The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?

V. R. Aggarwal, J. McBeth, J. M. Zakrzewska, M. Lunt, Gary John MacFarlane

Research output: Contribution to journalEditorial

218 Citations (Scopus)

Abstract

Background Syndromes for which no physical or pathological changes can be found tend to be researched and managed in isolation although hypotheses suggest that they may be one entity. The objectives of our study were to investigate the co-occurrence, in the general population, of syndromes that are frequently unexplained and to evaluate whether they have common associated factors.

Methods We conducted a population-based cross-sectional survey that included 2299 subjects who were registered with a General Medical Practice in North-west England and who completed full postal questionnaires (response rate 72%). The study investigated four chronic syndromes that are frequently unexplained: chronic widespread pain, chronic oro-facial pain, irritable bowel syndrome, and chronic fatigue. Validated instruments were used to measure the occurrence of syndromes and to collect information on a variety of associated factors: demographic (age, gender), psychosocial (anxiety, depression, illness behaviour), life stressors, and reporting of somatic symptoms.

Results We found that 587 subjects (27%) reported one or more syndromes: 404 (18%) reported one, 134 (6%) reported two, 34 (2%) reported three, and 15 (1%) reported all four syndromes. The occurrence of multiple syndromes was greater than would be expected by chance (P < 0.001). There were factors that were common across syndromes: female gender [odds ratio (OR) = 1.8; 95% confidence interval (95% CI) 1.5-2.2], high levels of aspects of health anxiety like health worry preoccupation (OR = 3.5; 95% CI 2.8-4.4) and reassurance seeking behaviour (OR = 1.4; 95% CI 1.1-1.7), reporting of other somatic symptoms (OR = 3.6; 95% CI 2.9-4.4), and reporting of recent adverse life events (OR = 2.3; 95% CI 1.9-2.8).

Conclusion This study has shown that chronic syndromes that are frequently unexplained co-occur in the general population and share common associated factors. Primary care practitioners need to be aware of these characteristics so that management is appropriate at the outset.

Original languageEnglish
Pages (from-to)468-476
Number of pages8
JournalInternational Journal of Epidemiology
Volume35
DOIs
Publication statusPublished - 2006

Keywords

  • unexplained
  • syndromes
  • chronic
  • co-occurrence
  • general population
  • CHRONIC-FATIGUE-SYNDROME
  • RANDOMIZED CONTROLLED-TRIAL
  • CHRONIC WIDESPREAD PAIN
  • OROFACIAL PAIN
  • PRIMARY-CARE
  • PSYCHOLOGICAL DISTRESS
  • PHYSICAL SYMPTOMS
  • COMMUNITY SURVEY
  • MENTAL-DISORDER
  • ABDOMINAL-PAIN

Cite this

The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? / Aggarwal, V. R.; McBeth, J.; Zakrzewska, J. M.; Lunt, M.; MacFarlane, Gary John.

In: International Journal of Epidemiology, Vol. 35, 2006, p. 468-476.

Research output: Contribution to journalEditorial

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title = "The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?",
abstract = "Background Syndromes for which no physical or pathological changes can be found tend to be researched and managed in isolation although hypotheses suggest that they may be one entity. The objectives of our study were to investigate the co-occurrence, in the general population, of syndromes that are frequently unexplained and to evaluate whether they have common associated factors.Methods We conducted a population-based cross-sectional survey that included 2299 subjects who were registered with a General Medical Practice in North-west England and who completed full postal questionnaires (response rate 72{\%}). The study investigated four chronic syndromes that are frequently unexplained: chronic widespread pain, chronic oro-facial pain, irritable bowel syndrome, and chronic fatigue. Validated instruments were used to measure the occurrence of syndromes and to collect information on a variety of associated factors: demographic (age, gender), psychosocial (anxiety, depression, illness behaviour), life stressors, and reporting of somatic symptoms.Results We found that 587 subjects (27{\%}) reported one or more syndromes: 404 (18{\%}) reported one, 134 (6{\%}) reported two, 34 (2{\%}) reported three, and 15 (1{\%}) reported all four syndromes. The occurrence of multiple syndromes was greater than would be expected by chance (P < 0.001). There were factors that were common across syndromes: female gender [odds ratio (OR) = 1.8; 95{\%} confidence interval (95{\%} CI) 1.5-2.2], high levels of aspects of health anxiety like health worry preoccupation (OR = 3.5; 95{\%} CI 2.8-4.4) and reassurance seeking behaviour (OR = 1.4; 95{\%} CI 1.1-1.7), reporting of other somatic symptoms (OR = 3.6; 95{\%} CI 2.9-4.4), and reporting of recent adverse life events (OR = 2.3; 95{\%} CI 1.9-2.8).Conclusion This study has shown that chronic syndromes that are frequently unexplained co-occur in the general population and share common associated factors. Primary care practitioners need to be aware of these characteristics so that management is appropriate at the outset.",
keywords = "unexplained, syndromes, chronic, co-occurrence, general population, CHRONIC-FATIGUE-SYNDROME, RANDOMIZED CONTROLLED-TRIAL, CHRONIC WIDESPREAD PAIN, OROFACIAL PAIN, PRIMARY-CARE, PSYCHOLOGICAL DISTRESS, PHYSICAL SYMPTOMS, COMMUNITY SURVEY, MENTAL-DISORDER, ABDOMINAL-PAIN",
author = "Aggarwal, {V. R.} and J. McBeth and Zakrzewska, {J. M.} and M. Lunt and MacFarlane, {Gary John}",
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T1 - The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?

