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OBJECTIVE Early life adversity is associated with somatic symptoms (SS) in adulthood, but the psychological mechanisms involved need to be further investigated. The aim of this study was to investigate whether disturbances in self-organization (DSO), consisting of affective dysregulation, negative self-concept, and disturbances in relationships, mediate the relationship between exposure to adverse childhood experiences (ACEs) and SS in adulthood. In addition, we investigated whether resilient coping buffers the direct and indirect effect of ACEs on SS. METHOD The study sample comprised 4,847 Slovenian adults aged 18 to 75 years and was broadly representative of the general population. RESULTS Results of the mediation analysis showed that DSO had a notable, significant mediating effect on the relationship between ACEs and SS, with the indirect effect (a × b = .386, p < .001) accounting for 53.3% of the total effect. A moderated mediation analysis revealed a significant interaction between ACEs and resilient coping in predicting DSO (B = -.074, p = .020), suggesting that resilient coping moderated the indirect effect of ACEs on SS. The flexible use of coping strategies to solve problems in stressful circumstances reduced the negative effect of ACEs on DSO, and hence the frequency of SS in adults with a history of ACEs. CONCLUSIONS Health care professionals should be aware of the role that DSO may have in maintaining or exacerbating SS in victims of early trauma. Strengthening the individual's capacities for resilient coping can alleviate the negative effects of early trauma on psychological functioning and health in later life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective Somatic symptom disorder (SSD) is one of the most common pediatric psychiatric disorders in adolescents, and several biological, psychological, and social factors have been considered to contribute to its development. The aim of the present study was to elucidate the link between psychological functioning (depression and anxiety), psychological characteristics (perfectionism and alexithymia), negative life events, and parental accommodation in children diagnosed with SSD. Methods Fifty patients (age range 7-18 years) were diagnosed with SSD in an outpatient clinic and completed multiple self-report questionnaires on SSD symptoms, negative life events, and psychological factors. Linear regression models were employed to indicate predictors of SSD symptoms. Cluster analysis was performed to identify gastrointestinal- and abdominal-related complaints and their associations. Results Association with SSD symptoms was strongest for state anxiety (Standardized β=0.85, 95% CI=0.44, 1.27, p=.0006), depression (β=0.72, 95% CI=0.38, 1.06, p=.0006), trait anxiety (β=0.60, 95% CI=0.22, 0.98, p=.0005), and family accommodation (β=0. 49, 95% CI=0.23, 0.75, p=.001). These factors were associated with gastrointestinal but not with neurological complaints. Family accommodation was associated with somatic complaints among children younger than 12 years (r=0.57, p=.007), while state anxiety (r=0.69, p=.007) and depression (r=0.65, p=.007) were significantly associated among older children. Conclusions Several psychological factors may result in a somatic response. The phenotypic expression of these factors may vary among different ages. Somatic complaints were related to parental accommodation among young children, while it was strongly associated with anxiety and depression among adolescents.

It has been established that major depressive disorder (MDD) is accompanied by various somatic symptoms that are related to the clinical course and severity of depression. However, the mechanisms of somatic symptoms in MDD have rarely been studied. In this study, we sought to investigate the functional neurological changes in MDD patients with somatic symptoms based off the regional homogeneity (ReHo) and the amplitude of low-frequency fluctuation (ALFF).Study participants included 74 first-episode, drug naïve MDD patients as well as 70 healthy subjects (HCs). Patients diagnosed with MDD were separated into two groups based on the presence (n=50) or absence (n=24) of somatic symptoms. Functional images were obtained and analyzed. Alterations in ReHo/ALFF and the severity of clinical symptoms were investigated using correlation analysis.More severe depressive symptoms were observed in the somatic depression group than that of the pure depression group (P 0.001). Furthermore, there was a significant reduction in ReHo and ALFF in the bilateral precentral gyrus, bilateral postcentral gyrus, and left paracentral gyrus in the somatic MDD group as compared to the pure depression group (GRF correction, voxel-P 0.001, cluster-P 0.01). Pearson correlation analysis revealed a negative correlation between ReHo and ALFF values in these abnomal regions with the severity of somatic and depressive symptoms (P 0.01).Somatic depression is more severe than pure depression. The ReHo and ALFF changes in the precentral gyrus, postcentral gyrus, and paracentral gyrus may serve a significant role in the pathophysiology of somatic symptoms in MDD.

Refereed/Peer-reviewed This study examined the prevalence of somatic symptoms in post-traumatic stress disorder (PTSD) in a population-based military sample (N = 14,445). Descriptive statistics explored somatic symptom endorsement in the entire sample. A latent class analyses was conducted on participants with a posttraumatic stress checklist (PCL) score ≥29 (n = 2433), with class differentiated by somatic symptom endorsement. Multinomial logistic regression explored correlates of latent class. Somatic disorder was more prevalent in probable-PTSD (59.6%) and subsyndromal-PTSD (26.5%) than no-PTSD (5.0%) groups, supporting an intersection of pathophysiological processes between somatic and PTSD symptoms. A 3-class solution of Syndromal (26.7%), Psychological (17.7%), and Somatic (55.5%) classes provided the optimal representation of latent somatic symptom typologies in probable PTSD and subsyndromal PTSD. Differences between classes on key characteristics supported potentially meaningful class distinctions. Class was not predicted by number of deployments nor whether a member had ever deployed. However, class was predicted by life-time trauma, indicating that the PTSD somatic symptom relationship is not confined to combat related PTSD or the effect of toxic exposures on deployment, but that pre-existing pathophysiology related to life-time trauma may drive the relationship. The high degree of coincidence between PTSD and somatic symptoms and the high prevalence of somatic distress in the Syndromal and Somatic classes support somatic symptoms are a ubiquitous aspect of the clinical presentation and should be considered a central characteristic of PTSD and therefore included in the diagnostic criteria, as suggested by the original formulations of PTSD.

The inclusion of somatic symptoms in assessing peripartum depression (PPD), which encompasses depression during pregnancy and the postpartum period, has remained controversial, as there is substantial overlap between somatic depression symptoms and normal features of pregnancy/postpartum. This study examined whether trajectories differed by PPD symptom subscale and whether PPD symptom networks changed as a function of the peripartum phase. 418 women with a history of neuropsychiatric illness participated in a longitudinal observational study, completing symptom questionnaires assessing affective, cognitive, and somatic symptoms throughout pregnancy and the first year postpartum. Assessments were grouped into five peripartum phases: three trimesters of pregnancy and early/late postpartum. Two analyses were performed. First, a series of multilevel spline regression models examined depression subscale trajectories over peripartum phase. Second, symptom networks and related metrics were estimated for each peripartum phase and compared. Somatic symptoms were most severe and had the most variable peripartum trajectory. The role of somatic symptoms within the networks also changed as a function of peripartum phase. Our results suggest that somatic symptoms can be severe and may play a crucial role in the maintenance of PPD. Thus, somatic symptoms should not be disregarded when assessing for PPD in obstetrical, psychiatric, and pediatric clinics, and clinical research.

