The relation between the patient health questionnaire-15 and DSM somatic diagnoses

Efficacy and safety of venlafaxine hydrochloride combined with tandospirone citrate for patients with vascular depression accompanied by somatic symptoms: An open-labeled randomized control trial

AIMS

To explore the pharmacological treatment of vascular depression (VaDep) and whether the blood levels of neurotransmitters can reflect the VaDep severity.

METHODS

VaDep patients with somatic symptoms were enrolled and randomly received venlafaxine + tandospirone (Combined Group) or venlafaxine (Monotherapy Group). The treatment efficacy was assessed by Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Patient Health Questionnaire-15 (PHQ-15). The levels of blood monoamine neurotransmitters were measured by enzyme-linked immunosorbent assay.

RESULTS

Both groups reported a progressive decrease in HAMD, HAMA, and PHQ-15 scores to below the baseline after the respective treatment. Compared with the Monotherapy Group, the Combined Group reported a significant decrease in HAMD score at week 2 and markedly lower HAMA and PHQ-15 scores at weeks 1, 2, 4, and 8. Both groups showed a decrease in the levels of blood monoamine neurotransmitters at weeks 4 and 8 when compared with the baseline. A strong positive association was evident between the plasma 5-HT levels and the HAMD score.

CONCLUSION

The combined therapy rapidly acts on VaDep comorbid with anxiety and somatic symptoms and significantly alleviates the anxiety and somatic symptoms. The plasma levels of 5-HT may serve as potential objective candidates in evaluating VaDep severity and the efficacy of the undertaken treatment regimen.

The psychological and physiological effects of integrated cognitive-behavioral and biofeedback therapy on panic disorder: A randomized controlled trial

BACKGROUND

Cognitive-behavioral therapy (CBT) and biofeedback therapy are commonly regarded as effective treatment modalities for panic disorder. The aim of this study was to establish a Taiwanese version of an integrated cognitive-behavioral and biofeedback therapy (ICB) and examine its effects on panic disorder using psychological and physiological indicators.

METHODS

Thirty patients with panic disorder were enrolled in this study. They were randomly assigned to either the ICB group (n = 15) or the treatment as usual (TAU) group (n = 15). The intervention consisted of six sessions, conducted once a week. Psychological indicators were measured at baseline (prior to intervention), week 3, and week 6, while physiological indicators were measured at baseline and week 6. The psychological indicators included five scales, with the Panic Disorder Severity Scale (PDSS) being the primary measure. The physiological indicators included respiratory sinus arrhythmia (RSA) and skin conductance, which respectively represent parasympathetic and sympathetic activity.

RESULTS

Considering all participants, PDSS scores significantly decreased over time, but the difference between the ICB and TAU groups did not reach statistical significance. Among the physiological indicators, resting-state RSA and RSA under relaxation showed significant between-group differences over time, with the ICB group demonstrating a more pronounced improvement in RSA.

CONCLUSION

In the context of existing pharmacological treatments, the benefits of ICB for panic disorder may not be observable through psychological indicators. However, it can lead to enhancement of parasympathetic activity as evidenced by the physiological indicators.

Psychological characteristics of young adults with temporomandibular disorders, somatization and combined conditions: A multidimensional evaluation

BACKGROUND

Temporomandibular disorders and somatization have shown interrelation in many studies. The physical and psychological factors which contributed to the occurrence and relation of both conditions are yet to be determined.

OBJECTIVES

The personality traits, coping styles and psychological distress of young adults with temporomandibular disorder (TMD) and somatic symptoms were characterized together with the determination of psychological risk factors for TMDs, somatization and combined conditions.

METHODS

Participants were recruited from university-attending young adults. TMD and somatic symptoms were appraised with the short-form Fonseca Anamnestic Index and Patient Health Questionnaire-15. Psychological variables were assessed with the Big Five Personality Inventory-10, Brief-COPE Inventory and Depression, Anxiety, and Stress Scales-21. Data were evaluated using chi-squared/non-parametric tests and logistic regression analyses (α = .05).

RESULTS

Among the 507 participants (mean age 22.2 ± 1.5 years), 46.4% reported no TMD/somatic symptoms (NS) while 7.5%, 34.5% and 11.6% had TMDs only (TS), somatization only (SS) and combined TMDs-somatization (CS), respectively. Significant differences in conscientiousness (NS > SS), agreeableness (NS, TS > CS; NS > SS), dysfunctional coping, general distress, depression, anxiety and stress (CS ≥ SS > NS) were discerned. Multivariate analyses indicated that the odds of TS were increased by anxiety (OR = 1.10; 95% CI = 1.01-1.21), while the odds of SS/CS were affected by anxiety (OR = 1.15; 95% CI = 1.06-1.25/OR = 1.34; 95% CI = 0.19-1.52) and problem-focused coping (OR = 0.71; 95% CI = 0.56-0.89/OR = 0.55; 95% CI = 0.39-0.78).

CONCLUSION

Though individuals with TMDs and somatization have dissimilar psychological profiles, anxiety constantly increased their likelihood. Problem-focused coping strategies may help alleviate psychosocial and physical stressors associated with TMDs and somatization.

Clarifying the link between psychopathologies and heart rate variability, and the sex differences: Can neuropsychological features serve as mediators?

