The predictors of somatic symptoms in a population sample: The Lifelines cohort study, 2022, Creed

Abstract
Objective
Multiple bodily symptoms predict poor health status, high healthcare use and onset of functional somatic syndromes. This study aimed to identify the predictors of somatic symptoms with special reference to mental disorders.

Methods
The prospective, population-based Lifelines cohort study included 80,888 adults who were followed up for a mean of 2.4 years. At baseline socio-demographic status, self-reported medical disorders, functional somatic syndromes, stress, neuroticism, mental disorders (assessed with MINI), health perception and analgesic use were assessed. These variables were tested as predictors of number of somatic symptoms at follow up using linear regression analysis which adjusted for baseline somatic symptoms (n = 65,904). Logistic regression was used to identify the predictors of a persistent high number of somatic symptoms.

Results
The strongest predictors of somatic symptoms at follow-up were life events and difficulties score, number of general medical illnesses/ functional somatic syndromes. Neuroticism and mental disorders were also independent predictors in all analyses. Generalised anxiety, major depressive and panic disorders were all independent predictors when entered individually into the regression analysis. A persistent high number of somatic symptoms was predicted most strongly by functional somatic syndromes, negative health perception and paracetamol use.

Conclusions
Number of somatic symptoms should be regarded as a multifactorial measure with many predictors. Mental disorders form one predictor but there are other, stronger ones including stress and general medical disorders. The bi-directional relationship between functional somatic syndromes and multiple somatic symptoms is compatible with the notion that perception of bodily symptoms is a key component of both.

Paywall, https://journals.lww.com/psychosoma...s_of_somatic_symptoms_in_a_population.35.aspx

 

I still get confused about what somatic symptoms actually are.

I was under the impression that they were just physical symptoms - e.g. I've got a sore back or a headache or a fever or a rash. Psychosomatic symptoms were considered to be rooted in a mental illness e.g. depression, anxiety.

But these days, without me ever seeing an explanation, somatic symptoms are also assumed to be rooted in mental illness, and the word "psychosomatic" is rarely, if ever, used. The more symptoms someone has (e.g. more than one, probably - I'm being sarcastic) the more likely they are to be diagnosed with a mental illness, specifically somatic symptom disorder.

Can someone clear up my confusion, please.

 

Illness doesn't begin at diagnosis. It's likely that all these people are already sick with whatever illness they have, even if it takes another few years before they're diagnosed. In that time, the illness could destroy their life and cause "life events".

By the time people make contact with the healthcare system things are probably already bad.

And apparently if the patient believes things are bad ("negative health perception") that is an indicator the perception is causing the poor outcome, not that the patient had an accurate perception of their situation.

 

Interesting to see a single author from the UK analyze a large Dutch database. Typically, to my knowledge, this would take a whole team, including statisticians and methodologists.

The findings are so unsurprising (ill people are ill and may be consequently depressed and/or anxious) that it is no wonder this paper only made it to the American Journal of Psychosomatic Medicine and not a top journal.

I cannot make much sense of the last sentence of the conclusion:

Surely perceiving bodily symptoms must be normal when one has such symptoms, because a symptom is defined by the very fact that it is perceivable. Isn’t this purely tautological?

 

I think the problem is that different people use the same word to mean radically different things:

Some use ‘somatic’ in its original sense that you describe, that is physical symptoms, others use it to describe physical symptoms that have no identified biomedical cause and then others use it to euphemistically mean psychosomatic.

You would have thought that, as with ‘functional’, that clinicians should ask themselves why they keep needing to develop ever more euphemisms for conversion symptoms and psychosomatic conditions. Shouldn’t they wonder if everything is going well if they have to try to keep the true nature of their diagnosis secret from the actual patients?

 

This is the academic version of every bad high school student essay half-ripped off from Wikipedia that ends with: "and in conclusion, [whatever country they chose to report on] is a land of contrasts. The end."

The all quantity, no quality model of academia is just as bad as it sounds. Most papers are so clearly pointless quarter-efforts only meant to publish something for the sake of publishing. Zero actual effort.

 

There it is again. Negative health perception. Used to be called "illness beliefs". And, maybe other terms.

Maybe, or probably, medicine has a definition of healthy not known or understood by the general public. It seems to me It's rather a low standard.

N=1: I've seen past reports on my situation that say I'm healthy.

However with more in-depth mainstream testing, my actual health status of decades has been revealed as not so groovy.

So, I have known, and been right all along.

As so frequently happens, health care systems desperately look for cheaper ways to get these "whiners" off the biomedical books. As we know one method is to do a few cursory lab tests, and say "I can't find anything wrong", and shunt the offending patient over to the shrinks.