Biopsychosocial factors associated with distress in people with suspected (POTS): A longitudinal regression and correlation study 2026 Moss-Morris+

[Andy]

Full title: Biopsychosocial factors associated with distress in people with suspected postural orthostatic tachycardia syndrome (POTS): A longitudinal regression and correlation study

Highlights​

• Patients reported experiencing moderate levels of distress.
• Distress levels did not change significantly 6 months after a specialist clinic appointment.
• Cognitive-behavioural factors were identified as potentially influencing distress levels.
• These factors could be suitable targets for integrated interventions to reduce distress.
• Formalised support for POTS-related distress should be a priority in service development.

Abstract​

Purpose​

Postural Orthostatic Tachycardia Syndrome (POTS) is a debilitating condition of the autonomic nervous system with no clear referral, diagnosis, and treatment pathways. Patients experience high levels of symptoms and moderate levels of distress. The purpose of this study was to explore biopsychosocial factors associated with distress in those under investigation for POTS, to identify potential targets for intervention.

Methods​

A longitudinal, quantitative survey. Participants (n = 149) completed demographic, psychosocial, and symptom questionnaires prior to a diagnostic POTS clinic visit and 6 months follow-up (n = 98). Correlation and regression analyses were used to identify factors associated with distress at baseline (within one month before diagnostic hospital visit) and at 6 months follow up.

Results​

At baseline, distress levels were moderate and greater symptom focusing, all-or-nothing and avoidance behaviours, threatening views of the illness, emotional reactivity, cardiac anxiety, POTS symptoms, number of specialists seen, lower social support, and younger age were significantly associated with higher levels of baseline distress. The baseline regression model including all demographic, clinical, and psychosocial factors explained 61.2 % of the variance in distress, with the psychosocial variables collectively explaining 55.6 % of this variance (F = 11.06, p < .001). There was no significant difference between distress levels at baseline and follow-up. Psychosocial variables explained 4.7 % of the variance (F = 0.76, p = .665) in changes in distress scores over 6 months. Baseline distress scores accounted for the vast majority of variance in distress at follow-up.

Conclusions​

This study identified key novel psychosocial factors that were significantly associated with distress which could be potential targets for intervention. Additional factors such as younger age and a higher number of specialists seen were also associated with higher levels of distress, which merits attention when assessing patients' psychological wellbeing this patient group. Distress levels did not significantly change following the specialist consultation and investigation.

Paywall

 

[Utsikt]

Psychosocial variables explained 4.7 % of the variance (F = 0.76, p = .665) in changes in distress scores over 6 months.

Presumably that means that attempting to address the psychosocial variables will make little to no difference?

 

[V.R.T.]

Can't they just give it a bloody rest? Every single day another paper is churned out, every time the same shoddy research practices.

They are trying to bury us beneath a blizzard of bad science.

 

[Kitty]

Effing distress. Again.

I get distressed when I drop heavy tools on my feet. I need steel toe-cap boots to prevent it, not a psychologist to treat it.

 

[rvallee]

This study identified key novel psychosocial factors that were significantly associated with distress

It, did not, though.

distress levels were moderate and greater symptom focusing, all-or-nothing and avoidance behaviours, threatening views of the illness, emotional reactivity, cardiac anxiety, POTS symptoms, number of specialists seen, lower social support, and younger age were significantly associated with higher levels of baseline distress

Literally none of this is novel, it's the same old generic nonsense, it's also mostly downstream, irrelevant, or plain weird. Symptoms are associated with... symptoms? Wow, such insight. This medical astrology stuff is so damn weird.

Distress is a preferred but invalid framing. Everything about POTS is the symptoms and how physically disabling they are, the rest is irrelevant. This is what they call distress, but it's just the illness. None of this has any value whatsoever. All the weird stuff about all-or-nothing, avoidance, emotional whatever is just complete gobbledygook.

It has become obvious to me that as long as medicine continues to pretend like this model is worth anything, it will simply remain stagnant in all aspects other than cutting edge biomedical research, where technology drives about 90% of all innovations. Which has been the case since it gained prominence. Health care has completely stopped innovating and progressing outside of scientific and technological breakthroughs, and it's all because of this flawed ideology. It would be as if biological sciences had stopped because Lysenkoism became widely adopted.

