Development of a Japanese version of the Somatic Symptom Scale-8: Psychometric validity and internal consistency

Loneliness and Social Isolation Factors Under the Prolonged COVID-19 Pandemic in Japan: 2-Year Longitudinal Study

BACKGROUND

Worsening loneliness and social isolation during the COVID-19 pandemic have become serious public health concerns worldwide. Despite previous research reporting persistent loneliness and social isolation under repeated emergency declarations and prolonged pandemics, long-term studies are needed to identify the actual conditions of loneliness and social isolation, and the factors that explain them.

OBJECTIVE

In this study, 3 web-based surveys were conducted at 1-year intervals during the 2 years after the first state of emergency to examine changes in loneliness and social isolation and the psychosocial factors associated with them in the Japanese population.

METHODS

The first survey (phase 1, May 11-12, 2020) was conducted at the end of the first emergency declaration period, the second survey (phase 2, June 14-20, 2021) was conducted at the end of the third emergency declaration period, and the third survey (phase 3, May 13-30, 2022) was conducted when the state of emergency had not been declared but many COVID-19-positive cases occurred during this period. We collected data on 3892 inhabitants (n=1813, 46.58% women; age: mean 50.3, SD 13.4 y) living in the 4 prefectures where emergency declaration measures were applied in phases 1 and 2. A linear mixed model analysis was performed to examine the association between psychosocial variables as explanatory variables and loneliness scores as the dependent variable in each phase.

RESULTS

While many psychosocial and physical variables showed improvement for the 2 years, loneliness, social isolation, and the relationship with familiar people deteriorated, and the opportunities for exercise, favorite activities, and web-based interaction with familiar people decreased. Approximately half of those experiencing social isolation in phase 1 remained isolated throughout the 2-year period, and a greater number of people developed social isolation than those who were able to resolve it. The results of the linear mixed model analysis showed that most psychosocial and physical variables were related to loneliness regardless of the phase. Regarding the variables that showed a significant interaction with the phase, increased altruistic preventive behavior and a negative outlook for the future were more strongly associated with severe loneliness in phase 3 (P=.01 to <.001), while the association between fewer social networks and stronger loneliness tended to be more pronounced in phase 2. Although the interaction was not significant, the association between reduced face-to-face interaction, poorer relationships with familiar people, and increased loneliness tended to be stronger in phase 3.

CONCLUSIONS

This study found that loneliness and social isolation remained unresolved throughout the long-term COVID-19 pandemic. Additionally, in the final survey phase, these issues were influenced by a broader and more complex set of factors compared to earlier phases.

Mindful Self-Compassion Smartphone Intervention for Worker Mental Health in Japan: Protocol for a Randomized Controlled Trial

BACKGROUND

Mental health problems among workers cause enormous losses to companies in Japan. However, workers have been considered to have limited access to psychological support because of time constraints, which makes it difficult for them to engage in face-to-face psychological support interventions.

OBJECTIVE

This study aimed to present an intervention protocol that describes a randomized controlled trial to examine whether brief guided mindfulness meditation (MM) or self-compassion meditation (SCM) provided by a smartphone app is effective for mental health and work-related outcomes among workers.

METHODS

This is an open-label, 3-arm randomized controlled trial. The participants will be recruited through an open call on relevant websites with the following inclusion criteria: (1) employees who are working more than 20 hours per week, (2) between the ages of 18 and 54 years, (3) not on a leave of absence, (4) not business owners or students, and (5) not currently diagnosed with a mental disorder and have a Kessler Psychological Distress Scale-6 score below 13 points. We will include 200 participants and randomly assign them to an SCM course (n=67), an MM course (n=67), and a waitlist group (n=66). The intervention groups (SCM and MM) will be instructed to engage in daily guided self-help, self-compassion, and MMs lasting 6-12 minutes per day over 4 weeks. Primary outcomes will include psychological distress and job performance, and secondary outcomes will include somatic symptoms, cognitive flexibility, self-esteem, self-compassion, perceived stress, well-being, emotion regulation, work engagement, anger, psychological safety, and creativity. All procedures were approved by the ethics committee of the University of Tokyo (22-326). All participants will be informed of the study via the websites, and written informed consent will be collected via web-based forms.

RESULTS

The recruitment of participants began in December 2022, and the intervention began in January 2023. As of September 2023, a total of 375 participants have been enrolled. The intervention and data collection were completed in late October 2023.

CONCLUSIONS

This study will contribute to the development of effective self-care intervention content that will improve mental health, work performance, and related outcomes and promote mindful and self-compassionate attitudes when faced with distress.

TRIAL REGISTRATION

University Hospital Medical Information Network Clinical Trials Registry UMIN000049466; https://tinyurl.com/23x8m8nf.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53541.

Proof of mechanism investigation of Transcutaneous auricular vagus nerve stimulation through simultaneous measurement of autonomic functions: a randomized controlled trial protocol

BACKGROUND

The autonomic nervous system plays a vital role in regulating physiological functions. Transcutaneous auricular vagus nerve stimulation (taVNS) is a method that provides insights into autonomic nerve modulation. This paper presents a research protocol investigating proof of mechanism for the impact of taVNS on autonomic functions and aims to both deepen theoretical understanding and pave the way for clinically relevant applications.

METHODS

This protocol employs a single-blind, randomized cross-over design involving 10 healthy male participants. Simultaneous assessment of both the afferent and efferent aspects of the vagus nerve will be performed by integrating physiological measures, magnetic resonance imaging, and a questionnaire survey. Electrocardiogram will be measured to assess changes in heart rate, as a primary outcome, and heart rate variability. Active taVNS and sham stimulation will be compared, which ensures precision and blinding. Electrical stimulation will be applied to the left concha cymba and the left lobule for the active and sham conditions, respectively. The specific parameters of taVNS involve a pulse width of 250 µs, a frequency of 25 Hz, and a current adjusted to the perception threshold (0.1 mA ≤ 5 mA), delivered in cycles of 32 s on and 28 s off.

CONCLUSIONS

This research investigates proof of mechanism for taVNS to elucidate its modulatory effects on the central and peripheral components of the autonomic nervous system. Beyond theoretical insights, the findings will provide a foundation for designing targeted neuromodulation strategies, potentially benefiting diverse patient populations experiencing autonomic dysregulation. By elucidating the neural mechanisms, this study contributes to the evolution of personalized and effective clinical interventions in the field of neuromodulation.

TRIAL REGISTRATION

JRCT, jRCTs032220332, Registered 13 September 2022; https://jrct.niph.go.jp/latest-detail/jRCTs032220332 .

