.

Kingma EM, de Jonge P, Ormel J, Rosmalen JGM. Predictors of a functional somatic syndrome diagnosis in patients with persistent functional somatic symptoms. Int J Behav Med 2012; in press.

19.

Functional Somatic Syndromes. Etiology, diagnosis and treatment. Cambridge: Cambridge University Press; 1998.

20.

Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet. 2007;369(9565):946–55.PubMedCrossRef

21.

Geisser ME, Strader DC, Petzke F, et al. Comorbid somatic symptoms and functional status in patients with fibromyalgia and chronic fatigue syndrome: sensory amplification as a common mechanism. Psychosomatics. 2008;49(3):235–42.PubMedCrossRef

22.

Aaron LA, Bradley LA, Alarcon GS, et al. Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness. Arthritis Rheum. 1996;39(3):436–45.PubMedCrossRef

23.

Spiegel BM, Kanwal F, Naliboff B, Mayer E. The impact of somatization on the use of gastrointestinal health-care resources in patients with irritable bowel syndrome. Am J Gastroenterol. 2005;100(10):2262–73.PubMedCrossRef

24.

Williams RE, Black CL, Kim HY, et al. Determinants of healthcare-seeking behaviour among subjects with irritable bowel syndrome. Aliment Pharmacol Ther. 2006;23(11):1667–75.PubMedCrossRef

25.

Creed F, Tomenson B, Guthrie E, et al. The relationship between somatisation and outcome in patients with severe irritable bowel syndrome. J Psychosom Res. 2008;64:613–20.PubMedCrossRef

26.

Palmer KT, Calnan M, Wainwright D, et al. Disabling musculoskeletal pain and its relation to somatization: a community-based postal survey. Occup Med (Oxford). 2005;55(8):612–7.CrossRef

27.

Aggarwal V, McBeth J, Zakrzewska JM, Lunt M, Macfarlane GJ. The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? Int J Epidemiol. 2006;35:468–76.PubMedCrossRef

28.

Koloski NA, Boyce PM, Talley NJ. Somatization an independent psychosocial risk factor for irritable bowel syndrome but not dyspepsia: a population-based study. Eur J Gastroenterol Hepatol. 2006;18(10):1101–9.PubMedCrossRef

29.

Locke GR, Weaver AL, Melton LJ, Talley NJ. Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study. Am J Gastroenterol. 2004;99(2):350–7.PubMedCrossRef

30.

Nicholl BI, Macfarlane GJ, Davies KA, Morriss R, Dickens C, McBeth J. Premorbid psychosocial factors are associated with poor health-related quality of life in subjects with new onset of chronic widespread pain — results from the EPIFUND study. Pain. 2009;141:119–26.PubMedCrossRef

31.

Hauser W, Schmutzer G, Brahler E, Glaesmer H. A cluster within the continuum of biopsychosocial distress can be labeled "fibromyalgia syndrome" — evidence from a representative German population survey. J Rheumatol. 2009;36(12):2806–12.PubMedCrossRef

32.

Vandvik PO, Wilhelmsen I, Ihlebaek C, Farup PG. Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications. Aliment Pharmacol Ther. 2004;20(10):1195–203.PubMedCrossRef

33.

Johansson PA, Farup PG, Bracco A, Vandvik PO. How does comorbidity affect cost of health care in patients with irritable bowel syndrome? A cohort study in general practice. BMC Gastroenterol. 2010;10:31.PubMedCrossRef

34.

Creed F, Ratcliffe J, Fernandez L, et al. Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome. Ann Intern Med. 2001;134(9 Pt 2):860–8.PubMed

35.

Creed FH. Somatization and pain syndromes. In: Mayer EA, Bushnell MC, editors. Functional chronic pain syndromes: presentation and pathophysiology. Seattle, WA: IASP Press; 2009. p. 227–44.

36.

Creed FH, Davies I, Jackson J, et al. The epidemiology of multiple somatic symptoms. J Psychosom Res. 2012;72:311–7.PubMedCrossRef

37.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedCrossRef

38.

Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27(2):363–70.PubMedCrossRef

39.

Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE. Research diagnostic questions for functional gastrointestinal disorders, Rome II modular questionnaire: investigator and respondent forms. In: Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE, editors. Rome II. The functional gastrointestinal disorders. Diagnosis, pathophysiology and treatment: a multinational consensus. McLean, VA: Degnon Associates; 2000. p. 669–88.