OBJECTIVE Psychological treatments for somatic symptom disorder and functional somatic syndromes (SSD/FSS) achieve moderate effects only, potentially because of the high chronicity in these patients. Therefore, we aimed to evaluate whether early treatment, i.e. treatment in populations at risk or with recent onset, improves outcome. METHODS We conducted a systematic review and meta-analysis of (cluster)-randomized controlled trials evaluating early psychological interventions in the prevention and treatment of SSD/FSS in adults compared to inactive control conditions, standard care or placebo. Individuals at risk for SSD/FSS, suffering from sub-threshold symptoms or new onsets of SSD/FSS, or presenting with SSD/FSS for the first time were included. RESULTS We identified 30 eligible studies, mostly examining pain-related conditions. Interventions were diverse, ranging from bibliotherapy to cognitive behavioral therapy. We found positive effects on depression post-treatment (Hedges' g = 0.12, 95%-CI: [0.03, 0.2], k = 5) as well as on somatic symptom severity (g = 0.25 [0.096, 0.41], k = 17) and health care utilization (g = 0.31 [0.18, 0.44], k = 3) at follow-up. However, due to high risk of bias, sensitivity to corrections for meta-bias, and missing outcome data, findings should be interpreted cautiously. CONCLUSIONS Our review shows that targeting SSD/FSS at an early stage represents a conceptual and practical challenge. Readily accessible interventions addressing transsymptomatic processes of SSD/FSS development and consolidation are highly needed. Future studies are needed to evaluate individuals with diverse symptoms, examine symptom history thoroughly, use placebo controls, and report outcomes completely to determine the efficacy of early psychological interventions for SSD/FSS.PROSPERO registration: CRD42020140122.

Contains fulltext : 245998.pdf (Publisher’s version ) (Open Access) Objectives: Frailty marks an increased risk for adverse health outcomes. Since childhood trauma is associated with the onset of physical and mental health diseases during the lifespan, we examined the link between childhood trauma and multidimensional frailty. Method: A cross-sectional study embedded in a clinical cohort study (ROM-GPS) of older (>=60 years) patients (n=182) with a unipolar depressive-, anxiety- and/or somatic symptom disorder according to DSM-criteria referred to specialized geriatric mental health care. Frailty was assessed with the Tilburg Frailty Indicator (TFI), comprising a physical, psychological, and social dimension. Physical, sexual and psychological abuse and emotional neglect before the age of 16 years was measured with a structured interview. Results: Of 182 patients, 103 (56.6%) had experienced any childhood trauma and 154 (84.6%) were frail (TFI sum score >=5). Linear regression analyses, adjusted for lifestyle, psychological and physical-health factors, showed that the presence of any type of childhood trauma was not associated with the TFI sum score, however when considered separately, physical abuse was (ß=0.16, p=.037). Regarding the specific frailty dimensions, any childhood trauma was associated with social frailty (ß=0.18, p=.019), with emotional neglect as main contributor. Conclusion: These findings demonstrate a complex link between different types of childhood trauma and multidimensional frailty among older psychiatric patients. Regarding the three dimensions of frailty, social frailty seems most affected by childhood trauma. This may have been underestimated until now and should receive more attention in clinical care and future research. 7 p.

Although previous studies have reported an association between patient-reported somatic symptom severity and the development of posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) in injured military service members (SMs), conclusions from other studies regarding the association between clinician-determined injury severity and PTSD or MDD remain unclear. The present study investigated whether somatic symptoms or injury severity predict the development of probable PTSD or MDD in wounded SMs medically evacuated from combat areas. Data including SM demographic characteristics, clinician-determined injury severity (i.e., Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] values), and self-report assessments of PTSD (PTSD Checklist-Civilian Version), MDD (Patient Health Questionnaire [PHQ]-9), and somatic symptoms (PHQ-15) were analyzed. A total of 2,217 SMs completed at least one self-assessment between 2003 and 2014, with 425 having completed assessments at each assessment period (AP), conducted 1-75 (AP1), 76-165 (AP2), and 166-255 (AP3) days postinjury. Between AP1 and AP3, the rates of probable PTSD and MDD increased from 3.0% to 11.7% and from 2.8% to 9.2%, respectively. Somatic symptom severity at AP1 predicted probable PTSD and MDD at all three APs, odds ratios (ORs) = 3.5-11.5; however, ISS values did not predict probable PTSD or MDD at any AP, ORs = 0.6-0.9. This suggests that the initial severity of self-reported somatic symptoms rather than clinician-determined injury severity predicts the development of probable PTSD and MDD in wounded SMs.

The high prevalence of somatic symptom disorder (SSD) led to cumulative burdens to the medical system. However, the pathogenesis of this disease still remains unclear. Graph theoretical analysis discovered altered network topology across various psychiatric disorders, yet alteration in the topological structure of brain functional network in SSD patients is still unexplored. Catastrophizing is a common cognitive distortion in SSD. We hypothesize that the network topological metrics of SSD should be altered, and should correlate with catastrophizing scales. 32 medication-naïve, first-episode SSD patients and 30 age, gender matched HCs were recruited. The 17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA) and Cognitive Emotion Regulation Questionnaire (CERQ) were accessed. Functional MRI were scanned and brain functional networks were constructed based on 166 anatomically cerebrum regions from the automated anatomical labeling 3 (AAL3) template. Network topological metrics were calculated and compared between the two groups. Correlation between these metrics and clinical scales were also calculated. Network global efficiency of SSD was significantly lower than that of HC. Nodal global efficiency of the left subgenual anterior cingulate cortex (sgACC) of SSD was significantly lower than that of HC. FCs between the left sgACC and other 21 seed nodes were significantly declined in SSD in comparison with HC. In SSD group, HAMD total score was significantly negatively correlated with the connection between the left medial superior frontal gyrus and the left sgACC. CERQ catastrophizing score was significantly negatively correlated with nodal global efficiency of left sgACC and with the FCs between the left sgACC and other 13 seed nodes. Catastrophizing could reflect the specific sgACC-centered dysfunction of brain network global efficiency of SSD. The left sgACC may be a future treatment target of dealing with catastrophizing, which is a core cognitive distortion of SSD.