A 2-year longitudinal study examining the change in psychosocial factors under the COVID-19 pandemic in Japan

To examine changes in individuals' psychosocial variables (e.g., psychological distress, social isolation, and alcohol use) during the prolonged COVID-19 pandemic, a two-year longitudinal survey was conducted at approximately one-year intervals between May 2020 and May 2022, after the first COVID-19-related state of emergency was announced in Japan. The online survey was conducted on May 11-12, 2020 (Phase 1), June 14-20, 2021 (Phase 2), and May 13-30, 2022 (Phase 3). The survey in Phase 1 was conducted during the first emergency declaration period, the survey in Phase 2 was conducted during the third emergency declaration period, and the survey in Phase 3 was conducted at a time when there was no state of emergency but many COVID-19 positive cases. Notably, 3,892 participants responded to all three surveys. In addition to psychosocial inventories often used worldwide, survey items included lifestyle and stress management indicators related to COVID-19 and various sociodemographic items including occupation (e.g., healthcare workers) or income, history of medical treatment for mental problems, severe physical illnesses, and COVID-19.

The Association of Central Sensitisation with Depression, Anxiety, and Somatic Symptoms: A Cross-Sectional Study of a Mental Health Outpatient Clinic in Japan

For patients with chronic pain and persistent physical symptoms, understanding the mechanism of central sensitisation may help in understanding how symptoms persist. This cross-sectional study investigated the association of central sensitisation with depression, anxiety, and somatic symptoms. Four hundred and fifteen adults attending an outpatient psychosomatic clinic were evaluated. Participants completed the Hospital Anxiety and Depression Scale, Somatic Symptom Scale 8, and the Central Sensitisation Inventory. The relationships between these factors were examined using descriptive statistics and multiple logistic regression analyses. The mean age was 42.3 years, and 59% were female. The disorders included adjustment disorders (n = 70), anxiety disorders (n = 63), depressive disorders (n = 103), feeding and eating disorders (n = 30), sleep-wake disorders (n = 37), somatic symptoms and related disorders (n = 84), and others (n = 28). In multiple logistic regression analyses, higher central sensitisation was associated with more severe anxiety, depression, and somatic symptoms after controlling for potential confounders. In the disease-specific analysis, somatic symptoms correlated more positively with central sensitisation than with depression or anxiety. Central sensitisation and depression, anxiety, and somatic symptoms were associated with patients attending an outpatient clinic. These findings highlight the importance of evaluating depression, anxiety, and somatic symptoms when assessing central sensitisation.

Exercise effect on pain is associated with negative and positive affective components: A large-scale internet-based cross-sectional study in Japan

Pain is a global health problem that leads to sedentary behavior and tends to cause negative emotion. In contrast, exercise is widely recommended for a health promotion, while pain often worsens with physical activity. Although exercise therapy is often prescribed to people with pain, the mechanisms of exercise effect on pain remains unclear. In this study, we tried to identify a universal association factor between regular exercise and pain intensity utilizing a cross-sectional web-based survey involving 52,353 adult participants from a large national study conducted in Japan. Using principal component analysis, we uncovered a mediation model of exercise effect on pain through psychological components. Analyses were performed in half of the population with pain (n = 20,330) and validated in the other half (n = 20,330), and showed that high-frequency exercise had a significant association with reduction in pain intensity. We also found Negative Affect and Vigor, two psychological components, are fully associating the exercise effect on pain (indirect effect =  - 0.032, p < 0.001; association proportion = 0.99) with a dose-dependent response corresponding to the frequency of exercise. These findings were successfully validated (indirect effect of high-frequency exercise =  - 0.028, p < 0.001; association proportion = 0.85). Moreover, these findings were also identified in subpopulation analyses of people with low back, neck, knee pain, and the tendency of the exercise effect on pain was increased with older people. In conclusion, the effect of exercise on pain is associated with psychological components and these association effects increased in parallel with the frequency of exercise habit regardless pain location.

Exploratory study of cold hypersensitivity in Japanese women: genetic associations and somatic symptom burden

Temperature perception is essential for humans to discern the environment and maintain homeostasis. However, some individuals experience cold hypersensitivity, characterized by a subjective feeling of coldness despite ambient environmental temperatures being normal, the underlying mechanisms of which are unknown. In this study, we aimed to investigate the relationship between subjective cold symptoms and somatic burden or single nucleotide polymorphisms to understand the causes of cold hypersensitivity. We conducted an online questionnaire survey [comprising 30 questions, including past medical history, subjective symptoms of cold hypersensitivity, and the Somatic Symptom Scale-8 (SSS-8)]. Respondents were 1200 Japanese adult female volunteers (age: 20-59 years), recruited between April 21 and May 25, 2022, who were customers of MYCODE, a personal genome service in Japan. Among the 1111 participants, 599 (54%) reported cold hypersensitivity. Higher cold hypersensitivity severity was positively associated with the SSS-8 scores. Additionally, a genome-wide association study for cold hypersensitivity was conducted using array-based genomic data obtained from genetic testing. We identified 11 lead variants showing suggestive associations (P < 1 × 10-5) with cold hypersensitivity, some of which showed a reasonable change in expression in specific tissues in the Genotype-Tissue Expression database. The study findings shed light on the underlying causes of cold hypersensitivity.

Association between the telecommuting environment and somatic symptoms among teleworkers in Japan

OBJECTIVES

This study aimed to clarify the association between telecommuting environments and somatic symptoms among teleworkers in Japan.

METHODS

This cross-sectional study, conducted from September 27 to October 29, 2021, used data from the Japan COVID-19 and Society Internet Survey (JACSIS study) in Japan. Of the 31 000 male and female respondents, who were Japanese residents aged 15-79 years and were randomly selected from the panel members of an internet survey company, 4569 home-based teleworkers were finally included in the analysis; 26 431 respondents who met the exclusion criteria were excluded. The analysis included 4 cut-offs (≥4, 8, 12, and 16 points) for somatic symptoms on the Somatic Symptom Scale-8 as objective variables, and the telecommuting environment, such as having adequate desk light and a quiet environment, as explanatory variables. Adjusted Poisson regression analysis was conducted using demographic variables as covariates.

RESULTS

The prevalence ratio (PR) for somatic symptoms increased significantly as the number of poor telecommuting conditions increased, regardless of the cut-off value for somatic symptoms or the frequency of teleworking. In the telecommuting environment, the PR for somatic symptoms was significantly higher for the following 6 items: poor teleworking space to concentrate, inadequate foot space, poor communication environment, poor space for relaxation, noise, and inappropriate temperature and humidity.

CONCLUSIONS

These results suggest that for home-based teleworkers, the more inadequate the telecommuting environment, especially in the aforementioned 6 areas, the higher the likelihood of somatic symptoms. Improving these environments may be useful in preventing various somatic symptoms.

