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Bernd Lowe - One of the best experts on this subject based on the ideXlab platform.
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causal attributions for Somatic Symptom disorder
Journal of Psychosomatic Research, 2020Co-Authors: Olaf Von Dem Knesebeck, Bernd Lowe, Marco Lehmann, Daniel LudeckeAbstract:Abstract Objectives Two research questions will be addressed: (1) What does the German public think about possible causes of Somatic Symptom disorder (SSD) and are there differences in causal attributions according to Symptom and course of SSD? (2) Are causal attributions associated with beliefs about treatment and stigmatizing attitudes? Methods Two vignettes with Symptoms of SSD were used in a national telephone survey in Germany (N = 1004). Vignettes differed regarding main type of Symptom (pain vs. fatigue) and existence of an earlier Somatic disease (yes vs. no). Respondents were asked about their agreement with five causal beliefs (broken home, heredity, lack of willpower, work stress, and misinterpretation of body signals). Results About 90% of the respondents agreed that work stress is a possible cause of the SSD Symptoms. Agreement was significantly more pronounced in case of a person with fatigue and an earlier severe Somatic disease. A quarter endorsed lack of willpower as a possible cause. Lack of willpower was associated with a significant increase of desire for social distance in both vignettes. Work stress was associated with a significantly increased likelihood of positively evaluating the effectiveness of psychotherapy in both cases of SSD. Conclusions Public beliefs about causes of SSD are associated with stigma and treatment beliefs. Emphasising work stress as a cause may promote the belief that psychotherapy is effective for treatment of SSD.
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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
Psychological Medicine, 2020Co-Authors: Anne Toussaint, Sebastian Kohlmann, Paul Husing, Bernd LoweAbstract: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.
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predictors of seeking psychotherapy in primary care patients with high Somatic Symptom burden
Behavioral Medicine, 2019Co-Authors: Amina Kuby, Bernd Lowe, Alexandra B Fabisch, Katharina Piontek, Martin Harter, Hanshelmut Konig, Meike C SheddenmoraAbstract:AbstractMany primary care patients with high Somatic Symptom burden do not initiate mental health treatment. Using a cross-sectional design, this study aimed to identify predictors of psychotherapy...
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Severity of Somatic Symptoms in outpatients with anorexia and bulimia nervosa
European Eating Disorders Review, 2018Co-Authors: Angelika Weigel, Bernd Lowe, Sebastian KohlmannAbstract:Prior studies investigated objective Somatic consequences of eating disorders whereas research on subjective Somatic Symptom severity, that is, profiles of subjective burden of Somatic Symptoms in patients with anorexia (AN) and bulimia nervosa (BN), is sparse. Somatic Symptom severity (Patient Health Questionnaire-15) was investigated in a cross-sectional consecutive sample of outpatients with AN or BN. Using regression and mediation analyses, effects of Somatic Symptom severity on days of sick leave during the last 2 weeks and quality of life were examined. Compared with AN-outpatients (n = 90, MBMI = 17.2, Mage = 27.9 years, 95% female), BN-outpatients (n = 63, MBMI = 21.8, Mage = 29.0 years, 93% female) reported a significantly higher Somatic Symptom severity (p = 0.016). Increased Somatic Symptom severity predicted days of sick leave during the last 2 weeks (p = 0.036) and physical quality of life (p = <0.001). However, after controlling for depression and anxiety as mediators, Somatic Symptom severity did no longer predict psychological quality of life (p = n.s.). Somatic Symptom severity is high in both eating disorders. As it is associated with increased sick leave during the last 2 weeks and decreased quality of life, it adds to the psychological burden of AN and BN. Future research should investigate predictors of subjective Somatic Symptom severity and whether direct Somatic Symptom management enhances treatment of AN and BN. © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.