BACKGROUND

Patients with common mental disorders (depression, anxiety, and somatic symptoms) often exhibit lower heart rate variability (HRV) than healthy individuals. Under the hypothesis that disorder status affects cognitive function, we examined whether neuropsychological features can be mediators between psychopathologies and HRV and possible sex differences.

METHODS

We recruited 359 individuals (aged 42.47 ± 12.23) with and without common mental disorders. Questionnaires were used to measure their psychopathologies. Eight tests from the Cambridge Neuropsychological Test Automated Battery were selected to measure neuropsychological functions. Resting-state HRV measurements were obtained for 5 min. The associations among these constructs were analyzed using multiple linear regression analysis and structural equation modelling.

RESULTS

Among women, Reaction Time (RTI, a task of psychomotor speed) indicator mediated the relationship between depression and low-frequency power (LF); Emotion Recognition Task (ERT, a task of emotional regulation) indicator mediated the relationship between health anxiety and high-frequency power (HF). Among men, Intra-Extra Dimensional Set Shift (IED, a task of shifting) indicator mediated the relationship between depression and LF; Match to Sample Visual Search (MTS, a task of selective attention) indicator mediated the relationship between health cognition and HF. The depression-RTI-LF pathway in women tended to lower HRV; whereas health anxiety-ERT-HF in women, depression-IED-LF and health cognition-MTS-HF in men tended to increase HRV.

LIMITATIONS

Possible medication effects; not directly measuring brain activity; only gathering resting-state HRV.

CONCLUSION

Our findings support the notion that neuropsychological features mediate the relationship between psychopathologies and HRV, and that sex differences exist.

Differences in psychometric characteristics of outpatients with somatic symptom disorder from general hospital biomedical (neurology/gastroenterology), traditional Chinese medicine, and psychosomatic settings

Objective

The aim of this study is to investigate the psychometric characteristics of outpatients diagnosed with somatic symptom disorder (SSD) in biomedical, Traditional Chinese Medicine (TCM) and psychosomatic settings.

Materials and methods

A total of 697 participants who completed SCID-5 and questionnaires were presented in our former study, as 3 of them had missed questionnaire data, a total of 694 participants are presented in this study. A secondary analysis of the psychometric characteristics of Somatic Symptom Disorder-B Criteria Scale (SSD-12), Somatic Symptom Severity Scale of the Patient-Health Questionnaire (PHQ-15), Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) is done to compare differences among outpatients from the three settings of medical specialties.

Results

Based on the DSM-5 criteria, 90 out of 224 (40.2%) participants enrolled in biomedical departments (represented by neurology and gastroenterology departments), 44/231 (19.0%) in TCM departments, and 101/239 (42.3%) in the psychosomatic medicine departments were diagnosed with SSD. The scores of PHQ-15 in the biomedical, TCM and psychosomatic settings were 11.08 (± 4.54), 11.02 (± 5.27) and 13.26 (± 6.20); PHQ-9 were 10.43 (± 6.42), 11.20 (± 5.46) and 13.42 (± 7.32); GAD-7 were 8.52 (± 6.22), 9.57 (± 5.06) and 10.83 (± 6.24); SSD-12 were 22.26 (± 11.53), 22.98 (± 10.96) and 25.03 (± 11.54) respectively. The scores of PHQ-15, PHQ-9 and GAD-7 in SSD patients were significantly higher in psychosomatic departments than that in biomedical settings (p < 0.05). The cutoff point for SSD-12 was ≥16 in total patients; 16, 16, 17 in biomedical, TCM and psychosomatic settings, respectively. The cutoff point for PHQ-15 was found to be ≥8 in total patients; 8, 9, 11 in biomedical, TCM and psychosomatic settings, respectively.

Conclusion

SSD patients from psychosomatic departments had higher level of somatic symptom severity, depression and anxiety than from TCM and biomedical settings. In our specific sample, a cutoff point of ≥16 for SSD-12 could be recommended in all three settings. But the cutoff point of PHQ-15 differs much between different settings, which was ≥8, 9, and 11 in biomedical, TCM, and psychosomatic settings, respectively.

Medically Unexplained Symptoms among Adults from Russia: An Assessment using the Patient Health Questionnaire-15

Background

The Patient Health Questionnaire-15 (PHQ-15) is one of the most frequently used instruments to measure medically unexplained symptoms in the general population, as well as in groups of patients with mental and physical health problems.

Objective

This study aimed to examine the psychometric properties of the PHQ-15 in assessing a Russian community sample.

Design

A total of 1153 Russian adults age 18 or older participated in this cross-sectional study. They completed the Russian versions of the PHQ-15 and Symptom Check List-90-Revised, SCL-90-R (SCL-90-R). Exploratory and confirmatory factor analyses were used to examine the factor structure of the Russian PHQ-15, and multi-group confirmatory factor analyses were used to test measurement invariance across sex and age. Cronbach's alpha coefficients and Pearsons Correlation Coefficients were used to evaluate the internal reliability and convergent validity of the Russian PHQ-15.

Results

Exploratory factor analysis revealed a three-factor solution highlighting pain-fatigue, gastrointestinal, and cardiopulmonary symptoms. Confirmatory factor analysis confirmed a bifactor structure for the Russian PHQ-15 merging general and specific somatic symptoms. A multi-group confirmatory factor analysis showed partial invariance across sex and age. The Russian PHQ-15 demonstrated acceptable Cronbach's alpha coefficients ranging from 0.72 to 0.75 for specific factors and a good Cronbach's alpha for the total score (a = 0.85), proving the questionnaire's internal reliability. Finally, positive correlations between the PHQ-15 and SCL-90-R dimensions, and positive intercorrelations between PHQ-15 specific factors, suggested convergent validity.