Measurement Invariance of Scores on the Somatic Symptom Scale-8: National Sample of Non-Clinical Adults in the United States

Objective

The aim of the present study was to test the factorial invariance and convergent validity evidence of scores on the Somatic Symptom Scale (SSS)-8 with a national sample of adults living in the United States.

Method

A data collection contracting service was hired to recruit a national, non-clinical sample (N = 821) of adults in the United States stratified by the census data for age, gender, ethnicity, and geographic location.

Results

Factorial invariance testing via multiple-group confirmatory factor analysis revealed strong factorial invariance evidence (configural, metric, and scalar) of SSS-8 scores across gender, ethnicity, help-seeking history, education, and income. Convergent validity testing displayed strong correlations between SSS-8 scores and the following established measures: Patient Health Questinaire-9, Generalized Anxiety Disorder-7, and Mental Health Inventory-5.

Conclusion

Collectively, the results suggest that professional counselors can use the SSS-8 to enhance somatic symptomology screening efforts with adults living in the United States.

Changes in neck pain and somatic symptoms before and after the adjustment of the pillow height

[Purpose] The purpose of this study was to determine whether strict adjustment of the pillow height using the Set-up for Spinal Sleep method improves clinical outcomes like neck pain and somatic symptoms. [Participants and Methods] A total of 84 participants with chief complaints of stiff shoulders and neck pain were evaluated using the numerical rating scale and the Somatic Symptom Scale-8. Questionnaires were used to collect data at the baseline, after two weeks, and after three months of adjusting the pillow height. [Results] Forty-two participants (50%) achieved the minimal clinically important difference for neck pain with a decrease of three points or higher in the numerical rating scale. The baseline neck pain scores were significantly higher in the group that achieved the minimal clinically important difference. The three-month change in neck pain and the Somatic Symptom Scale-8 was significantly greater in participants who were satisfied with treatment. There was a significant positive association between improvement in the numerical rating scale score and improvement in the Somatic Symptom Scale-8 at three months. [Conclusion] Strict adjustment of the pillow height using the Set-up for the Spinal Sleep method significantly improved both physical neck pain and somatic symptoms related to psychological and social problems.

Prevalence and associated factors of insomnia symptoms during the COVID-19 pandemic lockdown among Mettu town residents

BACKGROUND

Insomnia is a prevalent sleep disorder that affects people all over the world. Creating suitable interventions will require a better understanding of the magnitude and determinants of insomnia. This study aimed to assess the prevalence and associated factors of insomnia symptoms among residents of Mettu town during the pandemic lockdown.

METHODOLOGY

A community-based cross-sectional study was conducted among residents of Mettu town from October 1st to October 15th, 2020. Residents who lived in Mettu town at least for six months were included. To determine the prevalence and determinants of insomnia symptoms, both descriptive and inferential analyses were used. The chi-squared test of association and logistic regression was used to identify predictors of insomnia symptoms among residents of Mettu town. We used SPSS version 25 for all statistical analyses.

PRINCIPAL FINDINGS

The prevalence of depressive symptoms among residents of Mettu town was 52.6%. According to results of multivariable binary logistic regression, being female [AOR = 3.677, 95%CI: 2.124-6.365], being aged between 19 and 40 [AOR = 13.261, 95%CI: 6.953-25.291], being aged above 41 [AOR = 2.627, 95%CI: 1.120-6.159], smoking [AOR = 15.539, 95%CI: 7.961-30.329], satisfaction with information available [AOR = 0.310, 95%CI: 0.168-0.570], fear Corona Virus Disease 2019 (COVID-19), [AOR = 2.171, 95%CI: 1.262-3.733], feeling alienated from others [AOR = 3.288, 95%CI: 1.897-5.699], having somatic symptoms [AOR = 2.298, 95% CI: 1.360-3.884], having depressive symptoms [AOR = 1.841, 95% CI: 1.073-3.160], and experiencing psychological distress [AOR = 1.962, 95% CI: 1.173-3.281] were significantly associated with insomnia symptoms.

CONCLUSION

In this study, the prevalence of insomnia symptoms was found to be high among residents of Mettu town. Being female, being aged between 19 and 40, being aged above 41 years, smoking, fear of Corona Virus Disease 2019, feeling alienated from others, having somatic symptoms, having depressive symptoms, and experiencing psychological distress were all associated with an increased risk of developing insomnia symptoms while being satisfied with the information available decreased the risk of insomnia symptoms among residents of Mettu town. Interventions should be put in place to promote healthy sleep among residents of Mettu town.

Utility and optimal cut-off point of the Somatic Symptom Scale-8 for central sensitization syndrome among outpatients with somatic symptoms and related disorders

BACKGROUND

Central sensitization syndrome (CSS) involves severe functional symptoms due to central sensitization. for patients with severe somatic symptoms and related disorders (SSRDs), central sensitization may be responsible for their functional symptoms. We hypothesized that screening for CSS in patients with SSRDs would identify those with severe disease. The Somatic Symptom Scale-8 (SSS-8) is a simple tool to assess medical conditions related to SSRDs, but the cut-off point to identify severe cases of comorbid CSS is unknown. This study aimed to determine the optimal cut-off point of SSS-8 for screening the CSS of patients with severe SSRDs.

METHODS

In total, 143 patients with SSRDs attending outpatient clinics of a university hospital in Japan were included in the study. The participants were evaluated using the SSS-8 for somatic symptoms, Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms, Pain Catastrophizing Scale (PCS) for catastrophic thoughts, and Central Sensitization Inventory (CSI-A, B) for CSS. Receiver operating characteristic (ROC) curve analysis was performed using the propensity score. The area under the curve (AUC) was calculated using a propensity score considering PCS, age, sex, HADS, and CSI-B as confounders of SSS-8 and CSS to evaluate differences in diagnostic accuracy between patients with and without SSS-8. The sensitivity and specificity of the ROC analysis were then used to determine the cut-off point for discriminating severe cases of SSS-8.

RESULTS

Of the 143 participants, 126 responded (51 CSS group and 75 non-CSS group), with a valid response rate of 88.1 percent. In the ROC analysis, the propensity score including SSS-8 was statistically more accurate. The optimal cut-off point was 13, with an AUC of 0.88, sensitivity of 84.3 percent, and specificity of 77.3 percent.

CONCLUSIONS

The SSS-8 is a useful tool for discriminating severe cases of SSRDs comorbid with CSS.

Translation, cultural adaptation and validation of the Somatic Symptom Scale-8 (SSS-8) for the Brazilian Portuguese language

BACKGROUND

Assessment tools are commonly used in different fields of health to assist in the diagnosis, the evaluation of the response to treatment, the measurement of quality of life and the establishment of the prognosis.

OBJECTIVES

Translate, culturally adapt and perform the psychometric validation of the Somatic Symptom Scale (SSS-8) for use in the Brazilian population.