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comparing the diagnostic concepts of icd 10 somatoform disorders and dsm 5 Somatic Symptom disorders in patients from a psychoSomatic outpatient clinic
Journal of Psychosomatic Research, 2018Co-Authors: Paul Husing, Bernd Lowe, Anne ToussaintAbstract:Abstract Objective The reconceptualization of Somatic Symptom and related disorders in DSM-5 led to numerous consequences in terms of prevalence and affected patient populations. The present study aimed to investigate frequencies of ICD-10 somatoform disorders and DSM-5 Somatic Symptom disorders, and how the respective diagnostic groups differ in terms of sociodemographic and psychopathological characteristics. It discusses the usefulness and reliability of the new diagnostic criteria. Method Patients from a German psychoSomatic outpatient clinic ( n = 438) completed self-report questionnaires on depression (PHQ-9), anxiety (GAD-7), Symptom burden (PHQ-15), psychological distress (SSD-12), and quality of life (SF-12). ICD-10 diagnoses were provided by treating clinicians, DSM-5 diagnoses were assessed via semi-structured telephone interviews. The prevalence of Somatic Symptom disorders and their overlap with ICD-10 somatoform disorders was evaluated. Comparisons between patients with either diagnosis were drawn. Results More than half of the sample ( n = 239, 54.6%) fulfilled the criteria for a Somatic Symptom disorder. Compared to patients fulfilling ICD-10 criteria only, patients with a Somatic Symptom disorder presented higher levels of Symptom related distress ( p = .045), health related anxiety ( p = .004), general anxiety ( p = .011), and lower mental health-related quality of life ( p = .015), while patients with ICD-10 somatoform disorders reported a lower physical health-related quality of life ( p = .031). Conclusion DSM-5 criteria included more patients than ICD-10 somatoform disorders in our sample. Patients diagnosed with a Somatic Symptom disorder appear to be more severely impaired in terms of general and health-related anxiety and psychological distress associated to their Somatic Symptoms, especially when diagnosed with a severe form of Somatic Symptom disorder.
Anne Toussaint - One of the best experts on this subject based on the ideXlab platform.
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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
Psychological Medicine, 2020Co-Authors: Anne Toussaint, Sebastian Kohlmann, Paul Husing, Bernd LoweAbstract: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.
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comparing the diagnostic concepts of icd 10 somatoform disorders and dsm 5 Somatic Symptom disorders in patients from a psychoSomatic outpatient clinic
Journal of Psychosomatic Research, 2018Co-Authors: Paul Husing, Bernd Lowe, Anne ToussaintAbstract:Abstract Objective The reconceptualization of Somatic Symptom and related disorders in DSM-5 led to numerous consequences in terms of prevalence and affected patient populations. The present study aimed to investigate frequencies of ICD-10 somatoform disorders and DSM-5 Somatic Symptom disorders, and how the respective diagnostic groups differ in terms of sociodemographic and psychopathological characteristics. It discusses the usefulness and reliability of the new diagnostic criteria. Method Patients from a German psychoSomatic outpatient clinic ( n = 438) completed self-report questionnaires on depression (PHQ-9), anxiety (GAD-7), Symptom burden (PHQ-15), psychological distress (SSD-12), and quality of life (SF-12). ICD-10 diagnoses were provided by treating clinicians, DSM-5 diagnoses were assessed via semi-structured telephone interviews. The prevalence of Somatic Symptom disorders and their overlap with ICD-10 somatoform disorders was evaluated. Comparisons between patients with either diagnosis were drawn. Results More than half of the sample ( n = 239, 54.6%) fulfilled the criteria for a Somatic Symptom disorder. Compared to patients fulfilling ICD-10 criteria only, patients with a Somatic Symptom disorder presented higher levels of Symptom related distress ( p = .045), health related anxiety ( p = .004), general anxiety ( p = .011), and lower mental health-related quality of life ( p = .015), while patients with ICD-10 somatoform disorders reported a lower physical health-related quality of life ( p = .031). Conclusion DSM-5 criteria included more patients than ICD-10 somatoform disorders in our sample. Patients diagnosed with a Somatic Symptom disorder appear to be more severely impaired in terms of general and health-related anxiety and psychological distress associated to their Somatic Symptoms, especially when diagnosed with a severe form of Somatic Symptom disorder.