Objectives Health services to date have inadequately addressed the physical and mental health needs of patients with medically unexplained symptoms. This qualitative study evaluates a piloted facilitated support group (FSG) developed for patients with medically unexplained symptoms to inform recommendations and resources for this patient population. Methods Using a qualitative descriptive design, we conducted and thematically analyzed semi-structured interviews with participants (n = 8) and facilitators (n = 4) to explore their experiences of the facilitated support group. Common themes that captured strengths and challenges of the facilitated support group were identified. Results The following key themes were identified through analysis of the data: Participants described 1) feeling validated through sharing similar experiences with peers; 2) learning practical symptom management and coping strategies; and 3) gaining new perspectives for navigating conversations with PCPs. Conclusions Our findings show that a facilitated support group may provide additional forms of support and resources for patients with medically unexplained symptoms, filling a gap in currently available clinical care offered by health care professionals. Potential implications: This paper highlights lessons learned that can inform the design and delivery of future supports and resources directed toward optimizing patient care for this underserved patient population. Our findings are relevant to those who are involved in direct patient care or involved in designing and implementing self-management programs.

We tested if Latinx and Black individuals are more likely to somaticize depression compared with their White counterparts. We analyzed 14,745 depression ratings from 4,101 people living with HIV from 2007 to 2014. We calculated the percentage of each depression score accounted for by somatic symptom items (e.g., feeling tired). We analyzed depression scores using generalized estimation equations, which accounts for repeated measures within each person. Somatic symptoms accounted for 70% of depression scores for White patients, 66% for Latinx patients, and 68% for Black patients. Across the 14,745 assessments, adjusting for age and sex, and within-person correlation, the percentage of the depression scores made up of somatic items was lower for Latinx ( b = −.03, p < .0001) and Black patients ( b = −.02, p < .001), compared with White patients. The idea that Latinx and Black individuals are likely to somaticize depression may lead to underdiagnoses and perpetuate stereotypes and inequities that are not supported by empirical data.

Co-occurrence of mental disorders including severe PTSD, somatic symptoms, and dissociation in the aftermath of trauma is common and sometimes associated with poor treatment outcomes. However, the interrelationships between these conditions at symptom level are not well understood. In the present study, we aimed to explore direct connections between PTSD, somatic symptoms, and dissociation to gain a deeper insight into the pathological processes underlying their comorbidity that can inform future treatment plans. In a sample of 655 adult inpatients with a diagnosis of severe PTSD following childhood abuse (85.6% female; mean age = 47.57), we assessed symptoms of PTSD, somatization, and dissociation. We analyzed the comorbidity structure using a partial correlation network with regularization. Mostly positive associations between symptoms characterized the network structure. Muscle or joint pain was among the most central symptoms. Physiological reactivation was central in the full network and together with concentrations problems acted as bridge between symptoms of PTSD and somatic symptoms. Headaches connected somatic symptoms with others and derealization connected dissociative symptoms with others in the network. Exposure to traumatic events has a severe and detrimental effect on mental and physical health and these consequences worsen each other trans-diagnostically on a symptom level. Strong connections between physiological reactivation and pain with other symptoms could inform treatment target prioritization. We recommend a dynamic, modular approach to treatment that should combine evidence-based interventions for PTSD and comorbid conditions which is informed by symptom prominence, readiness to address these symptoms and preference.

Despite findings from previous studies, there is still little consistent knowledge regarding the co-occurrence patterns of somatic, depressive and anxiety symptoms in childhood and adolescence. Moreover, functional disability due to somatic symptoms at different concomitant levels of depression and anxiety is understudied. The present study examined the co-occurrence patterns of somatic symptoms and symptoms of depression and anxiety, in children and adolescents using two-step cluster analysis. Differences in functional disability due to somatic symptoms were tested with ANCOVA controlling for gender and age. The sample comprised 1127 Italian children and adolescents (48.7% males, n = 549) aged 8–16 years (Mage = 11.7, SD = 2.37). Data were collected using the Children Somatization Inventory-24, the Children Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, and the Functional Disability Inventory. A four-cluster solution based on the co-occurrence of internalizing symptoms best fit the data. The four clusters were labelled as follows: cluster 1: “High somatic symptoms and average depression/anxiety”; cluster 2: “High somatic symptoms and high depression/anxiety”; cluster 3: “Average somatic symptoms and above average depression/anxiety”; and cluster 4: “Low somatic symptoms and low depression/anxiety”. Significant differences between the four groups according to gender and age were shown. Participants with high levels of somatic, depressive, and anxiety symptoms reported greater functional disability due to somatic symptoms than the other three groups. Our findings indicate that children and adolescents who demonstrate high symptoms of depression and anxiety also reported higher levels of disability in daily life due to somatic symptoms.

The concept of a 'health care realm' is introduced. The healthcare realms considered were those patients who have only Physical Health Problems (PH), patients with neither physical nor mental health issues and who are seeking advice to remain healthy (HP), patients only with Mental Health Problems (MH), patients with both Physical Health and Mental Health Problems (PH&MH) and patients with Psychosomatic Health conditions (PS). Described is how patients' minds and bodies interact and its relevance to rheumatology practice. Presented is the culmination of 34 years of the author's experience of rheumatological disorders based in Family Medicine in a United Kingdom General Practice. Also presented are 2 small studies supplementing the main conclusions. The first small study counted the main consultation content of 246 patients, as considered by the principals in the practice. Of these 73.5% were for physical health conditions, 13.3% for health promotion, 11.5% for mental health conditions and 1.8% for psychosomatic conditions. The second small study was a survey of experienced GPs, Physicians and Psychiatrists, asking about their opinions on how well the patients in different health care realms were being managed across the healthcare system. Of the 5 realms, the collective view was that it was the patients in the PH realm who was clearly received the best care. The least good care was being given to patients in the PS realm and only marginally better were patients in the MH Realm. This paper argues that clinicians need a different thinking approach when meeting patients from different healthcare realms. It is known that when doctors treat PH patients, they consider the patient's symptoms against templates of knowledge for the conditions in the differential diagnosis. Furthermore, HP patients are assessed by comparing the patient's bio-measurements against known markers of good health When being consulted by patients in the MH or PS realms, it is advocated, not to follow the approach of PH patients. For patients in the MH realm it is best to address the patient's life as a whole and to consider, how did the person arrive to the situation he is in and what needs to be done to restore the patient's life back on track. For patients in the PS realm, ideally the aim is to help the patient make the link between the physical symptom and its psychological aetiology. A step towards this is to describe how the body physically mediates the symptom.