METHODS

Cross-cultural adaptation followed a combination of guidelines and for psychometric evaluation a sample of 300 patients was recruited. All recommended measurement properties by the Consensus-based Standards for the selection of health status Measurement Instruments were evaluated, including analysis by an expert committee and analysis by the target public. The Skindex-16 was used for the evaluation of convergent validity and Cronbach's alpha was used for the determination of the internal consistency of the translated version of the SSS-8.

RESULTS

The final version received approval from five experts and the agreement index was 100% for all items. During the pretest, the scale was administered to 300 patients with psoriasis and none of the items needed to be altered. A moderate correlation was found between the Skindex-16 and SSS-8-BRA. In the analysis of internal consistency, Cronbach's alpha for the SSS-8-BRA was 0.81.

CONCLUSION

The SSS-8 is a valid and reliable tool for the assessment of somatic symptoms in the Brazilian population.

Development and Psychometric Testing of a New Short-Form of the Premenstrual Symptoms Questionnaire (PSQ-S)

Purpose

The Premenstrual Symptoms Questionnaire (PSQ) is a patient-reported outcome measurement tool for premenstrual symptoms. Although the PSQ is a very useful tool with 14 items to screen for a wide variety of premenstrual symptoms, not everyone will respond to all the questions. Fewer questions would be less burdensome on the respondents. We aimed to develop and analyze the psychometric properties of a short-form of the PSQ (PSQ-S).

Patients and Methods

The study participants were from an earlier study with a sample of 1388 female students. We reanalyzed data collected from 922 students with regular menstrual cycles who completed the PSQ, premenstrual dysphoric disorder (PMDD) scale, Somatic Symptom Scale-8 (SSS-8), and numerical rating scale (NRS) for menstrual pain. First, we selected nine items for the PSQ-S based on the results of the corrected item-total correlation analysis. The PSQ-S was then analyzed for reliability and validity using the classical test theory. Moreover, item response theory was applied to test the psychometric properties of the PSQ-S.

Results

Cronbach's α for the PSQ-S score was 0.93. Principal component factor analysis revealed a one-factor model. Confirmatory factor analysis showed that the one-factor model was a good fit. The PSQ-S total score was strongly correlated with the PSQ total score, PMDD scale score, and SSS-8 score (r=0.978, 0.854, and 0.648, respectively) and moderately correlated with the NRS (r=0.437). Item response theory analyses showed that the constructs and items of the PSQ-S had satisfactory discrimination, difficulty parameters, item information curves, and test information curves. Receiver operating characteristic curve analysis revealed a cut-off score of ≥22 for suspected premenstrual disorders based on the total PSQ-S score.

Conclusion

The PSQ-S, consisting of nine items from the PSQ, had sufficient reliability and validity and could be a convenient assessment tool for premenstrual symptoms in routine clinical practice.

Characteristics of outpatients with functional somatic syndromes at a university hospital's general medicine clinic

Background

The term medically unexplained symptoms (MUS) is unhelpful for both patients and physicians, and more acceptable illness categories are needed as substitutes for MUS. While some potential substitutes are characterized by excessive psychological burden related to somatic symptoms, "functional somatic syndromes" (FSS) is a category that focuses on physical dysfunction and emphasizes similarities among individual syndromes. Examples of FSS include irritable bowel syndrome, functional dyspepsia, and fibromyalgia syndrome. This study aimed to distinguish FSS from MUS and compare the somatic and psychobehavioral characteristics of FSS with those of other diseases.

Methods

This study included 1975 first-visit outpatients at a Japanese university hospital's general medicine clinic. According to their first-listed diagnosis, they were classified as having FSS, acute infection, organic disease (OD), psychiatric disorder, and unknown condition (UC). The somatic symptom burden and health-related quality of life (HRQoL) were assessed using the Somatic Symptom Scale-8 and EuroQol-5 Dimension, respectively; the involvement of psychobehavioral factors affecting somatic symptoms was also evaluated.

Results

Overall, 33% of patients were included in the FSS category, and 93% of the supposed MUS (FSS and UC) were diagnosed with FSS. Compared with OD, FSS showed more severe somatic symptom burden, similar reduced HRQoL, and higher involvement of psychobehavioral factors.

Conclusion

It can be useful to improve FSS diagnostic skills for the reduction of MUS misdiagnosis. Psychobehavioral factors might be less associated with MUS (in the narrow sense of the term) than FSS.

The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS

Burning mouth syndrome (BMS) is defined by chronic oral burning sensations without any corresponding abnormalities. Besides amitriptyline, aripiprazole has been reported as a possible medication to manage BMS. However, especially for elderly patients, the adverse events of these medications would be a problem. The aim of the present study was to investigate the differences in the effectiveness and adverse events of amitriptyline and aripiprazole in very elderly patients with BMS. This is a retrospective comparative study of 80 years old and older patients with BMS who were initially treated with amitriptyline or aripiprazole and who were new outpatients of our department from April 2017 to March 2020. All clinical data, including sex, age, comorbid physical diseases, comorbid psychiatric disorders, the prescribed doses (initial, maximum, and effective dose), prognosis, and adverse events, were collected from their medical charts. Each medication was selected considering their medical history. Amitriptyline was prescribed in 13 patients (11 women, 82.3 ± 2.1 years old) and aripiprazole was prescribed in 27 patients (26 women, 84.2 ± 3.8 years old). There were no significant between-group differences in sex, age, duration of illness, pain intensity, salivation, and psychiatric comorbidity at the first examination. Amitriptyline clinically improved more patients (7 patients, 53.8%) with the effective dose of 10 (7.5, 15.0) mg than aripiprazole (11 patients, 40.7%) of which the effective dose was 1.0 (0.5, 1.5) mg, although there were no significant between-group differences. The adverse events of amitriptyline were found in 9 patients (69.2%) and most patients had constipation (46.2%). For aripiprazole, 7 patients (25.9%) showed adverse events, most of them reported sleep disorder (11.1%). Amitriptyline had significantly longer duration taking medication (p = 0.021) and lower discontinuation (p = 0.043) despite of higher occurrence rate of adverse events (p = 0.015) compared to aripiprazole. These results suggest that both psychopharmacotherapies with a low dose of amitriptyline and aripiprazole are effective for the very elderly patients with BMS. Furthermore, aripiprazole may have some advantages in the adverse events compared to amitriptyline; however, the low dose amitriptyline monotherapy may have more benefit in the effectiveness and tolerability over prudent collaboration with primary physicians.

Validation of the Chinese version of the Somatic Symptom Scale-8 in patients from tertiary hospitals in China

OBJECTIVE

To validate the Chinese language version of the Somatic Symptom Scale-8 (SSS-8) in a sample of outpatients attending tertiary hospitals in China.