Conclusion

The Russian PHQ-15 is a reliable and valid instrument for assessing medically unexplained symptoms in the general population. This instrument can be used in diagnostic and counseling settings.

Population-based prevalence of somatic symptom disorder and comorbid depression and anxiety in Taiwan

OBJECTIVE

The nationwide prevalence of somatic symptom disorder (SSD) has not yet been investigated in Asia. SSD is often comorbid with depression and anxiety, and the effects of these conditions on medical utilization await clarification. We hence performed a study in Taiwan to explore these issues.

METHODS

Using telephone-based sampling and interview, we obtained data for 3161 participants whose age, gender and living area were compatible with the Taiwan population. We gathered scores of the Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ) and Patient Health Questionnaire-4 (PHQ-4). Individuals with a PHQ-15 score of at least 4 and a HAQ score of at least 17 were considered to have SSD. Descriptive statistics were used to clarify the prevalence and normative data of the questionnaires. We used multiple logistic regression analyses to investigate the relation between diagnoses and medical utilization.

RESULTS

The prevalence of SSD was 5.00% and women had a higher SSD prevalence than men; participants aged 40-49 years had the highest SSD prevalence. In SSD patients, 33.58% had depression or anxiety. After correcting for demographics, SSD and anxiety (but not depression) were associated with a significantly high level of outpatient/emergency department attendance. Comorbid depression or anxiety did not significantly increase the medical utilization of SSD patients.

CONCLUSION

The nationwide SSD prevalence in Taiwan is compatible with the description in the DSM-5. The comorbidity of SSD and depression/anxiety is common, but depression or anxiety does not significantly increase the SSD patients' medical utilization.

Use of machine learning to diagnose somatic symptom disorder: Are the biomarkers beneficial for the diagnosis?

OBJECTIVES

We used machine learning to incorporate three types of biomarkers (respiratory sinus arrhythmia, RSA; skin conductance, SC; finger temperature, FT) for examining the performance of diagnosing somatic symptom disorder (SSD).

METHODS

We recruited 97 SSD subjects and 96 controls without psychiatric history or somatic distress. The values of RSA, SC and FT were recorded in three situations (resting state, under a cognitive task and under paced breathing) and compared for the two populations. We used machine learning to combine the biological signals and then applied receiver operating characteristic curve analysis to examine the performance of diagnosing SSD regarding the distinct indicators and situations. Subgroup analysis for subjects without depression/anxiety was also conducted.

RESULTS

FT was significantly different between SSD patients and controls, especially in the resting state and under paced breathing. However, the biomarkers (0.75-0.76) did not reveal an area under the curve (AUC) comparable with the psychological questionnaires (0.86). Combining the biological and psychological indicators gave a high AUC (0.86-0.92). When excluding individuals with depression/anxiety, combining three biomarkers (0.79-0.83) and adopting psychological questionnaires (0.78) revealed a similar AUC.

CONCLUSIONS

The performance of RSA/SC/FT was unsatisfactory for diagnosing SSD but became comparable when excluding comorbid depression/anxiety.

An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms, and symptom perception: the potential role of inflammatory markers in hospitalized COVID-19 patients

BACKGROUND

The context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms.

METHOD

We conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms.

RESULTS

The results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms.

CONCLUSIONS

Results demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.

Changes in bodily complaints (PHQ-15) over six years in a large general population sample

OBJECTIVE

The Patient Health Questionnaire-15 (PHQ-15) is a widely used instrument for measuring bodily complaints. The aims of this study were to analyze changes of bodily complaints over a six-year period in a large general population community sample, to test age and sex differences in these changes, and to examine associations between these changes and changes in other health-related variables.

METHODS

A total of 4821 adult subjects took part this longitudinal study at baseline (t1) and six years later (t2). The participants completed the PHQ-15 and several other questionnaires.

RESULTS

Over the six-year period, the mean score of the complaints increased from 5.18 ± 3.67 to 5.75 ± 3.97. The highest increase in terms of effect sizes was found for sexual pain/problems. While the increase in the PHQ-15 mean score was nearly identical for males and females, there were age differences in these increase rates: Participants of the oldest age group (70 years and above) experienced the greatest increase in complaints. Participants from lower socioeconomic levels also reported high increases in complaints. The correlation between the t1 and the t2 PHQ-15 score was r = 0.66. Changes in complaints from t1 to t2 were associated with changes in multiple other variables such as anxiety, social support, optimism, life satisfaction, and quality of life.

CONCLUSION

The data reported here can be used to better interpret changes in patients' health state over several years.