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

Medically unexplained symptoms (MUS) are persistent bodily symptoms without known pathology. An unofficial term has recently emerged in Taiwan to accommodate MUS: autonomic imbalance (AI). AI literally refers to disturbances of the autonomic nervous system (ANS) that innervates vital organs. However, AI is variously conceptualised by different parties. This study intends to investigate what is in the name of AI. It draws on available databases and in‐depth interviews with AI sufferers and Western and Chinese medicine physicians. Some physicians research ANS functions through heart rate variability measurements. Research findings show that physicians regard AI as a convenient term for clinical communication and a euphemistic substitute for MUS or even psychiatric diagnoses. It is not a ‘real thing’. However, AI sufferers treat AI as a bona fide disease, only that it has not been officially classified. AI is therefore an unfaithful translation, or an uncontrolled equivocation, of MUS. The paper concludes by discussing the implications of treating AI as an equivocation. These implications include the limitations of the current diagnostic criteria, the necessity to rethink the dichotomy of mind and body, and the underlying realities exposed or masked by ‘diagnosis’.

Aim: To provide a detailed profile of Veteran and community patients with chronic pain who completed preprocedural psychological evaluations for implantable pain devices. Patients & methods: A total of 157 candidates completed a preimplantable pain device evaluation between June 2018 and October 2019 with a pain psychologist that included a structured interview, elicitation of patient-centered goals for the implantable device, and psychometric testing. Results: Candidates demonstrated moderate to high rates of sleep impairment (73%), depressive symptoms (62%), anxiety symptoms (61%), pain catastrophizing (37%), cognitive impairment screen (30%) and somatic symptoms (24%). Conclusion: Candidates for implantable pain devices report high rates of mood, sleep and cognitive impairment, reinforcing the value of preprocedural psychological evaluations.

Soumoff et al. (2021) reported on a sample of 2,217 injured military service members and found that somatic symptom severity was more predictive of the development of probable posttraumatic stress disorder (PTSD) symptoms than injury severity. PTSD has been described as one of the invisible wounds of war, suggesting that many military service members with PTSD may suffer in silence because some symptoms-such as psychological and somatic symptoms-are often not observable by others. In contrast, friends, family, fellow service members, and health care providers often ask military service members with visible, physical wounds what happened, prompting a discussion of their injury and the events that contributed to it. I posit that the findings reported by Soumoff et al. may be an example of the differences that can occur in the course of natural recovery in military service members suffering from visible versus invisible wounds of war and further hypothesize that the repeated conversations that often occur after physical injuries in military service members may foster natural recovery from the co-occurring invisible, psychological wounds of war.

Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4-5 months follow-up. We enquired about somatic symptoms (headaches, abdominal pain and sickness) pre and post assault, and we assessed psychiatric disorders and functional impairment at follow-up using validated scales. Information was obtained on 94 females (mean age 15.6, SD 1.3). There was a statistically significant increase in the number of adolescents reporting somatic symptoms at 4-5-month follow-up (65/94, 69%) (p = 0.035), compared with estimated pre-assault rates (52/94, 55%) and a significant increase in somatic symptoms at follow-up among the victims of violent sexual abuse (p .001). Subjects with somatic symptoms at follow-up had significant higher rates of psychiatric disorders - especially generalised anxiety disorder, panic disorder and major depressive disorders - as well as lower psychosocial functioning (p 0.01), than those without somatic symptoms.

Corona virus disease (Covid-19) is a global pandemic. The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes Covid-19 is reported to have originated in a seafood market ...

Medically unexplained symptoms or persistent physical symptoms are common, real and are associated with significant distress, loss of functioning and high healthcare costs. History, examination and appropriate investigations are essential to make a diagnosis. Once the diagnosis has been made, exploring the impact of the symptoms helps us to tailor our advice to patients. This paper sets out a practical approach to taking a history, assessment and stepwise management principles.

Background Frequent Attenders with Medically Unexplained Symptoms (FA/MUS) are common in primary care, though challenging to identify and treat. Objectives This study sought to compare FA/MUS to FA with organic illnesses (FA/OI) and the general clinic population (Non-FA) to understand their demographic characteristics and healthcare utilisation patterns. Methods For this retrospective, observational study, Electronic Medical Records (EMR) were obtained from Clalit Health Services, regarding the population of a sizeable primary care clinic in Be’er-Sheva, Israel. Electronic medical records were screened to identify the top 5% of FA. FA were stratified based on whether they had OI. FA without OI were then corroborated as having MUS by their physicians. Demographics, healthcare utilisation and costs were analysed for FA/OI, FA/MUS and Non-FA. Results Out of 594 FA, 305 (53.6%) were FA/OI and 264 (46.4%) were FA/MUS. FA/OI were older (69.1 vs. 56.4 years, p

Objective Persistent somatic symptoms, such as pain and fatigue, have been referred to as somatization. Somatization is commonly associated with histories of trauma and posttraumatic stress disorder (PTSD). Although previous research has demonstrated that PTSD can predict somatic problems, there has been no examination of this at the level of PTSD symptom clusters and multidimensional assessment of somatic symptoms. We examined the association between the three International Classification of Disease (11th Edition) PTSD symptom clusters (reexperiencing in the here and now, avoidance, and sense of threat), measured in relation to the COVID-19 pandemic as the stressor, and somatic symptoms while statistically adjusting for confounding variables. Methods Participants were a nationally representative sample of 1041 adults from the general population of the Republic of Ireland. Physical health problems across the domains of pain, gastrointestinal, cardiopulmonary, and fatigue were assessed by the Patient Health Questionnaire, and PTSD symptoms were assessed using the International Trauma Questionnaire. Results Sense of threat was associated with the presence of pain (β = 0.254), fatigue (β = 0.332), gastrointestinal (β = 0.234), and cardiovascular symptoms (β = 0.239). Avoidance was associated with pain (β = 0.347). Reexperiencing was not associated with any physical health variable. Conclusions In the context of COVID-19, the sense of threat symptoms in PTSD is most strongly related to somatic problems. Findings suggest that interventions addressing sense of threat symptoms might provide relief from somatization.

