Demographic and health-related factors associated with reduced work functioning in people with moderate [MUPS], 2020, van Tilburg et al

[Andy]

Full title: Demographic and health-related factors associated with reduced work functioning in people with moderate medically unexplained physical symptoms: a cross-sectional study

Background
Medically unexplained physical symptoms (MUPS) are a leading cause of reduced work functioning. It is not known which factors are associated with reduced work functioning in people with moderate MUPS. Insight in these factors can contribute to prevention of reduced work functioning, associated work-related costs and in MUPS becoming chronic. Therefore, the aim of this study was to identify which demographic and health-related factors are associated with reduced work functioning, operationalized as impaired work performance and absenteeism, in people with moderate MUPS.

Methods
Data of 104 participants from an ongoing study on people with moderate MUPS were used in this cross-sectional study. Ten independent variables were measured at baseline to determine their association with reduced work functioning: severity of psychosocial symptoms (four domains, measured with the Four-Dimensional Symptom Questionnaire), physical health (RAND 36-Item Health Survey), moderate or vigorous physical activity (Activ8 activity monitor), age, sex, education level and duration of complaints. Two separate multivariable linear regression analyses were performed with backward stepwise selection, for both impaired work performance and absenteeism.

Results
Absenteeism rate rose with 2.5 and 0.6% for every increased point on the Four-Dimensional Symptom Questionnaire for domain ‘depression’ (B = 0.025, SE = 0.009, p = .006) and domain ‘somatization’ (B = 0.006, SE = 0.003, p = .086), respectively. An R2 value of 0.118 was found. Impaired work performance rate rose with 0.2 and 0.5% for every increased point on the Four-Dimensional Symptom Questionnaire for domain ‘distress’ (B = 0.002, SE = 0.001, p = .084) and domain ‘somatization’ (B = 0.005, SE = 0.001, p < .001), respectively. An R2 value of 0.252 was found.

Conclusions
Severity of distress, probability of a depressive disorder and probability of somatization are positively associated with higher rates of reduced work functioning in people with moderate MUPS. To prevent long-term absenteeism and highly impaired work performance severity of psychosocial symptoms seem to play a significant role. However, because of the low percentage of explained variance, additional research is necessary to gain insight in other factors that might explain the variance in reduced work functioning even better.

Open access, https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09415-9

 

[Trish]

Ooh, we're back to being called muppets again. Don't you just have to love the creativity of these wonderful people. [sarcasm]

 

[Sean]

Conclusions
Severity of distress, probability of a depressive disorder and probability of somatization are positively associated with higher rates of reduced work functioning in people with moderate MUPS. To prevent long-term absenteeism and highly impaired work performance severity of psychosocial symptoms seem to play a significant role. However, because of the low percentage of explained variance, additional research is necessary to gain insight in other factors that might explain the variance in reduced work functioning even better.

Or:

Severity of distress, probability of a depressive disorder and probability of [our preferred interpretation] are positively associated with higher rates of reduced work functioning in people with moderate MUPS.

That's better.

And who knew severity of distress, and propensity to get depressed, would increase for people as the burden of physical symptoms increased?

If they are looking for psychosocial factors, can I suggest that persisting in asserting psychosocial factors are primary when they are not is a major, direct and indirect, adverse psychosocial factor in the overall experience of serious chronic disease.

To prevent long-term absenteeism and highly impaired work performance severity of psychosocial symptoms seem to play a significant role. However, because of the low percentage of explained variance, additional research is necessary to gain insight in other factors that might explain the variance in reduced work functioning even better.

Doesn't seem much of a role then if it can't explain the variance, and other factors need to be considered.

How about severity of primary biological pathology? Aggravated by persistent dismissal of that possibility by medical 'authorities', the consequent lack of effective treatment, and all the other secondary social, economic, and personal consequences that visits upon patients.

Ever considered that interpretation, guys? It does fit the facts rather well.

 

[Mithriel]

So what we have is patients we don't believe have a real physical illness. If they had a real physical illness no one would be surprised if they had reduced work functioning but because we have decided they do not have a real physical illness we need money to do research studies to find why they can't work full time.

 

[Peter T]

Does no one explain to these people that correlation by itself neither indicates causality nor the direction of causality if there subsequently turns out to be a causal relationship?

I suspect there may be a correlation between depression and or anxiety and having both your legs blown off by a landmine, would these researchers then decided that having had both your legs missing is a symptom of their mental state. The logic of this research is no sounder than asserting this dubious causal relationship.

 

[Snowdrop]

Information regarding the Four-Dimensional Symptom Q mentioned in the abstract is linked below:

https://www.midss.org/content/four-dimensional-symptom-questionnaire-4dsq

The RAND scale is one we are already familiar with. It's also known as the SF-36.

Linked below:

https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form/survey-instrument.html

With all these sort of papers I begin to question how common does psychiatry think somatisation is? I mean it's beginning to seem that's it's as common as sand in the Sahara.

I wonder is there a way to study just how many researchers there are out there who study this? And if their numbers have grown over time is that a reflection on these imaginary functional / somatising syndromes multiplying? And is their over-invested belief in mass somatising a syndrome of it's own (somatising projection syndrome)?

NB: These are really just rhetorical questions.

 

[Peter T]

I wonder is there a way to study just how many researchers there are out there who study this? And if their numbers have grown over time is that a reflection on these imaginary functional / somatising syndromes multiplying? And is their over-invested belief in mass somatising a syndrome of it's own (somatising projection syndrome)?

I haven’t done a journal search for over 30 years, but I imagine it is a relatively easy task now to plug in a few search terms and get numbers of articles sorted by years published. I would have thought that ‘somatising projection syndrome’ is quite a valuable research topic as it indicates a lot about how ‘science’ can go wrong.