A simple version of resting-state heart rate variability interpretation for patients with affective disorders: A four-pattern perspective

Heart rate variability (HRV) is often considered as a biomarker reflecting well-being, but the clinical meaning of short-term resting-state HRV is not sufficiently defined. We assume that combining several common HRV indices as "HRV patterns" and using the patterns for screening purposes are meaningful approaches. Resting-state 5-min HRV data of 424 subjects were analyzed. Four of the most commonly used HRV indices were considered: standard deviation of normal-to-normal RR intervals, low-frequency power, high-frequency power and the ratio of low-frequency to high-frequency power. According to these indices, four HRV patterns were defined: normal pattern, low HRV pattern, relatively high sympathetic pattern, and relatively high vagal pattern. The associations between the demographics, lifestyles, personality traits, psychological states, and HRV patterns were explored: the low HRV pattern was positively associated with age, body mass index, and depression; the relatively high sympathetic pattern was positively associated with age and negatively associated with exercise habit; and the relatively high vagal pattern was negatively associated with having a steady job and novelty seeking. The pattern perspective may provide a convenient and evidence-based way to interpret resting-state HRV for patients with affective disorders.

The association between heart rate variability and skin conductance: a correlation analysis in healthy individuals and patients with somatic symptom disorder comorbid with depression and anxiety

Objective

To investigate the correlations between heart rate variability (HRV) and skin conductance (SC) in two populations under three different situations.

Methods

This cross-sectional study enrolled patients with somatic symptom disorder comorbid with depression and anxiety and healthy individuals without a psychiatric history. The biological signals were measured under three conditions: resting state, during a cognitive task and during paced breathing. Pearson’s correlation analysis and the generalized estimating equation were used to examine the correlations between SC and HRV in the two populations under the three situations.

Results

The study enrolled 97 patients with somatic symptom disorder comorbid with depression and anxiety and 96 healthy individuals. In healthy individuals, the ratio of low-frequency power to high frequency power (LF/HF) and normalized LF (LF%) were significantly correlated with SC in the resting state and during a cognitive task, but the correlation coefficients were low level. In patients with somatic symptom disorder comorbid with depression and anxiety, LF/HF and LF% did not show significant correlations with SC under any situation.

Conclusions

The two different populations and three situations might have affected the significance of the LF/HF-SC and LF%-SC correlations. The generally low correlations indicate that LF/HF and LF% cannot fully reflect the sympathetic cholinergic activity represented by SC.

Assessing Somatic Symptoms With the Patient Health Questionnaire (PHQ-15) in Syrian Refugees

Somatic symptoms are common among Syrian refugees. To quantify somatic symptom load, sum score models derived from the Patient Health Questionnaire (PHQ-15) have been frequently applied without psychometric justification. Across two studies (total N = 776), we (a) tested different PHQ-15 factor solutions in Syrian refugees, (b) investigated measurement invariance (MI) of the factor solutions compared with German residents, and (c) scrutinized whether sum score models adequately represent the data and differ in associations with external validators compared with factor scores. One-factor, three-factor, four-factor, and a reduced one-factor solution all displayed acceptable to good model fit. The four-factor solution showed the best fit, enabling differential symptom analyses. Sum score models often had poor model fit, necessitating independent investigations before applying them. For all factor solutions, (partial) strict MI between residents and refugees could be established. All scoring methods displayed high and comparable associations with functional impairment, depressive, and anxiety symptoms.

Detecting DSM-5 somatic symptom disorder in general hospitals in China: B-criteria instrument has better accuracy-A secondary analysis

OBJECTIVE

This study investigates the diagnostic accuracy of the PHQ-15, SSS-8, SSD-12 and Whitley 8 and their combination in detecting DSM-5 somatic symptom disorder in general hospitals.

METHODS

In our former multicenter cross-sectional study enrolling 699 outpatients from different departments in five cities in China, SCID-5 for SSD was administered to diagnose SSD and instruments including PHQ-15, SSS-8, SSD-12 and WI-8 were used to evaluate the SSD A and B criteria. In this secondary analysis study, we investigate which instrument or combination of instrument has best accuracy for detecting SSD in outpatients. Receiver operator curves were created, and area under the curve (AUC) analyses were assessed. The sensitivity and specificity were calculated for the optimal individual cut points.

RESULTS

Data from n = 694 patients [38.6% male, mean age: 42.89 years (SD = 14.24)] were analyzed. A total of 33.9% of patients fulfilled the SSD criteria. Diagnostic accuracy was moderate or good for each questionnaire (PHQ-15: AUC = 0.72; 95% CI = 0.68-0.75; SSS-8: AUC = 0.73; 95% CI = 0.69-0.76; SSD-12: AUC = 0.84; 95% CI = 0.81-0.86; WI-8: AUC = 0.81; 95% CI = 0.78-0.84). SSD-12 and WI-8 were significantly better at predicting SSD diagnoses. Combining PHQ-15 or SSS-8 with SSD-12 or WI-8 showed similar diagnostic accuracy to SSD-12 or WI-8 alone (PHQ-15 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; PHQ-15 + WI-8: AUC = 0.82; 95% CI = 0.79-0.85; SSS-8 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; SSS-8 + WI-8: AUC = 0.82; 95% CI = 0.79-0.84). In the efficiency analysis, both SSD-12 and WI-8 showed good efficiency, SSD-12 slightly more efficient than WI-8; however, within the range of good sensitivity, the PHQ-15 and SSS-8 delivered rather poor specificity. For a priority of sensitivity over specificity, the cutoff points of ≥13 for SSD-12 (sensitivity and specificity = 80 and 72%) and ≥17 for WI-8 (sensitivity and specificity = 80 and 67%) are recommended.

CONCLUSIONS

In general hospital settings, SSD-12 or WI-8 alone may be sufficient for detecting somatic symptom disorder, as effective as when combined with the PHQ-15 or SSS-8 for evaluating physical burden.

