The associated features of multiple somatic symptom complexes

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

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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. Most 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.
Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalJournal of Psychosomatic Research
Volume112
Early online date12 Jun 2018
DOIs
Publication statusPublished - Sep 2018

Fingerprint

Anxiety
Depression
Health Status
Chronic Pain
Fatigue
Medically Unexplained Symptoms
Irritable Bowel Syndrome
Health
Anxiety Disorders
Medical Records
Logistic Models
Prospective Studies
Pain
Population

Keywords

  • chronic fatigue
  • epidemiology
  • fibromyalgia
  • functional somatic syndromes
  • medically unexplained symptoms
  • population based

Cite this

The associated features of multiple somatic symptom complexes. / Creed, Francis; Tomenson, Barbara; Chew-Graham, Carolyn A.; Macfarlane, Gary; McBeth, John.

In: Journal of Psychosomatic Research, Vol. 112, 09.2018, p. 1-8.

Research output: Contribution to journalArticle

Creed, Francis ; Tomenson, Barbara ; Chew-Graham, Carolyn A. ; Macfarlane, Gary ; McBeth, John. / The associated features of multiple somatic symptom complexes. In: Journal of Psychosomatic Research. 2018 ; Vol. 112. pp. 1-8.
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abstract = "ObjectiveTo 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.MethodsIn 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.ResultsOf 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. Most 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.ConclusionsDepression, 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.",
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note = "We are grateful to the participants in the project and to the General Practitioners and their teams who facilitated it. The study would have been impossible without the work of our research assistants: Judy Jackson, Alison Littlewood and Ian Davies. The study was funded by the UK Medical Research Council. The UK MRC had no role in study design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.",
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AU - Macfarlane, Gary

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N1 - We are grateful to the participants in the project and to the General Practitioners and their teams who facilitated it. The study would have been impossible without the work of our research assistants: Judy Jackson, Alison Littlewood and Ian Davies. The study was funded by the UK Medical Research Council. The UK MRC had no role in study design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

PY - 2018/9

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N2 - ObjectiveTo 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.MethodsIn 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.ResultsOf 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. Most 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.ConclusionsDepression, 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.

AB - ObjectiveTo 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.MethodsIn 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.ResultsOf 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. Most 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.ConclusionsDepression, 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.

KW - chronic fatigue

KW - epidemiology

KW - fibromyalgia

KW - functional somatic syndromes

KW - medically unexplained symptoms

KW - population based

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JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

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