AU - Aggarwal, V. R.

AU - McBeth, J.

AU - Zakrzewska, J. M.

AU - Lunt, M.

AU - MacFarlane, Gary John

PY - 2006

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N2 - Background Syndromes for which no physical or pathological changes can be found tend to be researched and managed in isolation although hypotheses suggest that they may be one entity. The objectives of our study were to investigate the co-occurrence, in the general population, of syndromes that are frequently unexplained and to evaluate whether they have common associated factors.Methods We conducted a population-based cross-sectional survey that included 2299 subjects who were registered with a General Medical Practice in North-west England and who completed full postal questionnaires (response rate 72%). The study investigated four chronic syndromes that are frequently unexplained: chronic widespread pain, chronic oro-facial pain, irritable bowel syndrome, and chronic fatigue. Validated instruments were used to measure the occurrence of syndromes and to collect information on a variety of associated factors: demographic (age, gender), psychosocial (anxiety, depression, illness behaviour), life stressors, and reporting of somatic symptoms.Results We found that 587 subjects (27%) reported one or more syndromes: 404 (18%) reported one, 134 (6%) reported two, 34 (2%) reported three, and 15 (1%) reported all four syndromes. The occurrence of multiple syndromes was greater than would be expected by chance (P < 0.001). There were factors that were common across syndromes: female gender [odds ratio (OR) = 1.8; 95% confidence interval (95% CI) 1.5-2.2], high levels of aspects of health anxiety like health worry preoccupation (OR = 3.5; 95% CI 2.8-4.4) and reassurance seeking behaviour (OR = 1.4; 95% CI 1.1-1.7), reporting of other somatic symptoms (OR = 3.6; 95% CI 2.9-4.4), and reporting of recent adverse life events (OR = 2.3; 95% CI 1.9-2.8).Conclusion This study has shown that chronic syndromes that are frequently unexplained co-occur in the general population and share common associated factors. Primary care practitioners need to be aware of these characteristics so that management is appropriate at the outset.

AB - Background Syndromes for which no physical or pathological changes can be found tend to be researched and managed in isolation although hypotheses suggest that they may be one entity. The objectives of our study were to investigate the co-occurrence, in the general population, of syndromes that are frequently unexplained and to evaluate whether they have common associated factors.Methods We conducted a population-based cross-sectional survey that included 2299 subjects who were registered with a General Medical Practice in North-west England and who completed full postal questionnaires (response rate 72%). The study investigated four chronic syndromes that are frequently unexplained: chronic widespread pain, chronic oro-facial pain, irritable bowel syndrome, and chronic fatigue. Validated instruments were used to measure the occurrence of syndromes and to collect information on a variety of associated factors: demographic (age, gender), psychosocial (anxiety, depression, illness behaviour), life stressors, and reporting of somatic symptoms.Results We found that 587 subjects (27%) reported one or more syndromes: 404 (18%) reported one, 134 (6%) reported two, 34 (2%) reported three, and 15 (1%) reported all four syndromes. The occurrence of multiple syndromes was greater than would be expected by chance (P < 0.001). There were factors that were common across syndromes: female gender [odds ratio (OR) = 1.8; 95% confidence interval (95% CI) 1.5-2.2], high levels of aspects of health anxiety like health worry preoccupation (OR = 3.5; 95% CI 2.8-4.4) and reassurance seeking behaviour (OR = 1.4; 95% CI 1.1-1.7), reporting of other somatic symptoms (OR = 3.6; 95% CI 2.9-4.4), and reporting of recent adverse life events (OR = 2.3; 95% CI 1.9-2.8).Conclusion This study has shown that chronic syndromes that are frequently unexplained co-occur in the general population and share common associated factors. Primary care practitioners need to be aware of these characteristics so that management is appropriate at the outset.

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KW - chronic

KW - co-occurrence

KW - general population

KW - CHRONIC-FATIGUE-SYNDROME

KW - RANDOMIZED CONTROLLED-TRIAL

KW - CHRONIC WIDESPREAD PAIN

KW - OROFACIAL PAIN

KW - PRIMARY-CARE

KW - PSYCHOLOGICAL DISTRESS

KW - PHYSICAL SYMPTOMS

KW - COMMUNITY SURVEY

KW - MENTAL-DISORDER

KW - ABDOMINAL-PAIN

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DO - 10.1093/ije/dyi265

M3 - Editorial

VL - 35

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EP - 476

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

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