Measurement of Somatic Symptoms in the General Population: Standardization of the Russian PHQ-15

<p>The Patient Health Questionnaire (PHQ-15) is a self-report measure assessing presence and severity of somatic symptoms [15]. The aim of this study was to standardize the Russian version of PHQ-15. The study included 1157 respondents from the general population aged 18 to 71. In addition to the PHQ-15, the participants completed the Russian Depression, Anxiety, and Stress Scales-21 (DASS-21), evaluating the psychological distress symptoms. The results showed that 91% of the respondents reported at least one symptom bothering them in the past four weeks. Regarding gender and age specifics of somatization, the most predisposed to the psychosomatic burden were females and persons aged 35-49 years. Moreover, 28.2% of the respondents demonstrated a high level of somatization, as well as increased scores of depression, anxiety, and stress compared to the participants with low and moderate psychosomatic burden. In conclusion, the Russian version of PHQ-15 has been successfully standardized and can be recommended for screening and monitoring of medically unexplained symptoms.</p>

Clinical implications of panic attack in Chinese patients with somatoform disorders

OBJECTIVE

Somatoform disorders are frequently accompanied by panic attack and causes many clinical symptoms. This study aimed to compare clinical features between patients with and without panic attack in somatoform disorder.

METHODS

In this cross-sectional study, 341 patients with somatoform disorder according to the MINI-International Neuropsychiatric Interview (M.I.N·I.) were divided into two groups depending on with or without comorbidity of a panic attack, somatoform disorder with a panic attack (SPA, n = 88) and those without panic attack (SNPA, n = 253). Patient Health Questionnaire (PHQ-15), Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) scale was used to identify correlations between SPA group and SNPA group, respectively. Correlation analysis and multivariate regression analysis were used to determine the effects of demographic factors and psychiatric diagnoses on somatic, depressive and anxiety symptoms separately.

RESULTS

The SPA group's PHQ-15, PHQ-9 and GAD-7 scores were significantly higher than those of the SNPA group. Multiple linear regression analyses revealed that the associated factors for PHQ-15 were gender and panic disorder. PHQ-9 was just significantly associated with panic disorder. GAD-7 was significantly associated with education degree and panic disorder.

CONCLUSIONS

Our results suggest that somatoform disorder patients with panic attack suffered more severe clinical symptoms than those without a panic attack.

Psychopathology and Somatic Complaints: A Cross-Sectional Study with Portuguese Adults

(1) Background: Functional somatic symptoms (FSS) are physical symptoms that cannot be fully explained by medical diagnosis, injuries, and medication intake. More than the presence of unexplained symptoms, this condition is associated with functional disabilities, psychological distress, increased use of health services, and it has been linked to depressive and anxiety disorders. Recognizing the difficulty of diagnosing individuals with FSS and the impact on public health systems, this study aimed to verify the concomitant incidence of psychopathological symptoms and FSS in Portugal. (2) Methods: For this purpose, 93 psychosomatic outpatients (91.4% women with a mean age of 53.9 years old) and 101 subjects from the general population (74.3% women with 37.8 years old) were evaluated. The survey questionnaire included the 15-item Patient Health Questionnaire, the 20-Item Short Form Survey, the Brief Symptom Inventory, the Depression, Anxiety and Stress Scale, and questions on sociodemographic and clinical characteristics. (3) Results: Increases in FSS severity were correlated with higher rates of depression, anxiety, and stress symptoms. The findings also suggest that increased rates of FSS are associated with lower educational level and female gender. (4) Conclusion: Being aware of the relationship between FSS and psychopathological symptoms and the need to explore psychosocial issues during clinical interviews may favor early detection of these cases. The early detection of mental disorders is essential for individuals’ adherence to treatments, reflecting on healthcare costs.

Association between Stroop tasks and heart rate variability features in patients with somatic symptom disorder

OBJECTIVE

Patients with somatic symptom disorder (SSD) may have declined parasympathetic activity and selective attention to negative information. We combined Stroop tasks and heart rate variability (HRV) measurements to explore the brain mechanism of SSD.

METHODS

104 SSD patients (64 women) and 100 healthy adults (76 women) received three Stroop tasks (the "cognitive" color-word Stroop, "emotional" emotion Stroop, and "cognitive and emotional" face-word Stroop) with low and high interference conditions. The key HRV indexes included high-frequency power (HF) and standard deviation of normal to normal RR intervals (SDNN). The generalized estimating equation model was used to examine the effects of SSD on three Stroop tasks performance (accuracy and reaction time) and HRV (HF and SDNN) controlling for sex, age, body mass index, and the levels of anxiety and depression.

RESULTS

For Stroop tasks, the significant group difference in emotion Stroop task with the high level of interference (SSD patients had lower accuracy than healthy ones) was only found in women. As for HRV, only men during color-word Stroop, women during emotion Stroop revealed significant between-group differences; SDNN in SSD men was higher than healthy men, and HF in SSD women was lower than healthy women controlling for the confounding factors. The significantly longer reaction time in SSD women than in healthy women diminished in the adjusted analysis.

CONCLUSION

Emotion Stroop task and HRV helps distinguish SSD patients from healthy adults, particularly in women. Sex-specific measures for early detection and intervention for SSD are suggested.