MATERIALS AND METHODS

A Chinese language version of the SSS-8 was completed by outpatients (n = 699) from psychosomatic medicine, gastroenterology/neurology, and traditional Chinese medicine clinics of nine tertiary hospitals between September 2016 and January 2018 to test the reliability. The Patient Health Questionnaire-15 (PHQ-15), the Somatic Symptom Disorder-B Criteria Scale (SSD-12), the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder-7 (GAD-7) scale, the Medical Outcome Study 12-item Short Form Health Survey (SF-12) and the World Health Organization Disability Assessment Schedule (WHO DAS 2.0) were rated to test construct validity. The criterion validity was tested by using the Semi-structured Clinical Interview for DSM-5 (Research Version) (SCID-5-RV) for somatic symptom disorder (SSD) as the diagnostic gold standard to explore the optimal cutoff score of the SSS-8.

RESULTS

The average age of the recruited participants was 43.08 (±14.47). 61.4% of them were female. The internal consistency derived from the sample was acceptable (Cronbach α = 0.78). Confirmatory factor analyses resulted in the replication of a three-factor model (cardiopulmonary symptoms, pain symptoms, gastrointestinal and fatigue symptoms) (comparative fit index = 0.95, Tucker-Lewis index = 0.92, root mean square error of approximation = 0.10, 90% confidence interval = 0.08-0.12). The SSS-8 sum score was highly associated with PHQ-15 (r = 0.74, p < 0.001), SSD-12 (r = 0.64, p < 0.001), GAD-7 (r = 0.59, p < 0.001), and PHQ-9 (r = 0.69, p < 0.001). The patients with more severe symptoms showed worse quality of life and disability The optimal cutoff score of SSS-8 was 9 (sensitivity = 0.67, specificity = 0.68).

CONCLUSION

Our preliminary assessment suggests that the Chinese language version of the SSS-8 has reliability and validity sufficient to warrant testing further in research and clinical settings.

Clinical Characteristics of Predominantly Unilateral Oral Cenesthopathy With and Without Neurovascular Contact

Oral cenesthopathy (OC) is characterized by unusual oral discomfort without corresponding evidence, and it has often been categorized as "delusional disorder, somatic type". Regarding possible causative factors of OC, involvement of neurovascular contact (NVC) of the trigeminal nerve, which transmits not only pain but also thermal, tactile, and pressure sensations, has never been observed yet. This study aimed to investigate the relationship between clinical characteristics of unilateral OC and the presence of trigeminal nerve NVC. This is a retrospective comparative study that involved 48 patients having predominantly unilateral OC who visited the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between April 2016 and February 2019. Magnetic resonance imaging was performed to assess NVC presence. The Oral Dysesthesia Rating Scale (Oral DRS) was used to assess the various oral sensations and functional impairments besides psychometric questionnaires. Clinical characteristics were retrospectively obtained from the patients' medical charts. NVC was present in 45.8% (22/48) of the patients. There was no significant difference in sex, age, psychiatric history, oral psychosomatic comorbidity, and psychometric questionnaire scores between patients with and without NVC. However, compared to the patients with NVC, the patients without NVC had significantly higher scores for overall subjective severity of OC symptoms (p = 0.008). Moreover, patients having predominantly unilateral OC without NVC showed significantly higher scores in symptom severity and functional impairment of the following parameters: movement (p = 0.030), work (p = 0.004), and social activities (p = 0.010). In addition, compared with the patients with NVC, the patients without NVC showed significantly higher averages of the total symptom severity scale (SSS) and functional impairment scale (FIS) scores in the Oral DRS (p = 0.015 and p = 0.031, respectively). Furthermore, compared with the patients with NVC, the patients without NVC had significantly higher numbers of corresponding symptoms in both the SSS and FIS (p = 0.041 and p = 0.007, respectively). While NVC may be involved in the indescribable subtle OC symptoms, more complex mechanisms may also exist in OC patients without NVC, which yield varying and more unbearable oral symptoms.

Life With Corona: Increased Gender Differences in Aggression and Depression Symptoms Due to the COVID-19 Pandemic Burden in Germany

Gender differences (GD) in mental health have come under renewed scrutiny during the COVID-19 pandemic. While rapidly emerging evidence indicates a deterioration of mental health in general, it remains unknown whether the pandemic will have an impact on GD in mental health. To this end, we investigate the association of the pandemic and its countermeasures affecting everyday life, labor, and households with changes in GD in aggression, anxiety, depression, and the somatic symptom burden. We analyze cross-sectional data from 10,979 individuals who live in Germany and who responded to the online survey "Life with Corona" between October 1, 2020 and February 28, 2021. We estimate interaction effects from generalized linear models. The analyses reveal no pre-existing GD in aggression but exposure to COVID-19 and COVID-19 countermeasures is associated with sharper increases in aggression in men than in women. GD in anxiety decreased among participants with children in the household (with men becoming more anxious). We also observe pre-existing and increasing GD with regards to the severity of depression, with women presenting a larger increase in symptoms during the hard lockdown or with increasing stringency. In contrast to anxiety, GD in depression increased among participants who lived without children (women > men), but decreased for individuals who lived with children; here, men converged to the levels of depression presented by women. Finally, GD in somatic symptoms decreased during the hard lockdown (but not with higher stringency), with men showing a sharper increase in symptoms, especially when they lived with children or alone. Taken together, the findings indicate an increase in GD in mental health as the pandemic unfolded in Germany, with rising female vulnerability to depression and increasing male aggression. The combination of these two trends further suggests a worrying mental health situation for singles and families. Our results have important policy implications for the German health system and public health policy. This public health challenge requires addressing the rising burden of pandemic-related mental health challenges and the distribution of this burden between women and men, within families and for individuals who live alone.

Translation and validation of the Greek version of the Somatic Symptom Scale-8 (SSS-8) in patients with chronic low back pain

PURPOSE

To translate and validate the Greek version of the Somatic Symptom Scale-8 (SSS-8) in patients with chronic low back pain (CLBP).

MATERIALS AND METHODS

The Greek SSS-8, created through forth and back translation and cultural adaption processes, was handed over to 145 patients recruited using simple random sampling. Test-retest, composite, and internal consistency reliability were assessed. Construct validity was examined by assessing correlations with Patient Health Questionnaire-15 (PHQ-15), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and EuroQoL 5-dimension 5-level (EQ-5D-5L) instruments. Structural validity was assessed using confirmatory factor analysis (CFA). Convergent, discriminant, and known group validity were also evaluated.

