IL-6 and hsCRP in Somatic Symptom Disorders and related disorders, 2021, van der Feltz-Cornelis et al

[Andy]

Highlights

• IL-6 and hsCRP are biomarkers of Systemic Low grade inflammation in Somatic Symptom and Related Disorders.
• They are associated with childhood sexual abuse and physical symptoms.
• They are not associated with comorbid medical conditions.
• hsCRP is associated with pain and depression as well.
• For use as biomarker in SSRD, a cut-off score of 3.0 mg/l can be used for hsCRP, and a cut-off score of 2.0 pg/ml for IL-6.

Abstract

Background
Interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) are biomarkers of systemic low-grade inflammation (SLI) in depression and anxiety. The question if SLI in those conditions is related to comorbid chronic medical conditions has not been resolved. DSM-5 Somatic symptom disorders and related disorders (SSRD) are conditions with serious distress related to physical symptoms as main criterion. They can occur in patients with medically unexplained symptoms (MUS) and in patients with known comorbid chronic medical conditions. Often, comorbid depression and anxiety are present. SSRDs offer the opportunity to explore the role of SLI in relation to mental distress, including trauma, MUS, chronic medical conditions and comorbid mental disorder.

AIM: We hypothesized that increased IL-6 and hsCRP may be directly linked to SLI in SSRD, and that comorbid chronic medical conditions, childhood trauma, current stress and comorbid depression and anxiety may be risk factors that account for some of the variance of SLI in SSRD.

METHODS: We explored these relationships in a large sample of 241 consecutive outpatients with SSRD.

RESULTS: Mean hsCRP level was 3.66 mg/l, and mean IL-6 level was 3.58 pg/ml. IL-6 and hsCRP levels were associated with each other: τ = 0.249, p < .001; a medium size correlation. Comorbid chronic medical conditions, adverse childhood events other than sexual trauma, and current stress levels were not associated with IL-6 or hsCRP levels.

CONCLUSION: IL-6 and hsCRP are elevated in SSRD, indicating SLI in SSRD independently of comorbid chronic medical conditions. In clinical research, elevated IL-6 and hsCRP can be used as biomarkers of SLI and can indicate risk for childhood sexual abuse in SSRD. Elevated hsCRP may be a biomarker indicating risk for comorbid depression or high pain levels in SSRD as well.

Open access, https://www.sciencedirect.com/science/article/pii/S2666354620301411

 

[Peter T]

Could we see a risk of child protection procedures being wrongly invoked for children displaying ‘elevated IL-6 and hsCRP’?

Having worked in health care in Scotland at the time of the Orkney satanic abuse scandal, and seen several inappropriate sexual abuse accusations, one as a result of a referral I made for official confirmation of an autism diagnosis in a preschool girl, I am very aware of the damage that can arise in a system primed to prematurely conclude that sexual abuse has taken place.

 

[Dx Revision Watch]

Note that although the DSM-5 is not much used in the UK, there is now a SNOMED CT code available for the term "Somatic symptom disorder" in all editions of SNOMED CT terminology system as a result of IAPT leads successfully submitting for addition of the SSD term, in November 2019, for use in its new IAPT Data Set v2.0.

 

[alktipping]

how can they say there is systemic low grade inflammation and then claim said inflammation is caused by emotional trauma . they have never proved this in any acceptable way . says far more about how invested the authors are in their cultish beliefs than anything else

 

[Arnie Pye]

• IL-6 and hsCRP are biomarkers of Systemic Low grade inflammation in Somatic Symptom and Related Disorders.
• They are associated with childhood sexual abuse and physical symptoms.
• They are not associated with comorbid medical conditions.
• hsCRP is associated with pain and depression as well.
• For use as biomarker in SSRD, a cut-off score of 3.0 mg/l can be used for hsCRP, and a cut-off score of 2.0 pg/ml for IL-6.

I really don't understand this.

hsCRP is alleged to predict a patient's risk of developing heart disease.

See this link :

https://labtestsonline.org.uk/tests/hs-crp

Where does the apparent connection with childhood sexual abuse come from?

And why are so many BPS proponents obsessed with childhood sexual abuse? They seem to see evidence of it in every single adult and child who isn't in perfect health.

 

[Hutan]

I found myself sitting with my mouth agape, appalled at this study. Close inspection of it did not help at all.
Checking out Table 4 which presents a selection of the results - presumably the best they could muster from the vast cherry orchard that was this study:

IL6 was related to age (r=0.26, p<0.001)
IL6 and hsCRP were related to pain (BPI) (IL6 r=0.11, p=0.033) (CRP r=0.14, p=0.004)
GAD7 (the anxiety measure) was completely unrelated to these measures of inflammation
hsCRP was positively related to symptom burden (PSQ51). (r=0.12 p=0.011)

So, just to be clear, all they found was that IL6 levels increased with age (a known fact); that IL6 and hsCRP levels are correlated (hardly surprising); that IL6 and hsCRP are correlated to pain scores (again hardly surprising); and that hsCRP is correlated to reported symptom burden (also hardly surprising). Any normal person would see the inflammatory markers and start wondering if the person reporting the problematic symptoms might have some underlying physical cause for them. But no.