Psychometric Properties of the Chinese Version of the Cognitions About Body and Health Questionnaire

INTRODUCTION

The Cognitions About Body and Health Questionnaire (CABAH) is a self-rating questionnaire measuring cognitions about health. The psychometric properties of its Chinese version and its performance on evaluating somatic symptom disorder (SSD) were examined in this study.

METHODS

After translating the CABAH into Chinese, we collected data of the CABAH and another four questionnaires (Patient Health Questionnaire-15, Health Anxiety Questionnaire, Beck Depression Inventory-II, Beck Anxiety Inventory) in 208 SSD patients and 197 healthy individuals. We used exploratory factor analysis (EFA) to explore the structure of the Chinese CABAH. Internal consistency and criterion-related validity were analyzed. An independent t-test and receiver operating characteristic (ROC) curve analysis were used to evaluate the performance of the CABAH for evaluating SSD.

RESULTS

Six factors were suggested by EFA. Five (bodily weakness, health habits, catastrophizing interpretation of specific bodily complaints, somatosensory amplification, catastrophizing interpretation of general bodily complaints) are conceptually associated with the original CABAH. The sixth factor (reverse, with three items) is different from the original construct. Cronbach's alpha for the CABAH was 0.885. The CABAH score was moderately correlated with scores of the other four questionnaires. Scores for the whole CABAH and scores of the six factors were all significantly higher in SSD patients than in healthy individuals. The results of ROC curve analysis were as follows: area under the curve=0.700; suggested cutoff=58/59; Youden's J=0.295.

CONCLUSION

The reliability and validity of the Chinese CABAH were fair, although the three items in the reverse factor should be interpreted cautiously.

Is severity a clinically meaningful specifier of somatic symptom disorder?

OBJECTIVE

Few existing studies have investigated the clinical relevance of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) somatic symptom disorder (SSD) severity rated by clinicians. We examined the association of SSD severity with psychiatric and medical comorbidity, psychological features and help-seeking attitude and behaviours.

METHODS

A total of 123 patients with SSD were prospectively recruited and completed several types of self-report instrument. Information about medical comorbidity and healthcare use was gathered from the participants and medical record review. Common comorbid psychiatric diagnoses of SSD were assessed by psychiatrists. Group differences of patients with SSD of varying severity were assessed with ANOVA and chi-square tests. Multiple linear regression models were used to examine the relationships between SSD severity and psychological features.

RESULTS

Prevalence of medical comorbidity and comorbid psychiatric diagnoses of SSD was not significantly different among patients with varying SSD severity. Patients with severe SSD had the highest Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ), Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) scores. Help-seeking behaviour was not associated with SSD severity. After controlling for demographic variables, the associations between 'severe SSD' and the PHQ-15, HAQ, BDI-II and BAI scores were significant.

CONCLUSION

SSD severity rated by clinicians was not associated with comorbid medical or psychiatric diagnoses. Compared to patients with mild/moderate SSD, patients with severe SSD not only had higher somatic distress and health anxiety but also higher levels of anxiety/depression. However, SSD severity was not associated with help-seeking attitude and behaviour.

Application of heart rate variability during blood pressure measurement in patients with somatic symptom disorder

OBJECTIVE

This study wants to test whether the heart rate variability (HRV) analysis using sphygmomanometers can effectively reflect the physical and emotional distress of somatic symptom disorder (SSD) cases and assist in further health management.

METHODS

This study includes 66 female SSD cases and 32 male SSD cases. All cases received a 200-second blood pressure (BP) measurement, after which the numerical figure for the heart rate was obtained from the BP signal for HRV analysis. All cases also filled out Patient Health Questionnaire-15 (PHQ-15), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI) to understand the extent of their somatic distress, depression, and anxiety. The relationship between psychological conditions and HRV indicators are examined statistically. Receiver operating characteristic (ROC) curve analysis was used to understand whether HRV indicators can assist in the determination of psychosomatic problems.

RESULTS

Considering all and female SSD cases, low-frequency power (LF) and PHQ-15 in the HRV index have the most significant correlations. In male SSD cases, root mean square of successive NN interval differences (RMSSD) and BDI-II have the highest correlations. The results of ROC curve analysis indicate that LF is useful to judge the severity of female SSD cases, while RMSSD has reference value in determining whether male patients of SSD cases have depression or not. In addition, physical stress index (PSI) can also help determine the degree of depression in male SSD cases.

CONCLUSION

The use of BP in HRV analysis can help in the monitoring of somatic distress and depression issues in SSD cases. LF, RMSSD, PSI are potential physiological indicators.

Latent structure and factor invariance of somatic symptoms in the patient health questionnaire (PHQ-15)

BACKGROUND

Somatic symptoms are highly prevalent in primary care although insufficiently understood. The Patient Health Questionnaire (PHQ-15) is a valuable screening test but it has not yet been possible to unequivocally demonstrate its latent structure and measurement invariance.

METHODS

A total of 1,255 patients from 28 primary care centres suffering symptoms of anxiety, depression or somatisation participated in a clinical trial. They completed the PHQ-15 at baseline and 374 retook it at three months. Exploratory structural equation modelling (ESEM) was used to compare three models: 1) a single global factor for somatisation, 2) four specific correlated factors, and 3) a bifactor model integrating the first two models.