BackgroundMaternal depression has been linked to adverse outcomes in the offspring. Existing literature is mainly based on parental reports, which can be an unreliable source when the parent has depression.AimTo explore if maternal depression was associated with daily health complaints and low self-assessed health (SAH) in the offspring.Design and settingParticipants were 45 727 children from the Danish National Birth Cohort recruited between 1996 and 2002. At 11-year follow-up, mothers and their children were invited to complete a questionnaire. Maternal depression was categorised into: no depression, first-time treatment, continued treatment, post-treatment, and relapse.MethodBinomial regression was used to estimate the adjusted prevalence proportion ratio (aPPR) of frequent health complaints and low SAH in children of mothers with depression compared to children of mothers without depression.ResultsThe prevalence of any daily health complaint was 11.4%, daily somatic complaints 4.1%, daily mental complaints 8.9%, both daily mental and somatic complaints 1.5%, and low SAH 5.3%. Children of mothers with depression (any category) were more likely to report a daily health complaint: first-time treatment aPPR 1.35 (95% confidence interval [CI] = 0.96 to 1.85), continued treatment aPPR 1.59 (95% CI = 1.37 to 1.85), post-treatment aPPR 1.30 (95% CI = 1.20 to 1.41), and relapse aPPR 1.56 (95% CI = 1.35 to 1.79). Children of mothers with depression were also more likely to report low SAH: first-time treatment aPPR 1.58 (95% CI = 0.99 to 2.54), continued treatment aPPR 1.86 (95% CI = 1.51 to 2.28), post-treatment aPPR 1.34 (95% CI = 1.19 to 1.50), and relapse aPPR 1.56 (95% CI = 1.26 to 1.93). Girls had a higher prevalence of mental and somatic health complaints and more often reported low SAH compared to boys.ConclusionTreatment of maternal depression was associated with higher prevalence of daily health complaints and low SAH in the offspring at age 11 years. The association was strongest for children of mothers with continued depression or relapse.

Little is known about the school functioning of youth who are medically admitted with somatic symptom and related disorders (SSRD). The current study examines school absenteeism and associated factors in medically hospitalized children and adolescents with SSRDs. Retrospective data were reviewed of 243 patients aged 5 to 18 years admitted at a pediatric hospital from 2012 to 2014, referred to the Psychiatry Consultation Service and diagnosed with an SSRD. Only 10% of patients had normal school attendance in the past year and approximately 40% had severe school absenteeism (i.e. missed > 1 month of school). No association was found between school absenteeism and caregiver report of learning difficulties/disabilities. Patients with severe school absenteeism were more likely to be between the ages of 15 and 17, with higher somatization and functional disability scores, higher rates of suicidal ideation and/or attempts, greater psychotropic medication use and psychiatry sessions during admission, and greater rates of discharge to a higher level of psychiatric care. Findings from this study suggest that screening for school absenteeism during clinical visits by use of a single question “how many school days have you (or has your child) missed this past school year,” may serve as a proxy for functional disability and an indicator of psychiatric, and somatic symptom severity concerns.

Objective: Literature on older-age bipolar disorder (OABD) is limited. This first-ever analysis of the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) investigated associations among age, BD symptoms, comorbidity, and functioning. Methods: This analysis used harmonized, baseline, cross-sectional data from 19 international studies (N = 1377). Standardized measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), and Global Assessment of Functioning (GAF). Results: Mean sample age was 60.8 years (standard deviation [SD] 12.2 years), 55% female, 72% BD I. Mood symptom severity was low: mean total YMRS score of 4.3 (SD 5.4) and moderate-to-severe depression in only 22%. Controlled for sample effects, both manic and depressive symptom severity appeared lower among older individuals (p's

To the Editor: Medically unexplained physical symptoms (MUPS) and related disorders are especially common in healthcare-seeking populations. A recent meta-analysis revealed the prevalence of somatoform disorders of 34.8% (by International Classification of Diseases) and 26.2% (by Diagnostic and Statistical Manual of Mental Disorders [DSM]) in primary care patients. Further, at least one medically unexplained symptom was detected among 40% to 49% of primary care patients using questionnaires.

Purpose The purpose of this study was to explore the differences between youths with a sibling affected by a chronic condition or a disability (SCCD) and their peers with healthy siblings. Method Using data from the second wave of GenerationFRee study, we compared adolescents from each gender with healthy siblings to adolescents with SCDD on demographical, familial, internalizing and externalizing behavior variables. Subsequently we repeated the analysis excluding from each group adolescents who suffered from a chronic condition or disability themselves. Results At the bivariate and multivariate level, among those with SCDD, healthy females reported more somatic symptoms, healthy males more violent behaviors, and both genders lived more often in non-intact families. When considering both healthy and unhealthy adolescents, at bivariate analysis female adolescents with SCDD were more likely to have a poorer relationship to their mother, to be unhealthy, to smoke, to be at risk for disordered eating and to report somatic symptoms. At multivariate level, only the association with SCDD and smoking remained. Male adolescents with SCDD, at both bivariate and multivariate analyses, were more likely to be unhealthy and to live in larger and non-intact families. Conclusion Healthy adolescents with an SCDD are more at risk of somatic symptoms and violent behaviors than their peers with healthy siblings. Health professionals in contact with adolescents should always consider them with a systemic approach. Parents should be informed about the potential effect on the siblings of a CDD child, but also reassured, as adolescents with SCDD are not different from their peers with healthy siblings.

Objective:Medically unexplained physical symptoms (MUPS) and related syndromes are common and place a substantial burden on both patients and society. Chronic psychological distress and dysregulation of the autonomic nervous system may be common factors associated withMUPS, although previous studies have reported mixed results. The aims of this meta-analysis are to provide an updated synthesis of studies investigating heart rate variability (HRV) indices associated with autonomic nervous system functioning in three common MUPS syndromes and to explain inconsistencies in previous study findings. Methods: Literature search yielded 58 studies comparing HRV indices of reduced parasympathetic activity of healthy individuals with those of patients with chronic fatigue syndrome (npatients = 271), irritable bowel syndrome (npatients = 1005), and fibromyalgia (npatients = 534). Separate random-effects meta-analyses were conducted on studies measuring root mean square of successive differences (RMSSD) and high-frequency HRV (HF-HRV). Results: Regardless of syndrome type, patients had significantly lower RMSSD (k = 22,Hedges g = -0.37 [-0.53 to -0.21], p < .001) and HF-HRV (k = 52, Hedges g = -0.69 [-1.03 to -0.36], p < .001) than did healthy individuals. Sample age and publication year explained a substantial variation in RMSSD, whereas controlling for confounders in statistical analyses explained variation in HF-HRV. Conclusions: Lower RMSSD and HF-HRVin patients withMUPS versus healthy controls indicates that autonomic nervous system dysregulation, particularly lower parasympathetic activity, may play a role in patients with these conditions. This conclusion may have important implications for the underlying mechanisms and treatment of MUPS and related syndromes.