The problem is that there is no alternative concept, and so one must be developed. The biopsychosocial model of illness is basically the equivalent of old aristocracies and monarchies inventing concepts such as "noble blood" and divine rule, or whatever, it has zero real-life application and is conceptually bankrupt. It has become one of the biggest problems in health care. It must be replaced. A wet napkin with random doodles would be better.

 

[rvallee]

Presumably that means that attempting to address the psychosocial variables will make little to no difference?

I can't have any other reaction but laugh at the idea that they actually use significant digits on % while evaluating... whatever the hell this is. How any of this is taken seriously is something people will bash their heads on walls for centuries.

As if any of those numbers are any more real than doing statistical evaluations of how much Mercury ascendant someone's birth was, or whatever. I know nothing of astrology and frankly I consider those two ideologies to be philosophically equivalent.

 

[rvallee]

Can't they just give it a bloody rest? Every single day another paper is churned out, every time the same shoddy research practices.

They are trying to bury us beneath a blizzard of bad science.

Not even science, this junk is straight up textbook pseudoscience. But the problem is that this junk is popular. It's not even them. The people who work on this are fully interchangeable, if they had never existed and other people had been involved nothing would be different. It takes every single part of the system to fail to promote nonsense like this. Because it's wildly popular. It's not about solving problems or explaining anything, let alone helping anyone, it's all about stroking egos, with giant piles of ideological cocaine.

 

[Nightsong]

Correspondence in J Psychosom Res regarding this paper:

Distress in POTS is largely driven by ineffective healthcare, not patients' attitudes

A few quotes:

The study found significant level of distress in their cohort before and 6 months after seeing a specialist at an NHS POTS clinic [1], but missing from the study is a description of the actual interventions and therapeutic modalities that these patients received after consultation with a specialist. If the patients were told to increase fluids and salt intake and to exercise more – non- pharmacologic strategies that most patients implement prior to seeing a POTS specialist, given the available information online - then the level of distress after specialist appointment would be similar to that before the appointment.

In fact, studies demonstrate that the rate of major depression and anxiety disorders is not higher in POTS patients than in general population [4,5]. Additionally, many patients with POTS and EDS/HSD experience gaslighting and misdiagnosis with anxiety, functional neurologic disorder and other psychological disorders when the actual disorder is not diagnosed or properly treated

To this end, effective physician-patient communication is essential as adversarial and dismissive attitudes displayed by physicians can also result in significant patient distress and adversely impact the course of illness [8]

We, therefore, emphasize that while studies on biopsychosocial factors in physiologic disorders like POTS can be informative, they can also be weaponized by those who continue to erroneously believe that patients with POTS have abnormal behavioral, emotional and coping mechanisms – themes that have been debunked by robust physiologic studies and that only contribute, not alleviate, to ineffective patient care and distress.

Finally, assessment of psychological profile in this study utilizing various questionnaires may not paint an accurate picture of POTS because of the overlap between physical symptoms caused by sympathetic overactivity that underlies its pathophysiology and psychological symptoms of anxiety, somatization and distress. In fact, studies demonstrate that the rate of major depression and anxiety disorders is not higher in POTS patients than in general population [4,5]

 

[rvallee]

We, therefore, emphasize that while studies on biopsychosocial factors in physiologic disorders like POTS can be informative

I have literally not seen this in any illness, there is no such thing. There is no need to pretend like this is the case, it clearly isn't. The rest of the comment is pretty good, although I don't like the framing of distress, as contrary to its disabling nature, which is the main problem, 'distress' is not a universal experience and it's arbitrary and judgmental, in fact mostly confuses disability and its impact with... other things.

The problems with chronic illness are always in the disability, the loss of functioning, that they cause, everything else is secondary at best, and in most cases independent and/or uncommon. There is no need to accept an invalid framing as valid. Never privilege a lie, and never praise an opponent for being wrong, it's just bad politics.