RESULTS

A multi-group invariance analysis of the best-fit model was performed: the bifactor model (χ²=25.17, df=23, p = 0.34, RMSEA=0.009, CFI=1.00, TLI=0.999). Strict invariance was good for both gender (RMSEA = 0.046, CFI = 0.973, TLI = 0.963) and age (RMSEA = 0.048, CFI = 0.964, TLI = 0.962). Configural and metric invariance were confirmed for moment of assessment, but scalar invariance was not.

LIMITATIONS

The two main limitations were the sample (primary care patients with emotional disorders), which was not representative of the general population, and the utilisation of ESEM (vs. confirmatory factor analysis), which did not allow a second-order factor model to be tested.

CONCLUSIONS

PHQ-15 showed a bifactor structure, providing both a single global measure of somatisation and specific measures of pain, gastrointestinal, cardiopulmonary and fatigue factors. Its factor invariance with regard to both gender and age was confirmed.

Detecting DSM-5 somatic symptom disorder: criterion validity of the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Scale-8 (SSS-8) in combination with the Somatic Symptom Disorder - B Criteria Scale (SSD-12)

BACKGROUND

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced somatic symptom and related disorders (SSD) to improve the diagnosis of somatoform disorders. It is unclear whether existing questionnaires are useful to identify patients with SSD. Our study investigates the diagnostic accuracy of the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Scale-8 (SSS-8) in combination with the Somatic Symptom Disorder - B Criteria Scale (SSD-12).

METHODS

For this cross-sectional study, participants were recruited from a psychosomatic outpatient clinic. PHQ-15, SSS-8, and SSD-12 were administered and compared with SSD criteria from a diagnostic interview. Sensitivity and specificity were calculated for optimal individual and combined cutpoints. Receiver operator curves were created and area under the curve (AUC) analyses assessed.

RESULTS

Data of n = 372 patients [31.2% male, mean age: 39.3 years (s.d. = 13.6)] were analyzed. A total of 56.2% fulfilled the SSD criteria. Diagnostic accuracy was moderate for each questionnaire (PHQ-15: AUC = 0.70; 95% CI = 0.65-0.76; SSS-8: AUC = 0.71; 95% CI = 0.66-0.77; SSD-12: AUC = 0.74; 95% CI = 0.69-0.80). Combining questionnaires improved diagnostic accuracy (PHQ-15 + SSD-12: AUC = 0.77; 95% CI = 0.72-0.82; SSS-8 + SSD-12: AUC = 0.79; 95% CI = 0.74-0.84). Optimal combined cutpoints were ⩾9 for the PHQ-15 or SSS-8, and ⩾23 for the SSD-12 (sensitivity and specificity = 69% and 70%).

CONCLUSIONS

The combination of the PHQ-15 or SSS-8 with the SSD-12 provides an easy-to-use and time- and cost-efficient opportunity to identify persons at risk for SSD. If systematically applied in routine care, effective screening and subsequent treatment might help to improve quality of life and reduce health care excess costs.

Autonomic reactivity during reading of a somatic distress script in patients with somatic symptom disorder

OBJECTIVE

The relationship between resting-state heart rate variability (HRV) and somatic symptom disorder (SSD) has been explored in several studies. We planned to examine HRV during the performance of psychological tasks, and assumed that it could be applied for the diagnosis of SSD.

METHODS

Fifty-three patients with SSD and 52 healthy controls were recruited. Demographic and psychological data were collected. Subjects' HRV was measured over five 5-minute blocks during which they viewed different scripts (resting state; health anxiety; somatic distress; depression; neutral topic). After each block they completed a self-assessment manikin. Generalized estimated equation analysis was used to analyze the impact of mental scripts, SSD and sex on physiological and psychological indicators.

RESULTS

In men there was a script*SSD interaction concerning high-frequency power (HF) involving the neutral script; SSD men showed significantly higher HF than healthy men when viewing neutral script. In women there were script*SSD interactions with respect to low-frequency power (LF) and HF involving the somatic distress script and a script*SSD interaction with respect to LF and emotional valence involving the neutral script; SSD women revealed significantly lower LF and HF than healthy women when viewing somatic distress script, they also showed significantly lower LF and higher valence than healthy ones during neutral script. The somatic distress script*SSD interaction still influenced LF and HF in women after adjusting for potential confounders.

CONCLUSION

In women cue-specific HRV is a better method of differentiating people with SSD from healthy individuals than resting-state HRV.

TRIAL REGISTRATION INFORMATION

The Research Ethics Committee of National Taiwan University Hospital approved this study (approval number: 201410050RINB).

Functioning and quality of life in patients with somatic symptom disorder: The association with comorbid depression

OBJECTIVES

Patients with somatic symptoms often have impaired functioning and reduced quality of life (QOL), but the factors identified as responsible for these impairments vary between studies. We examined functioning and QOL in patients with somatic symptom disorder (SSD), exploring their associations with demographic factors, personality traits and psychological features.

METHODS

The sample comprised 107 SSD patients and 100 healthy controls. Several types of self-report instrument were administered. Group differences were assessed with independent t-tests. We used multiple linear regression to examine relationships between the independent variables and functioning and QOL. Finally, we used structural equation modeling (SEM) to perform path analysis and examine the fit of a model based on the earlier results.