RESULTS

The response rate was 95.1% (138 subjects, mean age 43.2 ± 11.7) and the overall Cronbach's alpha was 0.831. Test-retest reliability assessment revealed excellent results (Pearson's r > 0.996; Lin's concordance coefficient > 0.995; intraclass correlation coefficient >0.995, all p < 0.001). Composite reliability scores for the pain, cardiopulmonary, and fatigue domains were 0.712, 0.787, and 0.567, respectively. The correlation analyses indicated good construct validity. CFA revealed excellent fit results and known group validity output indicated a linear increasing trend in the severity of somatic symptom disorders (SSDs), depression, and anxiety with higher PHQ-15, PHQ-9, and GAD-7 scores (Jonckheere-Terpstra test, p value < 0.001).

CONCLUSIONS

The Greek SSS-8 was shown to be a reliable and valid tool for measuring SSDs in patients with CLBP.Implications for RehabilitationAccording to the Global Burden of Diseases Study 2017, LBP was one of the leading causes of disability for both sexes combined since 1990.Strategies to identify SSDs in patients with LBP at an earlier stage are essential both for the provision of an optimal targeted treatment and for minimizing its direct and indirect economic burden.The Greek SSS-8 is a standardized and validated instrument, which its utilization will enhance the physical therapy assessment process in the Greek population.Not only is the SSS-8 an easy-to-use and highly accurate diagnostic tool for detecting SSDs, but also a short alternative to PHQ-15 in settings with limited assessment time.

Excessiveness in Symptom-Related Thoughts, Feelings, and Behaviors: An Investigation of Somatic Symptom Disorders in the General Population

OBJECTIVE

The diagnostic criteria of somatic symptom disorder (SSD) emphasize that somatic symptoms receive disease value once they are accompanied by excessive thoughts, feelings, or behaviors. The main objective of this study was to examine what constitutes excessiveness in psychological reactions to somatic complaints and how excessive symptom-related behavior influences self-reported health status and health care utilization.

METHODS

A national, representative general population survey was performed between January and March 2016 in Germany, including 2395 individuals older than 13 years. Self-report questionnaires (Somatic Symptom Scale-8, Somatic Symptom Disorder-B Criteria Scale) were used to operationalize the SSD criteria. Group differences in the daily amount of time dedicated to physical complaints were analyzed between individuals with and without SSD. Stepwise linear regression analyses were performed to predict general mental and physical health status, and health care utilization.

RESULTS

There was a significant effect of group (SSD yes/no) in daily time spent on symptoms, after controlling for age, sex, depression, and anxiety (F(1,2336) = 447.53, p < .001). The SSD group (n = 213) reported an average of 4 hours, whereas individuals without SSD reported 30 minutes. Results of the regression analyses showed that the combination of somatic symptoms and symptom-related psychological features is predictive of worsened self-reported physical and mental health status, and increased health care utilization.

CONCLUSIONS

A range of 3 to 4 hours per day spent on dealing with physical complaints seems indicative of excessiveness. If, during a clinical consultation, a patient reports such a large amount of time, a more comprehensive clinical examination of SSD should follow.

Prevalence and Risk Factors Associated with Insomnia Symptoms Among the Chinese General Public After the Coronavirus Disease 2019 Epidemic Was Initially Controlled

INTRODUCTION

The prevalence rate and related factors of insomnia remained unknown after the COVID-19 epidemic had been under control. Therefore, we conducted this survey to investigate the prevalence rate and related factors of insomnia symptoms in the Chinese general public after the COVID-19 had been initially control.

METHODS

An online survey was conducted among Chinese citizens through the JD Health APP. The questionnaire was used for collecting demographic data and self-designed questions related to the COVID-19 outbreak. Insomnia Severity Index, Patient Health Questionnaire-9, Somatic Symptom Scale-8 and Impact of Events Scale-Revised were used for measuring psychological symptoms. To examine the associations of sociodemographic and psychological factors with insomnia symptoms, a binary logistic regression was used.

RESULTS

In total, there were 14,894 eligible participants, and 4601 (30.9%) participants were found to have insomnia symptoms. The regression model revealed that a higher risk of insomnia symptoms was associated with being over the age of 40 years, having history of psychiatric disorders, smoking, having infected friends or colleagues, having depressive or somatic symptoms, experiencing psychological distress and feeling estranged from family members. Meanwhile a lower risk of insomnia symptoms was associated with being female, having closer family relationships, not feeling alienated from others and being satisfied with the available information.

CONCLUSION

In our study, 30.9% of the participants in the general public reported insomnia symptoms after the COVID-19 epidemic had been initially controlled. When providing precise interventions for insomnia, extra attention should be paid to the individuals who are male, elderly and smokers, and those with psychiatric disorder history, with infected friends or colleagues, with psychological symptoms and with poor social support.

Developing the Patient Health Questionnaire-8 for a greater impact on the quality of life of patients with functional dyspepsia compared to Somatic Symptom Scale-8

Background

To develop the Patient Health Questionnaire-8 (PHQ-8) as a more reliable approach than the Somatic Symptom Scale-8 (SSS-8), evaluating somatization which might be a critical factor influencing the quality of life (QoL) in patients with functional dyspepsia (FD). Also, the effects of somatization on QoL of FD patients were assessed by these two approaches.

Methods

Herein, 612 FD patients completed a questionnaire involving 25 items. 8/25 items were selected to develop the PHQ-8 by four methods of discrete degree, correlation coefficient, factor analysis, and Cronbach’s α coefficient. Reliability and validity of the PHQ-8 and the SSS-8 were compared by principal component and confirmatory factor analyses. The effects of somatization, depression, and anxiety on the Nepean Dyspepsia Index (NDI) for QoL were explored by Pearson’s correlation coefficient and linear regression analysis.

Results

The Cronbach’s α coefficient for the PHQ-8 and the SSS-8 was 0.601 and 0.553, respectively, and the cumulative contribution rate of three extracted factors for the developed PHQ-8 and SSS-8 was 55.103% and 51.666%, respectively. Somatization evaluated by the PHQ-8 (r = 0.309, P < 0.001) and the SSS-8 (r = 0.281, P < 0.001) was found to be correlated to NDI. The model used for the PHQ-8 showed that the values of goodness-of-fit index (GFI) and adjusted GFI (AGFI) were 0.984 and 0.967, respectively, which indicated that the model fitted well. Linear regression analysis unveiled that somatization (β = 0.270, P < 0.001), anxiety (β = 0.163, P < 0.001), and depression (β = 0.136, P = 0.003) assessed by the PHQ-8 were correlated to NDI. In addition, somatization (β = 0.250, P < 0.001), anxiety (β = 0.156, P < 0.001), and depression (β = 0.155, P = 0.001) evaluated by the SSS-8 were correlated to NDI.

Conclusions

PHQ-8 showed a superior reliability and validity, and somatization assessed by the developed PHQ-8 showed a greater influence on the QoL of FD patients as compared to the SSS-8. Our findings suggested that the developed PHQ-8 may show improvement in a reliable assessment of the effects of somatization on FD patients in lieu of the SSS-8.