40.

Chalder T, Berelowitz G, Pawlikowska T, et al. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–53.PubMedCrossRef

41.

Cella M, Chalder T. Measuring fatigue in clinical and community settings. J Psychosom Res. 2010;69(1):17–22.PubMedCrossRef

42.

Derogatis LR, Lipman RS, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15.PubMedCrossRef

43.

Gandek B, Ware JE, Aaranson NK, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51:1171–8.PubMedCrossRef

44.

Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care. 1992;30(6):473–83.PubMedCrossRef

45.

Spiegel BM, Gralnek IM, Bolus R, et al. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med. 2004;164(16):1773–80.PubMedCrossRef

46.

Hoffman DL, Dukes EM. The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract. 2008;62:115–26.PubMedCrossRef

47.

Ware JE, Kosinski M. Keller S.D. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.PubMedCrossRef

48.

Williams A. Euroqol — A new facility for the measurement of Health-Related Quality-Of-Life. Health Policy. 1990;16(3):199–208.CrossRef

49.

Creed FH, Henningsen P, Byng R. Achieving optimal treatment organisation in different countries. Suggestions for service development applicable across different healthcare systems. In: Creed FH, Henningsen P, Fink P, editors. Medically unexplained symptoms, somatisation and bodily distress. Developing better clinical services. Cambridge: Cambridge University Press; 2011. p. 234–50.CrossRef

50.

Tomenson B, Essau C, Jacobi F et al. Total somatic symptom score is more closely correlated with outcome than "medically unexplained" symptoms. Submitted for publication, 2012.

51.

Drossman DA. Rome III, The functional gastrointestinal disorders. 3rd ed. McLean, VA: Degnon Associates Inc.; 2006.

52.

Lembo AJ, Zaman M, Krueger RF, Tomenson B, Creed FH. Psychiatric disorder, irritable bowel syndrome, and extra-intestinal symptoms in a population-based sample of twins. Am J Gastroenterol. 2009;104(3):686–94.PubMedCrossRef

53.

Nicholl BI, Holliday KL, Macfarlane GJ, et al. Association of HTR2A polymorphisms with chronic widespread pain and the extent of musculoskeletal pain. Arthritis Rheum. 2011;63(3):810–8.PubMedCrossRef

54.

Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee [see comment]. Arthritis Rheum. 1990;33(2):160–72.PubMedCrossRef

55.

Martin A, Chalder T, Rief W, et al. The relationship between chronic fatigue and somatization syndrome: a general population survey. J Psychosom Res. 2007;63(2):147–56.PubMedCrossRef

56.

Hickie I, Lloyd A, Hadzipavlovic D, Parker G, Bird K, Wakefield D. Can the chronic fatigue syndrome be defined by distinct clinical-features. Psychol Med. 1995;25(5):925–35.PubMedCrossRef

57.

Jason LA, Corradi K, Torres-Harding S, Taylor RR, King C. Chronic fatigue syndrome: the need for subtypes. Neuropsychol Rev. 2005;15(1):29–58.PubMedCrossRef

58.

Mueller W, Schneider M, Joos T, Hsu H, Stratz T. Subgroups of fibromyalgia. Schmerz. 2007;21(5):424–9.CrossRef

59.

Giesecke T, Williams DA, Harris RE, et al. Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum. 2003;48(10):2916–22.PubMedCrossRef

60.

Jackson J, Fiddler M, Kapur N, et al. Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics. J Psychosom Res. 2006;60(4):357–63.PubMedCrossRef

61.

Creed F. The relationship between somatic symptoms, health anxiety, and outcome in medical out-patients. Psychiatr Clin North Am. 2011;34(3):545–64.PubMedCrossRef

62.

Khoo EM, Mathers NJ, McCarthy SA, Low WY. Somatisation disorder and its associated factors in multiethnic primary care clinic attenders. Int J Behav Med 2011; May 12. [Epub ahead of print].

63.

Duddu V, Husain N, Dickens C, Duddu V, Husain N, Dickens C. Medically unexplained presentations and quality of life: a study of a predominantly South Asian primary care population in England. J Psychosom Res. 2008;65(4):311–7.PubMedCrossRef

64.