I know nothing about the stats required to describe transmission networks, but could models of disease transmission be used to establish how researcher networks in this field transmit this ‘syndrome’.

[Anyone know an able psychology undergraduate looking for a final year project, I would have though this is a nice contained topic, and because it requires no face to face contact it should also be Covid proof?]

 

[rvallee]

It is not known which factors are associated with reduced work functioning in people with moderate MUPS

I'll save you a lot of trouble here: they're sick. Those are the factors. Literally even Occam's razor. Move on from that. They're sick, that's why they say they're sick, behave like they're sick, are limited like they're sick, report that they're sick. They're sick, literally the only explanation that actually, you know, EXPLAINS things. Literally all those factors are normal features of illness, found in every ill population. They are in fact expected and just because they live in a fantasy world does not excuse this much incompetence.

These guys suck at their job so bad they are very likely the worst experts in the entire human history. They have everything they need to do better and actually managed to completely faceplant at every step. No one has ever failed so thorough at their job before, except their predecessors who wasted their entire career arguing the same nonsense for the same reasons with the same arguments.

And despite the needless incompetence of this experiment, there are literally hundreds of exactly identical papers like this one. Not just similar, literally identical. Always the same recipe, the same inability to ask relevant questions and interpretation of results that don't simply border on delusional, they basically own a huge chunk of real estate in delusional land. For decades on end the same things over and over again. "Why is it that those patients reject psychological explanations?" Why indeed? Occam's razor, that's why. Good grief the incompetence.

 

[Willow]

I'll save you a lot of trouble here: they're sick. Those are the factors. Literally even Occam's razor. Move on from that. They're sick, that's why they say they're sick, behave like they're sick, are limited like they're sick, report that they're sick. They're sick, literally the only explanation that actually, you know, EXPLAINS things. Literally all those factors are normal features of illness, found in every ill population. They are in fact expected and just because they live in a fantasy world does not excuse this much incompetence.

Hits the nail right on the head. In spite of the serious nature of your post, it made me laugh for quite some time. So refreshing to see such simple truth spoken so simply and directly. If only these bPS researchers could get out of their own way to recognize this simple truth.

 

[Hutan]

Merged thread

Chronic MUPS are characterized by the presence of a somatic symptom disorder or functional somatic syndrome according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), such as fibromyalgia, chronic fatigue syndrome or irritable bowel syndrome [9].

People with chronic MUPS visit a medical specialist approximately 7 to 8 times and a health professional approximately 13 to 15 times per year.

There's a reference quoted for this statement - I doubt it survives close examination. I think it's an extremely small percentage of people with ME/CFS who see a medical professional over 20 times a year. Maybe in the first year, although you'd have to be both extraordinarily organised and have a very high tolerance for being told that it's all in your head.

 

[NelliePledge]

If you’re off work sick or claiming benefits due to illness you have to go back to the doctor a minimum 4 times a year to get a sick note the longest one I had was 3 months. The shortest 3 days.

Especially at first you might get signed off for a week then you have to go back and it might be 2 weeks then a month then maybe a month a couple more times so most likely in first year you could have to see the GP say 8 times just for sick notes.

Then if you’re trying pain medication you probably have to see them a couple of times before they put new meds on repeat prescription and if they don’t work or cause side effects you might have to try two or 3 different ones. I can see how the appointments rack up but that’s not through the patients choice.

then if you add in any routine non ME health appointments for flu jabs or contraception or whatever or if they include something like attending CFS clinic sessions that’s going to add maybe 8-10 appointments as well

 

[Jonathan Edwards]

I read this as:

We took a load of patients who we thought were a bit nutty and lazy who kept us in work by coming along to our rehab programme. We tested them on all sorts of things to do with being nuts and lazy. We found that worse people were worse. But, annoyingly, not much worse, so we need to do it again until we get better results.

 

[Amw66]

Merged thread




There's a reference quoted for this statement - I doubt it survives close examination. I think it's an extremely small percentage of people with ME/CFS who see a medical professional over 20 times a year. Maybe in the first year, although you'd have to be both extraordinarily organised and have a very high tolerance for being told that it's all in your head.

This needs watching.
This linking to SSD
@Dx Revision Watch

 

[Dx Revision Watch]

Chronic MUPS are characterized by the presence of a somatic symptom disorder or functional somatic syndrome according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), such as fibromyalgia, chronic fatigue syndrome or irritable bowel syndrome [9].

From the DSM-5

Somatic symptom disorder

P 314

Differential Diagnosis

(...)

 

[Dx Revision Watch]

From one of my submissions to one of the three DSM-5 comment periods:

https://dxrevisionwatch.files.wordpress.com/2014/06/nchssumissionjune14.pdf

(...)

Concerns for the looseness of the Somatic symptom disorder definition and the ease with which these new criteria can be met have been discussed in a number of published papers and commentaries [7][8][9][10]. The over-inclusiveness of the SSD diagnosis is borne out by the results of the DSM-5 field trial study reported by Joel E Dimsdale, MD, chair of the Somatic symptom disorder Work Group, at the 2012 annual meeting of the American Psychiatric Association. 1

15% of the 'diagnosed illness' study group, comprising patients with cancer or coronary disease, were caught by SSD and would meet the criteria for application of an additional mental disorder diagnosis.

26% of the 'functional somatic' study group, comprising patients with irritable bowel syndrome or chronic widespread pain, met the SSD criteria.

SSD has a high false positive rate – capturing 7% of the 'healthy' field trial control group.

It is disturbing that the SSD Work Group (which had included no primary care physicians or pediatricians) appears not to have undertaken any field trials into the safety of application of the SSD criteria in children and adolescents.