Adverse childhood events were not related to IL6 or hsCRP (p's of 0.370, 0.277 respectively)
Childhood sexual trauma was not correlated wth levels of IL6 or hsCRP

IL6 r=0.08, p=0.146
hsCRP r=0.09, p=0.085​

No data was given for IL6 or hsCRP levels correlated with scores on the measure for depression. There was no relationship with the co-morbidities of depression, anxiety disorder or panic disorder.


So how did they justify the statements that childhood sexual trauma is relevant?
They looked at the percentages of people with a history of childhood sexual trauma in people with elevated IL6 (after removing 'outlier data) and hsCRP compared to the people without elevated IL6 and hsCRP.

Even then, childhood sexual trauma was not more common in the people with elevated IL6 (even after the data fiddling) - the p value was 0.112 (Table 5). Childhood sexual trauma was more common in the people with elevated hsCRP. 31% of people with elevated hsCRP reported childhood sexual trauma versus only 18% who didn't have elevated hsCRP. But the finding was only just statistically valid (p=0.042). It's complete nonsense to say, as the highlights do,

IL-6 and hsCRP are biomarkers of Systemic Low grade inflammation in Somatic Symptom and Related Disorders.
They are associated with childhood sexual abuse...

They briefly mention confounders in the discussion, and quote the result of a study that found this

another study found that an association between [Adverse Childhood Events] and hsCRP in depressed individuals disappeared after controlling for socioeconomic factors and health behaviours

but they don't seem to really understand how big of a problem that is.


And they go on to suggest the association with childhood sexual abuse needs more research....

4.2. Recommendations for research
Longitudinal studies are needed that explore a possible temporal association between IL-6 or hsCRP, pain levels, childhood sexual abuse and treatment outcome in SSRD. This program of research should enable us to describe patient profiles (van der Feltz-Cornelis, 2020) that may benefit from different treatment provisions for SSRD, taking clinical characteristics and biomarkers into account. To this end, a personalised medicine approach for SSRD might be developed.

I am constantly surprised at the incredibly bad quality of this sort of research.

 

[Hutan]

I think we should acknowledge the researchers who are willing to put their names to this paper and the institutions that allow them to produce this rubbish:

Christina M.van der Feltz-Cornelis Department of Health Sciences, Hull York Medical School, University of York, UK

Marjan Bakker Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands

Arvind Kaul St. George’s University Hospitals NHS Foundation Trust, London, UK

Taco W.Kuijpersd Emma Children’s Hospital, Dept. of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, the Netherlands

Rolandvon Känel Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland

Jonna F.van Eck van der Sluijsfg Altrecht Psychosomatic Medicine, Zeist, the Netherlands; Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands

The journal that thought this paper was fine is 'Brain, Behavior, & Immunity - Health'.
And the centre providing the trial participants was the Clinical Centre of Excellence for Somatic Symptom Disorders and Related Disorders (CLGG), Tilburg, the Netherland - now there's an oxymoron of a name.

 

[Solstice]

Almost makes you feel ashamed to be Dutch.

 

[MEMarge]

Almost makes you feel ashamed to be Dutch.

Many UK papers are just as bad

 

[Mithriel]

I can think of no biological process that would connect levels of IL6 and hsCRP with childhood sexual abuse especially since that sort of abuse has such wide parameters.

The trauma of that sort of abuse is no different from that of any other abuse so why specify it? I've not been able to track it down again, but I read that many psychologists became very taken with the idea that repressed memories of sexual abuse were at the root of much of adult ill health physical and mental, very Freudian, and that recovering the memory was the cure. When it was shown that these memories were actually implanted by the therapists the poor souls had to do something else to justify their existence.

I suspect they just moved sideways into the more general idea that sexual abuse causes all sorts of ill health but dropped the repressed memories bit.

What angers me is that MUS and FND are seen as psychogenic because they are not "congruent" with accepted medicine yet they do not think they need any sort of congruence for their far fetched ideas despite the widespread deleterious social consequences. (And lack of any evidence they are useful)

 

[Solstice]

Many UK papers are just as bad

I know. I've had some discussions about benefits with some people in the last days here in the Netherlands and the amount of wishful thinking for lack of a better term... Thinking you can shape people just the way you want them to if only you give them the proper guidance. It's as asinine as thinking there isn't a whole lot of luck involved into whether you become rich or not. It does my head in. You are poor so your character must be at fault, pull yourself up by the bootstraps. You are sick so your character must be at fault, let's get to the root source of it.

The way psychologists have been getting away with their bullshit is imo grounded in how society thinks the world works. I'd get deeper into it, but it would become a political rant.

*edited* for clarity.