Annotated Abstracts of Journal Articles
2015, 3rd Quarter
Annotations by Anna Dickerman, MD and Michael Sharpe, MD, FAPM
ANNOTATION (Dickerman & Sharpe)
The Finding: Among a general adolescent population in Sweden, it was more common for subjects to report a greater number of distressing somatic symptoms as opposed to somatic symptom(s) combined with significant psychological distress. There was an association between the number of medical/psychiatric conditions and overall functional impairment in the group reporting higher number of somatic complaints and greater psychological concern associated with these symptoms. Using a diagnostic strategy based on the combination of somatic symptoms and psychological concern resulted in lower prevalence rates than using a strategy based on somatic symptoms alone. This result is in accordance with studies in the adult population. The addition of a dimension of psychological concern to the somatic symptoms identified an even more vulnerable group of adolescents.
Strength and Weaknesses: The studied sample was relatively large with a high response-rate and equal gender distribution. Weakness of the study were its retrospective design, as well as the fact that the questionnaire used was not specifically designed to investigate somatic symptom disorder.
Relevance: This study addresses two main concerns regarding the new DSM-5 criteria for somatic symptom disorders: 1) that the new diagnostic criteria will increase prevalence rates by extending the diagnosis to individuals low in symptoms and functional impairment; and 2) that it will mistakenly identify many individuals with medical conditions as mentally ill. The findings suggest that the combination of one or more persistent somatic symptoms with a dimension of serious psychological concerns is indeed helpful in identifying subgroups of adolescents with an increased risk of functional impairment. Though diagnostic thresholds based merely on the number of somatic complaints may be arbitrary and non-specific, the findings of this study do suggest that number of symptoms should be taken into account in order to fully capture the burden of disease. The authors propose that for large-scale population studies, measures should be based on multiple somatic symptoms in combination with psychological concerns, as well as the severity of the somatic complaints themselves. Methodologically sound measures of functional impairment are also needed to further expand the definition of clinically significant distress in somatic symptom disorder.
Objective: DSM-5 somatic symptom disorder (SSD) constitutes a major change for psychosomatic medicine and psychiatry, as well as for epidemiological research in these fields. This study investigates somatic symptoms and psychological concerns among adolescents in order to systematically explore the relevance of SSD for general adolescent populations.
Methods: A cross-sectional population-based design, with a symptoms-based strategy and a symptom-and-psychological-concern-based strategy, was used to estimate the prevalence of somatic symptoms and psychological concerns in a general adolescent population (n=2476, mean age=16years, 49% boys, 51% girls). Somatic symptoms and psychological concerns in relation to gender, and self-reported medical and psychiatric conditions were investigated. The association between somatic symptoms, psychological concerns, and functional impairment in school-, family-, peer- and physical activities was studied.
Results: Reporting 3+ persistent distressing somatic symptoms was significantly more common than reporting one or more persistent distressing somatic symptom(s) combined with serious psychological concern. The prevalence of such complaints was significantly higher in girls. The proportion of medical and psychiatric conditions was highest in the group reporting 3+ persistent distressing somatic symptoms combined with serious psychological concern. Belonging to this group most significantly increased odds ratios for functional impairment.
Conclusion: For large-scale studies on SSD, results suggest the use of measures based on multiple somatic items in combination with psychological concerns, and a methodologically sound standardized measure of functional impairment. To further enhance clinical decision-making, the relation of symptoms to functional impairment, and the substantial overlap of SSD with medical and psychiatric conditions during adolescence should be addressed.