Background: Racial and ethnic minority women in the United States have an elevated risk of depression or depressive symptoms compared with White women. There is evidence to suggest that these women are more likely to report somatic symptoms. The objective of this systematic review was to determine whether there are racial and ethnic differences in somatization in women with depression or depressive symptoms. Materials and Methods: The study focused on peer-reviewed, English-written publications of adult women that compared two or more racial or ethnic women and used reliable measures. Quantitative studies conducted in the United States were considered. Articles were reviewed from March 2017 to April 2019, with no publication start date. Results: Seven studies met the inclusion criteria. Results suggest that African American women were more likely to endorse somatic symptoms compared with White women and, in one instance Hispanic/Latinas. Three of four studies found that Hispanic/Latinas were significantly more likely to endorse somatic symptoms compared with White women; one study found that White women were significantly more likely to report somatic symptoms than Hispanic women. Another study found that White women endorsed significantly higher somatic symptoms than Chinese American women. One study did not find significant differences. Conclusions: A pattern emerged with African American and Hispanic/Latina women with depression or depressive symptoms more likely to report somatic symptoms compared with White women. However, it is not clear whether differences were a function of culturally acceptable presentation of symptoms or if the stress of being depressed increased somatization in minority women. Future studies should assess how depression/depressive symptoms affect racial and ethnic minority women to identify mechanisms involved in increased somatization.

ObjectiveTo determine whether self-rated health of patients with motor functional neurologic disorder (FND) can be improved by unguided Internet-based self-help and education.MethodsIn this nonblinded randomized controlled trial, patients were allocated 1:1 unbiased to an unguided education and self-help website in addition to usual care or usual care only. Patients over 17 years of age with a functional motor symptom that caused distress or disability were included. The primary outcome was self-rated health on the Clinical Global Improvement scale at 3 and 6 months. Secondary outcomes were severity of motor symptoms, other physical and psychiatric symptoms, physical functioning, quality of life, work and social adjustment, illness beliefs, and satisfaction with care.ResultsA total of 186 patients were randomized, with a follow-up rate of 87% at 6 months. There was no difference in improvement of self-rated health at 3 months (44% vs 40%, p = 0.899) or 6 months (42% vs 43%, p = 0.435). Secondary outcomes did not differ between groups, with a threshold of p < 0.01. Satisfaction was high, with 86% of patients recommending the website to other patients.ConclusionWe found no significant effect of the intervention added to usual care on self-rated health or secondary outcome measures, despite high patient satisfaction with the intervention. These results suggest that online education and nonguided self-help could be valuable additions to stepped care for motor FND, but are not effective treatments as interventions in their own right.Clinicaltrials.gov identifierNCT02589886.Classification of evidenceThis study provides Class III evidence that for patients with motor FND, online education and self-help intervention does not significantly improve self-rated health.

Objective Cognitive-behavioural models suggest that vicarious illness experiences precipitate health anxiety; however, this assumption is largely untested. This study aimed to (a) compare the severity of health anxiety and rates of clinical health anxiety, Illness Anxiety Disorder (IAD), and Somatic Symptom Disorder (SSD) in participants with and without a loved one with cancer, and (b) determine the predictors of health anxiety severity in participants with vicarious cancer experiences. Methods Participants with (n = 142) and without (n = 65) vicarious cancer experiences completed an online battery of questionnaires assessing the severity and cognitive, physiological, and behavioural components of health anxiety. Participants reporting clinical levels of health anxiety completed a diagnostic telephone interview to assess for IAD and SSD. Results Severity and rates of clinical health anxiety, IAD, and SSD did not differ between groups. Participants with a vicarious experience of cancer reported elevated fear of cancer recurrence regarding their loved one's illness, however only 15.8% reported clinically significant health anxiety. Hierarchical regression revealed that in participants with vicarious cancer experiences, less relationship closeness and greater perceived risk of cancer, severity of somatic symptoms, bodily hypervigilance, and catastrophic interpretation of symptoms predicted health anxiety. Being a caregiver for or genetically related to the person with cancer, the expectedness of the cancer diagnosis, and whether the loved one died from cancer were not significant predictors. Conclusions These results suggest that people reporting vicarious cancer experiences do not have elevated rates of health anxiety. However, how these individuals interpret their experiences influences health anxiety severity.

The outbreak of COVID-19 that commenced in December 2019 in Wuhan, China, has caused extensive public health concerns and posed substantial challenges to health professionals, especially for those in the center of the epidemic. The current study aimed to assess the prevalence, related factors, and mechanism of acute stress disorder (ASD) among health professionals in Wuhan during this critical period.The study used a cross-sectional design. Self-administered questionnaires were distributed to the frontline health professionals in Wuhan hospitals from January 28 to February 1, 2020. Mental health-related measurements included ASD, depression, anxiety, conflict experiences, hostility, and psychosomatic symptoms. Structural equation modeling was used to analyze the factors associated with ASD among health professionals.A total of 332 frontline health professionals were included in the analysis (mean [standard deviation] age = 32.21 [8.77] years; 78.0% women). ASD was a prominent mental health problem in the health professionals surveyed, with a prevalence of 38.3%. Anxiety (24.7%) and depression (20.2%) were also common. Structural equation modeling analyses revealed that emotional distress (i.e., anxiety and depressive symptoms) fully mediated the association between conflicts with ASD (the standardized indirect coefficient β = 0.47, p = .016). The most common reported symptom was chest pain (51.2%). ASD was significantly associated with psychosomatic symptoms. The majority (67.8%) reported being easily annoyed or irritated, and ASD was associated with hostility.During the COVID-19 outbreak, a substantial number of health professionals in Wuhan suffered from ASD. Furthermore, ASD was found to be associated with psychosomatic symptoms as well as the hostility. The poor mental health of health professionals has detrimental impacts both on the well-being of staff in health care systems and may adversely affect the quality of patient care. We call for interventions that aim to relieve the psychological and occupational stress. Considering that most of our participants were young, female frontline health professionals, the results may not be generalized to more heterogenous samples.

Background The dysfunctional activity of the medial prefrontal cortex has been associated with the appearance of the somatic symptom disorder, a key feature of the Parkinson's disease (PD) psychosis complex. Objectives The objectives of this study were to investigate whether the basal contents of inhibitory γ-aminobutyric acid and excitatory glutamate plus glutamine neurotransmitter levels are changed in the medial prefrontal cortex of patients with PD with somatic symptom disorder and whether this alteration represents a marker of susceptibility of PD to somatic symptom disorder, thus representing a signature of psychosis complex of PD. Methods Levels of the γ-aminobutyric acid and glutamate plus glutamine were investigated, at rest, with proton magnetic resonance spectroscopy. Total creatine was used as an internal reference. The study cohort included 23 patients with somatic symptom disorder plus PD, 19 patients with PD without somatic symptom disorder, 19 healthy control subjects, and 14 individuals with somatic symptom disorder who did not show other psychiatric or neurological disorders. Results We found that, compared with patients with PD without somatic symptom disorder or healthy control individuals, patients with somatic symptom disorder, with or without PD, show increased γ-aminobutyric acid/total creatine levels in the medial prefrontal cortex. The medial prefrontal cortex contents of glutamate plus glutamine/total creatine levels or γ-aminobutyric acid/glutamate plus glutamine were not different among groups. Conclusions Our findings highlight a crucial pathophysiologic role played by high γ-aminobutyric acid within the medial prefrontal cortex in the production of somatic symptom disorder. This phenomenon represents a signature of psychosis complex in patients with PD. © 2020 International Parkinson and Movement Disorder Society.