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validity of the Somatic Symptom disorder b criteria scale ssd 12 in primary care
Family Practice, 2018Co-Authors: Anne Toussaint, Bernd Lowe, Bernhard Riedl, Simon Kehrer, Antonius Schneider, Klaus LindeAbstract:Aim:The Somatic Symptom Disorder-B Criteria Scale (SSD-12) assesses the psychological features of DSM-5 Somatic Symptom disorder. The purpose of the current study was to investigate the psychometric characteristics and validity of the 12-item instrument to demonstrate its suitability in primary care. Method:The study was designed as a cross-sectional survey set in five primary care practices from Munich, Germany (n = 501, 52.0% female, mean age 47 ± 16 years). Item and scale characteristics, as well as measures of reliability and validity, were determined. Results:The SSD-12 has good item characteristics and excellent reliability (Cronbach's α = 0.92). Confirmatory factor analyses provided evidence to support a general factor model of the SSD-12 in primary care (comparative fit index > 0.98, Tucker-Lewis index > 0.98, root mean square error of approximation = 0.090, 90% confidence interval: 0.078-0.102). SSD-12 total sum-score was significantly associated with Somatic Symptom burden (r = 0.48, P < 0.001), general anxiety (r = 0.54, P < 0.001) and depressive Symptoms (r = 0.60, P < 0.001). At the group level, SSD-12 scores could differentiate between different patient groups (e.g. with and without chronic illness). Conclusions:The SSD-12 appears to be a reliable, valid and time-efficient self-report measure of the psychological characteristics related to the experience of Somatic Symptoms which is suitable for primary care. Future research should evaluate its responsiveness to treatment and feasibility as a screening tool in different clinical settings.
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comparing the patient health questionnaire 15 and the Somatic Symptom scale 8 as measures of Somatic Symptom burden
Journal of Psychosomatic Research, 2017Co-Authors: Anne Toussaint, Kurt Kroenke, Fitsum Baye, Spencer LourensAbstract:Abstract Purpose The Patient Health Questionnaire – 15 (PHQ-15) and the Somatic Symptom Scale – 8 (SSS-8) are self-report measures which assess Somatic Symptom burden. The present study investigates whether the two measures are comparable in terms of their psychometric properties and estimates of Symptom burden. Method Item characteristics, reliability, Symptom severity and construct validity with regard to other relevant psychological, health-related quality of life and disability measures were compared for the PHQ-15m and the SSS-8 in 294 primary care patients who participated in a randomized comparative effectiveness trial targeting pain and mood Symptoms. Results The reliabilities of the PHQ-15m and the SSS-8 were α = 0.66 and α = 0.72, respectively. Both measures were highly correlated (r = 0.79). All item characteristics were comparable and both instruments showed the same pattern of correlations with instruments measuring depression, anxiety, pain, quality of life and impairment (r = 0.25 to 0.53). A 1-point score increase (worsening of Somatic Symptoms) on either instrument resulted in a 3.7% to 3.9% increase in the number of disability days reported for the last four weeks. Using the same severity thresholds (5: low, 10: medium, 15: high), both measures identified nearly identical subgroups of patients with regard to health-related quality of life and disability. Conclusion The PHQ-15m and the SSS-8 are comparable measures in terms of reliability and validity and severity classifications. These findings are in line with previous results and support the use of the SSS-8 as a valuable and short alternative to the original PHQ-15 in settings with limited assessment time.
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the Somatic Symptom disorder b criteria scale ssd 12 factorial structure validity and population based norms
Journal of Psychosomatic Research, 2017Co-Authors: Anne Toussaint, Elmar Brahler, Bernd Lowe, Pascal JordanAbstract:Abstract Purpose The Somatic Symptom Disorder - B Criteria Scale (SSD-12) assesses the psychological features of DSM-5 Somatic Symptom Disorder (SSD). The present study investigates the dimensionality and psychometric properties in a general population sample and provides norm values. Method Test dimensionality was evaluated via confirmatory factor analysis and nonparametric item response theory. Correlational analyses and logistic regression models based on related measures (SSS 8, PHQ-2, GAD-2, Health Care Utilization) were used to derive predictive validity. Age and gender specific norms were derived via quantile regression. Results The SSD-12 has good item characteristics and excellent reliability (Cronbach's α = 0.95). Confirmatory factor analyses revealed a high correlation between the three proposed psychological subscales interpreted as cognitive, affective and behavioral aspects, indicating a general factor model of the SSD-12 in the general population (n = 2362, CFI = 0.99, TLI = 0.998, RMSEA = 0.09, 90% CI: 0.09–0.1). SSD-12 total sum-score was significantly associated with Somatic Symptom burden (r = 0.73, p Conclusion The SSD-12 is a reliable and valid self-report measure of the psychological characteristics of DSM-5 Somatic Symptom Disorder. The provided norms enable researchers and clinicians to compare SSD-12 scores with reference values of a general population sample.