RESULTS

Most function scores were lower in SSD patients than in healthy controls. In SSD patients overall WHO Quality of Life-BREF (WHOQOL-BREF) score was correlated with exercise level and Beck Depression Inventory-II (BDI-II) score. There were also associations between Sheehan Disability Scale (SDS) score and age, novelty seeking, Cognitions About Body and Health Questionnaire (CABAH) score and BDI-II score. Family APGAR score was only related to BDI-II score. Path analysis revealed that BDI-II score was related to all three indices of functioning.

CONCLUSIONS

Depression is associated with functioning and QOL in SSD patients.

TRIAL REGISTRATION INFORMATION

The Research Ethics Committee of National Taiwan University National Taiwan University Hospital approved this study (approval number: 201507007RINB).

Association of Physical Morbidity and Health-Related Quality of Life in a Representative Sample of Older German People

Abstract. The association between health-related quality of life (HRQoL; Short-Form Health Survey-12; SF-12) and patient-reported morbidity-related symptoms measured by the Patient Health Questionnaire-15 (PHQ-15) is analyzed in a representative sample of older people in the general German population. Data from 1,659 people aged 60 to 85 years were obtained. Latent class analysis identified six classes of patients, which optimally categorize clusters of physical symptoms the participants reported: musculoskeletal impairments (39.8%), healthy (25.7%), musculoskeletal and respiratory/cardiac impairments (12.8%), musculoskeletal and respiratory impairments, along with bowel and digestion problems (12.9%), general impairments (4.9%), and general impairments with no bowel and digestion problems (4.8%). The participants’ SF-12 Physical Health Scores (η2 = .39) and their Mental Health Scores (η2 = .28) are highly associated with these latent classes. These associations remain virtually identical after controlling for age. The results provide evidence that profiles of patient-reported physical impairments correspond strongly with reduced HRQoL independently from aging processes.

Subsyndromal psychosomatic concepts and personality traits in community adults

OBJECTIVE

To investigate the prevalence of features of the Diagnostic Criteria for Psychosomatic Research (DCPR) in the Taiwanese community and to explore their relationships with psychological states and personality traits.

METHOD

The participants were 153 individuals without a DSM-5 psychiatric diagnosis who were grouped according to whether they had a DCPR diagnosis (at least one DCPR diagnosis, DCPR(+): n=66; no DCPR diagnosis, DCPR(-): n=87). The groups were compared with respect to psychological states (measured with Patient Health Questionnaire-15 [PHQ-15], Health Anxiety Questionnaire [HAQ], Beck Depression Inventory-II [BDI-II], Beck Anxiety Inventory [BAI)]) and personality (measured with Tridimensional Personality Questionnaire). Multiple logistic and linear regressions were used to examine associations among demographic, personality, DCPR, and psychological states.

RESULTS

The DCPR(+) group had higher BDI-II, BAI, PHQ-15 and HAQ scores than the DCPR(-) group and also had a higher anticipatory worry. The most common DCPR diagnoses were health anxiety (42.42%) and alexithymia (37.88%). Anticipatory worry was the variable most closely associated with all the DCPR diagnoses. Health anxiety was related to anticipatory worry and age, whereas alexithymia was associated with dependence and fatiguability. PHQ-15, HAQ, and BDI-II scores were related to health anxiety but not alexithymia.

CONCLUSION

DCPR has clinical utility in the community samples without DSM-5 diagnoses. DCPR may be a valid mediator between psychological trait and state.

The relation between the patient health questionnaire-15 and DSM somatic diagnoses

BACKGROUND

Our purpose was to examine the reliability and validity of the Chinese version of the Patient Health Questionnaire-15 (PHQ-15) in Taiwan, and to explore its relation to somatoform disorders (DSM-IV) and to somatic symptom and related disorders (DSM-5).

METHODS

We recruited 471 individuals, 151 with somatoform disorders and 200 with somatic symptom and related disorders. Subjects completed the Chinese version of the PHQ-15, Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and received a DSM-IV- and DSM-5-based diagnostic interview. We performed exploratory factor analysis and assessed test-retest reliability, internal consistency, and correlation with BDI-II/BAI to confirm reliability and validity, and carried out ROC curve analysis to determine suitability for evaluation or screening purposes. PHQ-15 scores were compared between patients with various DSM-IV psychiatric diagnoses (such as DSM-IV somatoform disorders, panic disorder, other anxiety/depressive disorders) or no DSM-IV diagnosis and patients with DSM-5 somatic symptom and related disorders or no DSM-5 diagnosis.

RESULTS

The Chinese version identified cardiopulmonary, pain-fatigue, and gastrointestinal as major factors and had good reliability (0.803-0.930), internal consistency (0.637-0.861), and correlation coefficients with BDI-II/BAI (0.407-0.619, 0.536-0.721, respectively). The PHQ-15 scores were similar in patients with somatoform disorders and patients with panic disorder; higher in patients with somatoform disorders and panic disorder than in patients with other anxiety/depressive disorders; and significantly higher in patients with somatic symptom and related disorders than in patients without this diagnosis. The AUC of the PHQ-15 was 0.678 (cutoff 6/7) for screening somatoform disorders (DSM-IV) and 0.725 (cutoff 4/5) for screening somatic symptom and related disorders (DSM-5).

CONCLUSIONS

The Chinese version of the PHQ-15 is suitable for evaluating somatic symptom and related disorders. The preponderance of somatic symptom disorder in our sample, lack of evaluation of functional disorders, and recruitment solely from psychiatric clinics are possible limitations.