Background Long-term sickness absence results in increased risks of permanent disability and a compromised quality of life. Return to work is an important factor in reducing these risks. Little is known about return to work factors for long-term sick-listed workers with subjective health complaints. The aim of this study was to evaluate prognostic factors for partial or full return to a paid job for at least 28 days for long-term sick-listed workers with subjective health complaints, and to compare these factors with those of workers with other disorders. Methods Data from a prospective cohort study of 213 participants with subjective health complaints and 1.037 reference participants were used. The participants answered a questionnaire after 84 weeks of sickness absence. Return to work was measured after one and two years. Univariable logistic regression analyses were performed (P ≤ 0.157) for variables per domain with return to work (i.e. demographic, socio-economic and work-related, health-related, and self-perceived ability). Subsequently, multivariable logistic regression analyses with backward selection (P ≤ 0.157) were performed. Remaining factors were combined in a multivariable and final model (P ≤ 0.05). Results Both for workers with subjective health complaints and for the reference group, non-health-related factors remained statistically significant in the final model. This included receiving a partial or complete work disability benefit (partial: OR 0.62, 95% CI 0.26–1.47 and OR 0.69, 95% CI 0.43–1.12; complete: OR 0.24, 95% CI 0.10–0.58 and OR 0.12, 95% CI 0.07–0.20) and having a positive self-perceived possibility for return to work (OR 1.06, 95% CI 1.01–1.11 and OR 1.08, 95% CI 1.05–1.11). Conclusions Non-health-related factors seem to be more important than health-related factors in predicting return to work after long-term sickness absence. Receiving a work disability benefit and having negative expectations for return to work seem to complicate return to work most for workers with subjective health complaints. With respect to return to work predictors, workers with subjective health complaints do not differ from the reference group.

BackgroundIt is increasingly recognized that existing diagnostic approaches do not capture the underlying heterogeneity and complexity of psychiatric disorders such as depression. This study uses a data-driven approach to define fluid depressive states and explore how patients transition between these states in response to cognitive behavioural therapy (CBT).MethodsItem-level Patient Health Questionnaire (PHQ-9) data were collected from 9891 patients with a diagnosis of depression, at each CBT treatment session. Latent Markov modelling was used on these data to define depressive states and explore transition probabilities between states. Clinical outcomes and patient demographics were compared between patients starting at different depressive states.ResultsA model with seven depressive states emerged as the best compromise between optimal fit and interpretability. States loading preferentially on cognitive/affective v. somatic symptoms of depression were identified. Analysis of transition probabilities revealed that patients in cognitive/affective states do not typically transition towards somatic states and vice-versa. Post-hoc analyses also showed that patients who start in a somatic depressive state are less likely to engage with or improve with therapy. These patients are also more likely to be female, suffer from a comorbid long-term physical condition and be taking psychotropic medication.ConclusionsThis study presents a novel approach for depression sub-typing, defining fluid depressive states and exploring transitions between states in response to CBT. Understanding how different symptom profiles respond to therapy will inform the development and delivery of stratified treatment protocols, improving clinical outcomes and cost-effectiveness of psychological therapies for patients with depression.

Adverse childhood experiences (ACEs) increase risk for negative health outcomes. The goal of this study was to examine the relationships among cumulative ACEs, ACEs type, posttraumatic stress disorder (PTSD) symptoms, PTSD symptom clusters, and physical health symptoms in a sample of women veterans (N = 76). Bivariate correlations were used to determine which ACE domains were associated with PTSD and physical health symptoms. Follow-up linear regressions indicated cumulative ACEs were significantly associated with total PTSD symptoms. Cumulative ACEs were also significantly associated with the avoidance and hyperarousal symptom clusters, but not the re-experiencing symptom cluster. Total PTSD symptoms were significantly related to physical health symptoms. Of the three symptom clusters, only hyperarousal was significantly associated with physical health symptoms. Cross-sectional mediation analyses indicated the total and direct effects of ACEs on physical health were not significant. However, the indirect effect through PTSD was significant (b = 0.46, [95% CI: 0.02, 0.91]), as well as through the avoidance (b = 0.47, [95% CI: 0.06, 0.90]), and hyperarousal symptom clusters (b = 0.56, [95% CI: 0.11, 1.04]). This study highlights the potential impact of ACEs on PTSD symptoms and physical health and suggests that hyperarousal symptoms of PTSD, may play a potential role in the development of physical health problems.

In their daily practice dentists frequently have patients showing signs of stress-related oral manifestations in different forms. Stress-related aetiology of oral changes are still not investigated enough, and present a subgroup of psychosomatic diseases which had been recognized in medicine a long time ago. Recognition of such psychological or emotional disturbance needs deep evaluation “per exclusionem”, and is beneficial for both the patient and clinician. Psychological management should be taken into consideration when treating patients with these psychosomatic disorders. Therapeutic approach comprises different forms of psychotherapy and medication as well.

BackgroundWe examined demographic, clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology.MethodsPrior to randomisation within the CODES RCT, we collected demographic and clinical data on 368 participants. We assessed psychiatric comorbidity using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and a screening measure of personality disorder and measured anxiety, depression, psychological distress, somatic symptom burden, emotional expression, functional impact of DS, avoidance behaviour, and quality of life. We undertook comparisons based on reported age at DS onset (v. ⩾40), gender (male v. female), and DS semiology (predominantly hyperkinetic v. hypokinetic).ResultsOur cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. Two-thirds had predominantly hyperkinetic DS. Of the total, 69% had ⩾1 comorbid M.I.N.I. diagnosis (median number = 2), with agoraphobia being the most common concurrent diagnosis. Clinical levels of distress were reported by 86% and characteristics associated with maladaptive personality traits by 60%. Moderate-to-severe functional impairment, high levels of somatic symptoms, and impaired quality of life were also reported. Women had a younger age at DS onset than men.ConclusionsOur study highlights the burden of psychopathology and socio-economic deprivation in a large, heterogeneous cohort of patients with DS. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort.