Kurt Kroenke - One of the best experts on this subject based on the ideXlab platform.
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comparing the patient health questionnaire 15 and the Somatic Symptom scale 8 as measures of Somatic Symptom burden
Journal of Psychosomatic Research, 2017Co-Authors: Anne Toussaint, Kurt Kroenke, Fitsum Baye, Spencer LourensAbstract:Abstract Purpose The Patient Health Questionnaire – 15 (PHQ-15) and the Somatic Symptom Scale – 8 (SSS-8) are self-report measures which assess Somatic Symptom burden. The present study investigates whether the two measures are comparable in terms of their psychometric properties and estimates of Symptom burden. Method Item characteristics, reliability, Symptom severity and construct validity with regard to other relevant psychological, health-related quality of life and disability measures were compared for the PHQ-15m and the SSS-8 in 294 primary care patients who participated in a randomized comparative effectiveness trial targeting pain and mood Symptoms. Results The reliabilities of the PHQ-15m and the SSS-8 were α = 0.66 and α = 0.72, respectively. Both measures were highly correlated (r = 0.79). All item characteristics were comparable and both instruments showed the same pattern of correlations with instruments measuring depression, anxiety, pain, quality of life and impairment (r = 0.25 to 0.53). A 1-point score increase (worsening of Somatic Symptoms) on either instrument resulted in a 3.7% to 3.9% increase in the number of disability days reported for the last four weeks. Using the same severity thresholds (5: low, 10: medium, 15: high), both measures identified nearly identical subgroups of patients with regard to health-related quality of life and disability. Conclusion The PHQ-15m and the SSS-8 are comparable measures in terms of reliability and validity and severity classifications. These findings are in line with previous results and support the use of the SSS-8 as a valuable and short alternative to the original PHQ-15 in settings with limited assessment time.
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development and validation of the Somatic Symptom disorder b criteria scale ssd 12
Psychosomatic Medicine, 2016Co-Authors: Annekristin Toussaint, Benjamin Gierk, Kurt Kroenke, Winfried Rief, Peter Henningsen, Alexandra M Murray, Katharina Voigt, Annabel Herzog, Bernd LoweAbstract:To develop and validate a new self-report questionnaire for the assessment of the psychological features of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Somatic Symptom disorder.The Somatic Symptom Disorder-B Criteria Scale (SSD-12) was developed in several steps from an initial pool of 98 items. The SSD-12 is composed of 12 items; each of the three psychological subcriteria is measured by four items. In a cross-sectional study, the SSD-12 was administered to 698 patients (65.8% female, mean [standard deviation] age = 38.79 [14.15] years) from a psychoSomatic outpatient clinic. Item and scale characteristics as well as measures of reliability and validity were determined.The SSD-12 has good item characteristics and excellent reliability (Cronbach α =.95). Confirmatory factor analyses suggested that a three-factorial structure that reflects the three psychological criteria interpreted as cognitive, affective, and behavioral aspects (n = 663, Comparative Fit Index > 0.99, Tucker-Lewis Index > 0.99, Root Mean Square Error of Approximation = 0.06, 90% confidence interval = 0.01-0.08). SSD-12 total sum score was significantly associated with Somatic Symptom burden (r = 0.47, p <.001) and health anxiety (r = 0.71, p <.001), and moderately associated with general anxiety (r = 0.35, p <.001) and depressive Symptoms (r = 0.22, p <.001). Patients with a higher SSD-12 psychological Symptom burden reported higher general physical and mental health impairment and significantly higher health care use.The SSD-12 is the first self-report questionnaire that operationalizes the new psychological characteristics of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Somatic Symptom disorder. Initial assessment indicates that the SSD-12 has sufficient reliability and validity to warrant further testing in both research and clinical settings.
