Potentially traumatic events, social support and burden of persistent somatic symptoms: A longitudinal study, 2022, Barends et al

Highlights

• PTEs in childhood were associated with higher burden of PSS over four-year time.
• Cumulative exposure to PTEs was associated with higher burden of PSS.
• Burden of PSS was higher in terms of symptom severity and physical functioning.
• Recent PTEs (last year) showed no association with burden over four-year time.
• Social support did not attenuate the associations.

Abstract

Objective
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.

Methods
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.

Results
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.

Conclusions
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.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399922002306

 

The methodological problems with these studies are so well rehearsed here there is no point in repeating them, however it is interesting that their recent ‘potentially traumatic events’ when self reporting may be more accurate had no impact the ‘persistent somatic symptoms’ did not encourage the authors to question their belief in a causal relationship.

I am surprised that recent traumatic events did not have an effect, as in such as ME, such events as death of a parent, a car crash or an assault also result in a demand for increased activity both physical and cognitive that you would expect to trigger PEM and potentially a worsening of the underlying condition.

 

Another problem with these sorts of studies* is that there can be confounds that lead to differences in patient presentation to the clinic and hence study inclusion in the first place.

*(besides well-documented biases in retrospective reporting of experiences before the study commenced and the fact that they are correlating one set of questionnaires to another and hence there can be common questionnaire answering biases that could explain the correlation)

No, they reported that it was an effect only in people who reported childhood PTEs which is even more curious. I think this is quite suspect and suggests there could be a confounding reporting/response bias going on by those participants.