Objective We examined characteristics of depressive symptoms in patients who received left ventricular assist devices (LVAD) to assess their effects on negative outcomes post-implantation. Methods We retrospectively identified 203 adults with pre-operative PHQ-9 scores who underwent LVAD placement as bridge to transplant (BTT) or destination therapy (DT). We analyzed effects of PHQ-9 total, somatic, and cognitive/affective scores and proportion of patients with clinical depression on all-cause mortality, rehospitalization, major bleeding, and neurologic events post-implantation, controlling for demographics and other medical comorbidities. Results Mean total PHQ-9 scores did not differ between 81 BTT and 122 DT patients (BTT 6.4 vs. DT 7.5, p = 0.12). A higher proportion of DT patients had clinical depression (BTT 22% vs. DT 39%, p = 0.015). Somatic symptoms accounted for three-quarters of total scores in both groups. PHQ-9 domains were not associated with negative outcomes post-implantation. Conclusion Depression severity did not differ based on implant strategy, but more DT patients had clinical depression. Somatic symptoms were the biggest contributor to depressive symptoms. Pre-implantation PHQ-9 scores were not associated with outcomes, possibly because depression was mild in both groups. Additional work is needed in LVAD patients to better characterize depressive symptoms and their unique effects on clinical course and well-being.

Background Attention to and interpretation of symptoms are influenced by psychological and contextual factors. Preoperative anxiety, and to some extent depression, has been found to predict the perceived impact of somatic symptoms one year after Roux-en-Y gastric bypass (RYGB). Post-operative changes in negative affect may possibly both influence and be influenced by the perception of somatic symptoms. Objectives This study aimed to explore whether preoperative anxiety and depressive symptoms correlated with perceived impact of somatic symptoms three years after RYGB. Secondly, we aimed to examine the three-year trajectory of depressive and anxiety symptoms, and their interaction with perceived somatic symptoms postoperatively. Setting University hospital. Methods Pre-surgery, 1-, and 3-years post-surgery data were collected from 169 participants (62.4% follow-up). Anxiety and depressive symptoms were assessed at all time points. The participants reported the degree of perceived impact of various somatic symptoms one and three years after surgery. A cross-lagged, autoregressive regression analysis was employed to examine the mutual interaction of trajectories over the follow-up period. Results Fatigue (30.8%) and dumping (23.7%) were common high-impact symptoms three years postoperatively. Higher baseline anxiety was associated with higher impact of fatigue, pain, and diarrhea), while depressive mood was related to higher impact of diarrhea at 3-year follow-up. Higher anxiety/depression symptoms were bidirectionally related to higher perceived total symptom impact at both one and three years postoperatively, controlling for percent total weight loss. Higher perceived impact of somatic symptom burden at one-year post-surgery predicted a significant increase in depressive symptoms the next two years. Conclusion Baseline anxiety was associated with higher perceived impact of several somatic symptoms three years after RYGB. Higher total symptom burden (pain, fatigue, dumping, diarrhea, and vomiting) at one-year post-surgery predicted increase in depression over the next two years. The results underscore the importance of managing somatic symptoms after surgery to prevent patients’ distress.

ObjectiveIncreasing evidence confirms a strict relationship between mental disorders and physical health. Particularly, stressful life events and post-traumatic stress disorder (PTSD) have been closely correlated with various physical disorders and somatic symptoms, such as chronic pain, gastrointestinal disorders, and headaches. The aim of this study was to investigate the emergence of somatic symptoms in a sample of young adult survivors 21 months after exposure to the L’Aquila 2009 earthquake, with particular attention to PTSD and gender impact.MethodsFour hundred and fifty high-school senior students (253 male and 197 female) exposed to the 2009 L’Aquila earthquake, 21 months earlier, were enrolled and evaluated by the Trauma and Loss Spectrum Self-Report (TALS-SR), for symptomatological PTSD, and the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR) “rhythmicity and vegetative functions” domain, for somatic symptoms.ResultsSignificantly higher rates of endorsement of the MOODS-SR somatic symptoms emerged in survivors with PTSD compared to those without. Females reported higher rates of endorsement of at least one MOODS-SR somatic symptom compared to males; however, a Decision Tree model and a two-way analysis of variance model confirmed a significant effect of PTSD only. A multivariate logistical regression showed a significant association between the presence of at least one MOOD-SR somatic symptom and re-experiencing and maladaptive coping TALS-SR domains.ConclusionThis study corroborates a relevant impact of symptomatological PTSD, across both the genders, on somatic symptoms occurring in young adults after months from exposure to a massive earthquake.

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.

Medically unexplained symptoms, defined as physical symptoms for which no organic pathology can be found, represent 4% of all emergency department attendances annually. The standard management of these patients involves extensive investigation to rule out organic pathology, followed by simple reassurance. We conducted a literature review to determine if there was any intervention that could improve these patient's symptoms and reduce emergency department attendances. A search of MEDLINE, EMBASE and PsycINFO yielded 1612 unique citations, of which six studies met inclusion criteria. The studies were heterogeneous in terms of the participants involved, interventions tested and conclusions drawn. Three studies tested cognitive behavioural therapy, with two finding a reduction in emergency department attendance. Overall, evidence regarding interventions for patients with medically unexplained symptoms in the emergency department is limited and of a variable quality, despite comprising 4% of emergency department attendances. Further research is required to determine the best intervention for this challenging patient group.

Miranda Fricker’s influential concept of epistemic injustice (Oxford University Press, Oxford, 2007) has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.

The association among alexithymia, somatic symptoms and clinical correlates has been scantly investigated in children. The present study examined alexithymic features and somatic symptomatology in schoolchildren with high and low levels of depression, testing the role of depressive symptoms in mediating the associations between alexithymia and somatic symptoms. Seven-hundred schoolchildren were involved in this study and divided into two subgroups (8-10 years and 11-14 years) in order to test differences according to the age. Participants completed the Children's Somatization Inventory-24 for the assessment of somatic symptoms, the Alexithymia Questionnaire for Children to evaluate alexithymic features and the Children's Depression Inventory-2 to investigate depressive symptoms. Results showed that children with high levels of depression reported both higher alexithymia and somatic symptoms levels. Despite a direct effect of alexithymia on somatic symptoms, the mediation analyses also highlighted an indirect effect of alexythimia on somatic symptoms through depressive symptoms. Findings suggested that a depressive symptomatology may clarify why schoolchildren with high alexithymia scores tend to report higher levels of health problems. Results also support the possibility that depressive symptoms may contribute to the development of somatic symptomatology among schoolchildren in the presence of high levels of alexithymia.