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the Somatic Symptom scale 8 sss 8 a brief measure of Somatic Symptom burden
JAMA Internal Medicine, 2014Co-Authors: Benjamin Gierk, Sebastian Kohlmann, Kurt Kroenke, Lena Spangenberg, Markus Zenger, Elmar Brahler, Bernd LoweAbstract:Importance Somatic Symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of Somatic Symptom burden, but its reliability, validity, and usefulness have not yet been tested. Objective To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8. Design, Setting, and Participants A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years. Main Outcomes and Measures The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire–2 depression scale, Generalized Anxiety Disorder–2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores. Results The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general Somatic Symptom burden. Somatic Symptom burden as measured by the SSS-8 was significantly associated with depression ( r = 0.57 [95% CI, 0.54 to 0.60]), anxiety ( r = 0.55 [95% CI, 0.52 to 0.58]), general health status ( r = −0.24 [95% CI, −0.28 to −0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) Somatic Symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits. Conclusions and Relevance The SSS-8 is a reliable and valid self-report measure of Somatic Symptom burden. Cutoff scores identify individuals with low, medium, high, and very high Somatic Symptom burden.
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The Somatic Symptom Scale–8 (SSS-8): A Brief Measure of Somatic Symptom Burden
JAMA Internal Medicine, 2014Co-Authors: Benjamin Gierk, Sebastian Kohlmann, Kurt Kroenke, Lena Spangenberg, Markus Zenger, Elmar Brahler, Bernd LoweAbstract:Importance Somatic Symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of Somatic Symptom burden, but its reliability, validity, and usefulness have not yet been tested. Objective To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8. Design, Setting, and Participants A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years. Main Outcomes and Measures The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire–2 depression scale, Generalized Anxiety Disorder–2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores. Results The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general Somatic Symptom burden. Somatic Symptom burden as measured by the SSS-8 was significantly associated with depression ( r = 0.57 [95% CI, 0.54 to 0.60]), anxiety ( r = 0.55 [95% CI, 0.52 to 0.58]), general health status ( r = −0.24 [95% CI, −0.28 to −0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) Somatic Symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits. Conclusions and Relevance The SSS-8 is a reliable and valid self-report measure of Somatic Symptom burden. Cutoff scores identify individuals with low, medium, high, and very high Somatic Symptom burden.
Rainer Schaefert - One of the best experts on this subject based on the ideXlab platform.
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a european research agenda for Somatic Symptom disorders bodily distress disorders and functional disorders results of an estimate talk estimate delphi expert study
Frontiers in Psychiatry, 2018Co-Authors: Christina M Van Der Feltzcornelis, Michael Sharpe, Ulrik F Malt, Rainer Schaefert, Iman Elfeddali, Ursula Werneke, Omer Van Den Bergh, Antonio Lobo, Wolfgang SollnerAbstract:Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of PsychoSomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and Somatic Symptoms develop from Somatic conditions and biological and behavioural pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe.
