The associated features of multiple somatic symptom complexes (Creed et al. 2018)

Dolphin

Dolphin

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The Journal of Psychosomatic Research

https://www.jpsychores.com/article/S0022-3999(18)30127-2/abstract

September 2018 Volume 112, Pages 1–8
The associated features of multiple somatic symptom complexes

Francis Creed,
Barbara Tomenson,
Carolyn Chew-Graham,
Gary Macfarlane,
John McBeth

DOI: https://doi.org/10.1016/j.jpsychores.2018.06.007

Publication History
Published online: June 11, 2018
Accepted: June 11, 2018
Received in revised form: April 25, 2018
Received: February 13, 2018

Highlights





    • •An existing functional somatic syndrome is a risk factor for developing another.
    • •Multiple functional somatic syndromes are associated with distress, impaired function and high healthcare use.
    • •Depression, anxiety, medical illness & health anxiety demonstrated exposure-response relationship with number of somatic symptom complexes
    • •Impaired health status 1 year later was predicted by multiple somatic symptom complexes even after adjustment for confounders

Abstract
Objective
To assess whether two or more functional somatic symptom complexes (SSCs) showed stronger association with psychosocial correlates than single or no SSC after adjustment for depression/anxiety and general medical disorders.

Methods
In a population-based sample we identified, by standardised questionnaire, participants with chronic widespread pain, chronic fatigue and irritable bowel syndrome, excluding those with a medical cause for pain/fatigue. We compared psychosocial variables in three groups: multiple (>1), single or no FSS, adjusting for depression/anxiety and general medical disorders using ordinal logistic regression. We evaluated whether multiple SSCs predicted health status 1 year later using multiple regression to adjust for confounders.

Results
Of 1443 participants (58.0% response) medical records were examined in 990: 4.4% (n = 44) had 2 or 3 symptom complexes, 16.2% a single symptom complex. Many psychosocial adversities were significantly associated with number of SSCs in the expected direction but, for many, statistical significance was lost after adjustment for depression/anxiety and medical illness. Somatic symptoms, health anxiety, impairment and number of prior doctor visits remained significantly associated. Impaired health status 1 year later was predicted by multiple somatic symptom complexes even after adjustment for depression, anxiety, medical disorders and number of symptoms.

Conclusions
Depression, anxiety, medical illness and health anxiety, demonstrated an exposure-response relationship with number of somatic symptom complexes. These may be core features of all Functional Somatic Syndromes and may explain why number of somatic symptom complexes predicted subsequent health status. These features merit inclusion in prospective studies to ascertain causal relationships.


Keywords:
Chronic fatigue, Epidemiology, Fibromyalgia, Functional somatic syndromes, Medically unexplained symptoms, Population based
 
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I've only read the abstract.

Read the first sentence and alarm bells ring:

In a population-based sample we identified, by standardised questionnaire, participants with chronic widespread pain, chronic fatigue and irritable bowel syndrome, excluding those with a medical cause for pain/fatigue
Click to expand...

So a bunch of psychologists/epidemiologists/statisticians who have no medical knowledge make the assumption that CFS, chronic widespread pain (FM?) and IBS don't have a medical cause.

There follows more wild speculation based on questionnaire data and a conclusion that doesn't seem to follow from the results. Is it just me or is this garbage?
 
A higher prevalence of depression and anxiety in the FSS population could be merely the consequence of the "poorly understood" status of these conditions. Patients with poorly understood conditions will find it more difficult to receive appropriate treatment, will encounter more disbelief and ignorance, and so on. These are probably risk factors for depression and anxiety.
 
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I'm surprised we're still getting research like this. Interesting that the abstract made so many of the limitations clear, but then their conclusion still tried to make it sound exciting.

John McBeth is the Deputy Director of the Arthritis Research UK Centre for Epidemiology. That's not a great sign. Were Arthritis UK linking to the CMRC in some way?
 
Just to note:

Professor emeritus, Francis Creed, had been one of the UK members of the DSM-5 Somatic symptom disorders Work Group, along with Prof Michael Sharpe.

Prof Creed has also been a key member of the ICD-11 sub working group for Somatic Distress and Dissociative Disorders Working Group (S3DWG), that has developed the Bodily distress disorder [1] diagnostic construct for the ICD-11 core edition (ICD-11 MMS) that was launched by the WHO yesterday (Post #31 onwards).

(Note that contrary to suggestions in a recent paper, Bodily distress disorder has been the only construct under consideration for the core ICD-11 version, since BDD was first added to the ICD-11 draft in early 2012.)


Prof Creed has been heavily involved with EU MUS working groups and this publication [2] evolved out of an EU MUS group, in which Henningsen and Fink had been key members.

He is also involved with the European Association of Psychosomatic Medicine (EAPM).

The Journal of Psychosomatic Research (JPR) (in which the paper that is the subject of this thread is published) is the official journal of the EAPM and Prof Creed has been a past editorial board member of the JPR.

The EAMP awards an annual award (The Alison Creed Award in memory of Prof Creed's late wife) for life time achievement in the field of Psychosomatic Medicine/Consultation Liaison Psychiatry.

Last year, the Alison Creed Award was presented to Prof Per Fink. Whose award lecture is published here:

Syndromes of bodily distress or functional somatic syndromes - Where are we heading. Lecture on the occasion of receiving the Alison Creed award 2017. Per Fink. The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark. June 2017 Volume 97, Pages 127–130 (initially free access, now paywalled).https://www.jpsychores.com/article/S0022-3999(17)30445-2/fulltext

and presentation slides here: http://www.eapm2017.com/images/site/abstracts/PLENARY_Prof_FINK.pdf


1 Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry. 2012 Dec;24(6):556-67. doi: 10.3109/09540261.2012.741063. [PMID: 23244611]

2 Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services, Francis Creed, Peter Henningsen, Per Fink (Eds), Cambridge University Press, 2011
 
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