Psychometric Testing of the Premenstrual Symptoms Questionnaire and the Association Between Perceived Injustice and Premenstrual Symptoms: A Cross-Sectional Study Among Japanese High School Students

Purpose

Premenstrual symptoms comprise a wide range of mood, behavioral, and physical symptoms occurring during the luteal phase. Perceived injustice is a belief linked to unfairness (ie, unnecessary suffering caused by illness). This study aimed to assess the validity and reliability of the Premenstrual Symptoms Questionnaire (PSQ), a patient-reported outcome measurement tool, and to examine the association between perceived injustice/perception of menstruation and premenstrual symptoms, as measured by the PSQ.

Materials and Methods

Of 1388 female students, we analyzed 879 students with regular menstrual cycles who completed the PSQ, the premenstrual dysphoric disorder (PMDD) scale, the Somatic Symptom Scale-8 (SSS-8), and the Injustice Experience Questionnaire-chronic (IEQ-chr). First, the PSQ was examined for evidence of reliability and validity. Next, we used multiple regression and multivariate logistic regression to investigate the association between perceived injustice and premenstrual symptoms, using PSQ score as both a continuous variable and a dichotomous variable (premenstrual disorders or not). Moreover, the association between PSQ score and perceived menstruation was tested using student's t-test and analysis of variance.

Results

In terms of reliability, Cronbach's α for PSQ score was 0.93. To assess structural validity, we used confirmatory factor analysis, which showed that the one-factor model and the two-factor model were a good fit. The PSQ showed good agreement with the PMDD scale. In terms of concurrent validity, PSQ total score correlated strongly with PMDD scale score, SSS-8 score, and IEQ-chr score (r = 0.88, 0.69, 0.57, respectively). IEQ-chr score predicted PSQ score (standardized regression coefficient = 0.53; P < 0.0001) and higher prevalence of premenstrual disorders (odds ratio: 1.15; 95% confidence interval: 1.12-1.19). Negative perception of menstruation was associated with premenstrual symptoms.

Conclusion

The PSQ showed sound psychometric properties among the adolescents in our sample. Perceived injustice and negative perception of menstruation were associated with premenstrual symptoms.

Reliability and Validity of the Korean Version of Somatic Symptom Scale-8

OBJECTIVE

Somatic symptoms in psychiatry include underlying depression, anxiety, or other psychiatric disorders. This study aimed to conduct a validation study of a Korean version of the Somatic Symptom Scale-8 (K-SSS-8), and to utilize the K-SSS-8 effectively in clinical settings.

METHODS

For reliabilty, test-retest reliability and internal consistency were analyzed. For construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Known-group validity was verified, Jonckheere-Terpstra test (J-T statistic) were used.

RESULTS

Maternal Cronbach's alpha was 0.85 and r value of test-retest reliability was 0.777. In the EFA, 2-, 3- and 4-factor model showed cumulative percentile for variance of 60% or more. In the CFA, the 3-factor model was found to be the most appropriated and simplest (χ2=10.992, df=17, CFI=1.000, TLI=1.022, RMSEA=0.000). The verifying the difference in K-SSS-8 also showed significant difference. (J-T statistic=-2.510, p<0.05).

CONCLUSION

K-SSS-8 can be useful for exploring symptoms such as panic symptoms, physical pain, and physiological symptoms experienced by patients in a short time. In addition, the K-SSS-8 is expected to be very useful for determining the current severity by using the severity categories and for establish additionally required assessment plans for depression and anxiety symptoms.

Internet-based cognitive-behavioural therapy for prevention of depression during pregnancy and in the post partum (iPDP): a protocol for a large-scale randomised controlled trial

INTRODUCTION

The objective of this randomised controlled trial (RCT) is to examine the effects of smartphone-based cognitive-behavioural therapy (CBT) in preventing the onset of major depressive episodes (MDE) among pregnant women.

METHODS AND ANALYSIS

The target study population will be pregnant women of 16-20 weeks gestation who are currently users of 'Luna Luna Baby', the most widely used app for pregnant women in Japan. Those who meet the eligibility criteria will be randomly allocated to the 6-module internet CBT programme that was newly developed for pregnant women (n=2500), or to a treatment-as-usual control group (n=2500). Participants in the intervention groups will be required to complete the programme by 32 weeks gestation. The primary outcomes are the number of new onsets of MDE, measured by using WHO Composite International Diagnostic Interview 3.0 at 32 weeks gestation and 3 months post partum. Survival analysis will be conducted to test for the effectiveness of the intervention on the time to the onset of MDE.

ETHICS AND DISSEMINATION

The study plan has been approved by the Research Ethics Review Board of the Graduate School of Medicine/Faculty of Medicine, the University of Tokyo (2019150NI). If the intervention programmes are found to produce a significant positive effect in this RCT, these programmes can be made available for all users of the app in the future.

TRIAL REGISTRATION NUMBER

UMIN000038190; Pre-results.

The relation between emotion regulation and migraine: A cross-cultural study on the moderating effect of culture

BACKGROUND

Effects of emotion suppression on physical health might be contingent on culture. Existing research on emotion regulation has mainly included western participants. Herewith the question arises, whether this gained expertise is transferable to an Asian culture.

OBJECTIVES

This cross-sectional study evaluated to what extent the regulation of emotions is related to migraine and if the relation between emotion regulation and migraine complaints differs between a Western and an Asian population. Therefore, the main characteristics and symptoms of patients with migraine from both Germany and Japan are compared.

METHODS

261 Japanese and 347 German headache patients participated in this online study and completed self-report measures of emotion regulation (suppression and reappraisal) and headache complaints.

RESULTS

Cultural groups did not differ regarding their demographic data, intake of medication and number of days with headache. German participants showed significantly higher levels of anxiety and lower levels of emotion suppression compared to Japanese patients. Emotion regulation is not correlated with headache complaints either in the Japanese or in the German patient group.

CONCLUSION

Although group differences were found with respect to anxiety and emotion suppression, subsequent regression analysis revealed these differences were unrelated to headache complaints. As our baseline analysis focused on group means, approaches that examine individual reaction patterns to stress and accompanying sensory stimulus processing may prove to be more fruitful and illuminating.