Creed F, Guthrie E, Ratcliffe J, et al. Reported sexual abuse predicts impaired functioning but a good response to psychological treatments in patients with severe irritable bowel syndrome. Psychosom Med. 2005;67(3):490–9.PubMedCrossRef

65.

Fiddler M, Jackson J, Kapur N, et al. Childhood adversity and frequent medical consultations. Gen Hosp Psychiatr. 2004;26(5):367–77.CrossRef

66.

Filipkowski KB, Smyth JM, Rutchick AM, et al. Do healthy people worry? Modern health worries, subjective health complaints, perceived health, and health care utilization. Int J Behav Med. 2010;17(3):182–8.PubMedCrossRef

67.

Duddu V, Isaac MK, Chaturvedi SK, Duddu V, Isaac MK, Chaturvedi SK. Somatization, somatosensory amplification, attribution styles and illness behaviour: a review. Int Rev Psychiatr. 2006;18(1):25–33.CrossRef

68.

Köteles F, Simor P. Modern health worries, somatosensory amplification and subjective symptoms: a longitudinal study. Int J Behav Med 2011;Dec 30. [Epub ahead of print].

69.

Van Oudenhove L, Vandenberghe J, Vos R, Holvoet L, Demyttenaere K, Tack J. Risk factors for impaired health-related quality of life in functional dyspepsia. Aliment Pharmacol Ther. 2011;33(2):261–74.PubMedCrossRef

70.

Katon W, Lin EHB, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatr. 2007;29(2):147–55.CrossRef

71.

Fink P, Schroder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res. 2010;68(5):415–26.PubMedCrossRef

72.

Dimsdale J, Creed FH. The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV—a preliminary report. J Psychosom Res. 2009;66:473–6.PubMedCrossRef

73.

Rief W, Isaac M. Are somatoform disorders 'mental disorders'? A contribution to the current debate. Curr Opin Psychiatr. 2007;20:143–6.CrossRef

74.

Rief W, Rojas G, Rief W, Rojas G. Stability of somatoform symptoms—implications for classification. Psychosom Med. 2007;69(9):864–9.PubMedCrossRef

75.

Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology. 2002;122(4):1140–56.PubMedCrossRef

76.

Moss-Morris R, Spence M, Moss-Morris R, Spence M. To "lump" or to "split" the functional somatic syndromes: can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosom Med. 2006;68(3):463–9.PubMedCrossRef

77.

Moss-Morris R, Spence M, Hou R. The pathway from glandular fever to chronic fatigue syndrome: can the cognitive behavioural model provide the map? Psychol Med. 2011;41(5):1099–107.PubMedCrossRef

78.

Spence MJ, Moss-Morris R, Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis [see comment]. Gut. 2007;56(8):1066–71.PubMedCrossRef

79.

Kato K, Sullivan PF, Evengard B, Pedersen NL. Chronic widespread pain and its comorbidities — A population-based study. Arch Intern Med. 2006;166(15):1649–54.PubMedCrossRef

80.

Kroenke K, Spitzer RL, deGruy III FV, et al. A symptom checklist to screen for somatoform disorders in primary care. Psychosomatics. 1998;39(3):263–72.PubMedCrossRef

81.

Hickie I, Davenport T, Vernon SD, et al. Are chronic fatigue and chronic fatigue syndrome valid clinical entities across countries and health-care settings? Aust New Zeal J Psychiatr. 2009;43(1):25–35.CrossRef

82.

Hickie I, Davenport T, Wakefield D, et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ. 2006;333(7568):575.PubMedCrossRef

83.

Schumacher S, Rief W, Brähler E, Martin A, Glaesmer H, Mewes R. Disagreement in doctor's and patient's rating about medically unexplained symptoms and health care use. Int J Behav Med 2011;Dec 21. [Epub ahead of print].

Titel: Multiple Somatic Symptoms Predict Impaired Health Status in Functional Somatic Syndromes
verfasst von: F. H. Creed
B. Tomenson
C. Chew-Graham
G. J. Macfarlane
I. Davies
J. Jackson
A. Littlewood
J. McBeth
Publikationsdatum: 01.06.2013
Verlag: Springer US
Erschienen in: International Journal of Behavioral Medicine / Ausgabe 2/2013
Print ISSN: 1070-5503
Elektronische ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-012-9257-y

Springer Medizin

Abstract

Background

Purpose

Methods

Results

Conclusions

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