Social position and functional somatic disorders: The DanFunD study, 2021, Signe et al

[Andy]

Abstract

Background and aim:
It is generally accepted that functional somatic disorders (FSDs) are a product of biological, psychological, and social factors. Social position might be part of this complex, but the literature on this issue is currently heterogeneous and inconsistent. The aim of the present study was – in a population-based cohort – to test the hypothesis that lower social position would be associated with higher a risk of FSD.

Method:
The association between social position and FSD was examined in a cross-sectional study with various measures of social position (education as measured by vocational training; employment; cohabitation; subjective social status) and delimitations of FSD (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, bodily distress syndrome, and symptom profiles). The associations were analyzed using logistic regressions to calculate odds ratios and 95% confidence intervals. Each social measure was analyzed independently and was adjusted for age and sex.

Results:
Lower levels of vocational training, being unemployed, and living alone were associated with higher risk of FSD, regardless of the FSD delimitation. There was also a significant negative association between subjective evaluated social status and FSD. The associations remained after multiple adjustments, and seemed to be strongest for the more severe FSD-types.

Conclusions:
Lower social position is associated with higher risk of FSD, especially the more severe FSD delimitations, which might constitute an especially vulnerable group. However, the mechanisms behind the relations remain unknown.

Paywall, https://journals.sagepub.com/doi/10.1177/14034948211056752

 

[Peter T]

The authors state ‘It is generally accepted …‘ when in fact what they mean is ‘we and our narrow peer group believe…’.

Yet again we see an inability to distinguish between correlation and causality, even if you accept their evidence base is in any way reliable.

 

[rvallee]

Lower levels of vocational training, being unemployed, and living alone were associated with higher risk of FSD, regardless of the FSD delimitation.

And obviously large puddles on the ground lead to large clouds. And famine is what causes crops to die in the fields. Are these people aware that being sick as a young adult leads to exactly this? Again they are looking at the very obvious and normal outcomes of a situation and simply can't process the outcomes because they arbitrarily reject the context and invent their own. They want to find correlations to carve out their preferred direction of causality but can't imagine the obvious cause-and-effect. When they hear hoofs, they think howling monkeys, I guess.

I also do love the "people are saying". Lots of people are saying lots of things. That this passes editorial review is absurd. It is also generally accepted that medical professionals espousing psychosomatic ideology are perceived as incompetent and useless. This one is actually true. You can even find it as such in thousands of academic articles, all of which happen to conclude that reality is wrong because they themselves can't possibly be wrong. Amazing.

 

[CRG]

Yeah but you know - Yuppy Flu init.

 

[ola_cohn]

Did they look at whether people were unemployed now, or before they got sick?

Sorry, I can't see it behind the paywall.

 

[Hutan]

There's this open access paper that seems to be about the set-up of the study:
Cohort description: The Danish study of Functional Disorders, 2017, Dantoft et al
Abstract: The Danish study of Functional Disorders (DanFunD) cohort was initiated to outline the epidemiology of functional somatic syndromes (FSS) and is the first larger coordinated epidemiological study focusing exclusively on FSS.

In 2009, motivated by the growing concern about the FSS within the medical community, a “think tank” of scientists, medical experts, and medical social workers were invited by the Danish foundation TrygFonden to discuss possible interdisciplinary and cross-national research studies. The outcome was the formation of the DanFunD Steering Committee with the overall objectives to design and launch a large-scale epidemiological population-based longitudinal study with special focus on FSS, encompassing researchers from basic science, clinical science, biostatistics, and epidemiology.

The DanFunD cohort is anchored at the Research Centre for Prevention and Health (RCPH), Glostrup, Denmark and is a random sample of the general adult population. The cohort comprises a total of 9,656 men and women aged 18–76 years, born in Denmark and living in the western part of the greater Copenhagen.

It looks as though only a third of the nearly 10,000 people approached agreed to participate.

I've skimmed the paper, and I still can't tell if they assessed lifestyle factors as at the time of illness onset, or if education and social status are just assessed now. There looks to be some linkage to government databases with information about education and employment and cohabitations (as well as medical care usage) - but the references to that sound more like tracking into the future than getting information from the time of illness onset. I can't even see that they asked about the year of illness onset.


What is clear is what they are expecting to find:

The analysis of risk factors will comprise a broad range of physical, emotional, cognitive, social, and health care variables (Figure 2). Studies have found that cognitive and behavioral factors, such as illness worrying, symptom catastrophizing, and pain avoidance behavior, are important risk factors and determinants of FSS.32,33,70–72 However, the mechanisms behind these associations between psychological factors and FSS, as well as the impact of personality, self-efficacy, and perceived stress in particular, are still unclear. Analyses will be conducted to assess whether personality traits and general self-efficacy act as independent risk factors for FSS, and self-perceived stress, illness worrying, pain avoidance behavior, and physical activity will be investigated as potential mediating factors.

It strikes me as the sort of study insurance companies would love.