The association between neck and shoulder discomfort-Katakori-and high somatizing tendency

Objectives: 'Katakori', discomfort or dull pain around the neck and shoulder, is common in Japan. Somatizing tendency is important in the quality of daily living. This study aimed to examine the association between disability due to Katakori and high somatizing tendency.Methods: This internet study included 34,754 Japanese adults who reported Katakori in the past four weeks. Katakori was classified into four grades: 1) no Katakori, 2) Katakori without difficulty in activities for daily living (ADL), 3) Katakori with ADL difficulty but without absence from social activities, and 4) Katakori with absence from social activities. Somatizing tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). The association between a very high (SSS-8 ≥ 16) somatizing tendency and Katakori grade was examined using logistic regression adjusting for age, sex, body mass index, marital status, smoking, regular exercise, low back pain, depression, and the number of chronic conditions.Results: Katakori grade was significantly associated with a very high somatizing tendency (Odds ratio (OR)= 5.36 [4.36-6.60] in grade 4 vs. 2, and OR= 2.57 [2.30-2.89] in grade 3 vs. 2).Conclusion: When treating severe Katakori with disability, somatizing tendency should be assessed to facilitate better management.

Association between somatic symptom burden and health-related quality of life in people with chronic low back pain

Depression is a relevant risk factor for low back pain and is associated with the outcomes of low back pain. Depression also often overlaps with somatisation. As previous studies have suggested that somatisation or a higher somatic symptom burden has a role in the outcomes of low back pain, the aim of the present cross-sectional study was to examine whether somatic symptom burden was associated with health-related quality of life in individuals with chronic low back pain independent of depression. We analyzed internet survey data on physical and mental health in Japanese adults aged 20–64 years with chronic low back pain (n = 3,100). Health-related quality of life was assessed using the EuroQol five dimensions (EQ-5D) questionnaire. Somatic symptom burden and depression were assessed using the Somatic Symptom Scale-8 (SSS-8) and the Patient Health Questionnaire-2 (PHQ-2), respectively. SSS-8 score was categorized as no to minimal (0–3), low (4–7), medium (8–11), high (12–15), and very high (16–32). The association between SSS-8 and EQ-5D was examined using linear regression models, adjusting for depression and other covariates, including age, sex, BMI, smoking, marital status, education, exercise, employment, and the number of comorbid diseases. A higher somatic symptom burden was significantly associated with a lower health-related quality of life independent of depression and the number of comorbid diseases (regression coefficient = 0.040 for SSS-8 high vs. very high and 0.218 for non to minimal vs. very high, p trend <0.0001). In conclusion, somatic symptom burden might be important for the health-related quality of life of individuals with chronic low back pain.

Disability due to knee pain and somatising tendency in Japanese adults

BACKGROUND

Knee pain is common and related to knee osteoarthritis. However, there is a discrepancy between knee pain and radiographic osteoarthritis. In the general population, knee pain is associated with psychological and cognitive factors, which would be one explanation for the discrepancy. Limited evidence demonstrates that somatization is associated with knee pain. This study examined the association between disability due to knee pain and a high somatising tendency.

METHODS

Japanese adults (aged 20-64 years) who had experienced knee pain in the past four weeks were included in this study (n = 14,695, 50% women). Data were extracted from a large internet survey. Somatising tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). Disability due to knee pain was categorized into three levels: 1) knee pain without difficulty with activities of daily living (ADL), 2) knee pain with ADL difficulty but without requiring sick leave, and 3) knee pain requiring sick leave. The association between ≥ high somatising tendency (SSS-8 score ≥ 12) as well as very high somatising tendency (SSS-8 score ≥ 16) and disability due to knee pain was examined using logistic regression models adjusted for age, sex, body mass index, depressive symptoms, education level, regular exercise, chronicity of knee pain (≥3 months), osteoarthritis, rheumatoid arthritis, and fibromyalgia.

RESULTS

Greater disability due to knee pain was associated with a higher odds ratio for ≥ high somatising tendency (adjusted odds ratio (aOR) = 2.36 [2.10-2.66] in group 2 vs. group 1, aOR = 3.23 [2.66-3.92] in group 3 vs. group 1). Stronger associations were found for a very high somatising tendency (aOR = 2.80 [2.42-3.23] in group 2 vs. group 1, aOR = 4.51 [3.64-5.58] in group 3 vs. group 1).

CONCLUSIONS

Somatization may play a role in disability due to knee pain in the general adult population with knee pain, similar to the role of somatization in low back pain.

Comparing the Patient Health Questionnaire - 15 and the Somatic Symptom Scale - 8 as measures of somatic symptom burden

PURPOSE

The Patient Health Questionnaire - 15 (PHQ-15) and the Somatic Symptom Scale - 8 (SSS-8) are self-report measures which assess somatic symptom burden. The present study investigates whether the two measures are comparable in terms of their psychometric properties and estimates of symptom burden.

METHOD

Item characteristics, reliability, symptom severity and construct validity with regard to other relevant psychological, health-related quality of life and disability measures were compared for the PHQ-15m and the SSS-8 in 294 primary care patients who participated in a randomized comparative effectiveness trial targeting pain and mood symptoms.

RESULTS

The reliabilities of the PHQ-15m and the SSS-8 were α=0.66 and α=0.72, respectively. Both measures were highly correlated (r=0.79). All item characteristics were comparable and both instruments showed the same pattern of correlations with instruments measuring depression, anxiety, pain, quality of life and impairment (r=0.25 to 0.53). A 1-point score increase (worsening of somatic symptoms) on either instrument resulted in a 3.7% to 3.9% increase in the number of disability days reported for the last four weeks. Using the same severity thresholds (5: low, 10: medium, 15: high), both measures identified nearly identical subgroups of patients with regard to health-related quality of life and disability.

CONCLUSION

The PHQ-15m and the SSS-8 are comparable measures in terms of reliability and validity and severity classifications. These findings are in line with previous results and support the use of the SSS-8 as a valuable and short alternative to the original PHQ-15 in settings with limited assessment time.

Monitoring somatic symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the Somatic Symptom Scale - 8 (SSS-8)

OBJECTIVE

The SSS-8 is a brief questionnaire for the assessment of somatic symptom burden. This study examines its sensitivity to change and the minimal clinically important difference (MCID) in patients with mental disorders.

METHOD

55 outpatients with mental disorders completed the SSS-8 and measures of anxiety, depression, and disability before and after receiving treatment. Effect sizes and correlations between the change scores were calculated. The MCID was estimated using a one standard error of measurement threshold and the change in disability as an external criterion.

RESULTS

There was a medium decline in somatic symptom burden for the complete sample (n=55, d_z=0.53) and a large decline in a subgroup with very high somatic symptom burden at baseline (n=11, d_z=0.94). Decreases in somatic symptom burden were associated with decreases in anxiety (r=0.68, p<0.001), depression (r=0.62, p<0.001) and disability (r=0.51, p<0.001). The MCID was estimated as a 3-point decrease.

CONCLUSION

The SSS-8 is sensitive to change. A 3-point decrease reflects a clinically important improvement. Due to its brevity and sound psychometric properties, the SSS-8 is useful for monitoring somatic symptom burden.