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physical and psychological correlates of high Somatic Symptom severity in chinese breast cancer patients
Psycho-oncology, 2017Co-Authors: Rainer Leonhart, Kurt Fritzsche, Lili Tang, Ying Pang, Jinjiang Li, Lili Song, Irmela Fischer, Maike Koch, Alexander Wuensch, Rainer SchaefertAbstract:Objective: We researched associations between Somatic Symptom severity (SSS), and physical and psychological factors in Chinese breast cancer patients. Methods: This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (Patient Health Questionnaire [PHQ]-15), depression (PHQ-9), anxiety (General Anxiety Disorder [GAD]-7), health anxiety (Whiteley-7 [WI-7]), illness perception (Brief-Illness Perception Questionnaire [IPQ]), illness attribution (Illness Perception Questionnaire-Revised [IPQ-R]), and sense of coherence (Sense of Coherence [SOC]-9). Logistic regression was applied to identify the strongest correlates with SSS. Results: Our sample of high (PHQ-15 ≥ 10) and low SSS differed significantly in the following physical and psychological variables: Symptom duration (r = 0.339, P < .001), Symptom-related disability (Karnofsky Index) (r = 0.182, P < .001), depression (r = 0.556, P < .001), anxiety (r = 0.433, P < .001), health anxiety (r = 0.400, P < .001), illness perception (r = 0.349, P < .001), psychological illness attributions (r = 0.217, P < .01), and sense of coherence (r = −0.254, P < .001). In an adjusted stepwise multiple binary logistic regression analysis, higher health anxiety (WI-7, B = 0.388, P = .002), higher depression (PHQ-9, B = 0.158, P < .001), younger age (B = −0.042, P = .048), higher impairment in daily life (B = 1.098, P = .010), and longer Symptom duration (Wald = 18.487, P = .001) showed a significant association with high SSS; the model explained 55.1% of the variance. Conclusions: High Somatic Symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, SSD concept in cancer patients and to better operationalize psychobehavioral factors in this patient group.
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quality of doctor patient relationship in patients with high Somatic Symptom severity in china
Complementary Therapies in Medicine, 2015Co-Authors: Heng Wu, Kurt Fritzsche, Rainer Schaefert, Rainer Leonhart, Xudong Zhao, Astrid LarischAbstract:Summary Background High Somatic Symptom severity (SSS) is associated with reduced health-related function and may affect doctor–patient interactions. This study aimed to explore the quality of the doctor–patient relationship (DPR) and its association with SSS in Chinese general hospitals outpatients. Patients and methods This multicenter cross-sectional study assessed the quality of DPR from both the doctor's and patient's perspective in general outpatients (n = 484) from 10 departments of PsychoSomatic Medicine (PM), Traditional Chinese Medicine (TCM), and Biomedicine (BM). SSS was assessed with the PHQ-15. The quality of the DPR was measured with the CARE, PDRQ-9, and DDPRQ-10 questionnaires. In addition, several standard instruments were used to assess psychosocial variables such as depression, anxiety, sense of coherence and quality of life. Results From the doctor's perspective, patients with high SSS were rated as significantly more difficult than patients with low SSS. No differences were noted from the perspective of the patients. Patients from the TCM department rated the quality of their DPR significantly higher than those in BM and PM and were rated from doctor's perspective as less difficult than those in BM and PM. Multiple regression analysis revealed satisfaction of treatment, time of treatment and psychosocial variables, such as age, health related anxiety, depression, mental quality of life and sense of coherence as predictors for DPR. Conclusion PM and BM departments should learn from TCM departments to be empathic, to manage patients with high SSS and to establish long-term relationships with their patients.
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dysfunctional illness perception and illness behaviour associated with high Somatic Symptom severity and low quality of life in general hospital outpatients in china
Journal of Psychosomatic Research, 2014Co-Authors: Yaoyin Zhang, Kurt Fritzsche, Michael Wirsching, Rainer Leonhart, Jianzhong Yang, Astrid Larisch, Xudong Zhao, Lan Zhang, Ricarda Natermewes, Rainer SchaefertAbstract:Abstract Objective In primary care populations in Western countries, high Somatic Symptom severity (SSS) and low quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients. Methods This multicentre cross-sectional study enrolled 404 patients from 10 outpatient departments, including Neurology, Gastroenterology, Traditional Chinese Medicine [TCM] and PsychoSomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with Somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15 n = 203, SOM−) were compared to patients who reported high SSS (PHQ-15 ≥ 10, n = 201, SOM +). Results As compared to SOM − patients, SOM + patients showed significantly more frequently adverse psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS was significantly associated with “catastrophising” and “illness vulnerability”; low physical QoL was associated with “avoidance of physical activities” and “disuse of body parts”; low mental QoL was associated with “need for immediate medical help.” Conclusion In accordance with the results from Western countries, high SSS was associated with negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.
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association of costs with Somatic Symptom severity in patients with medically unexplained Symptoms
Journal of Psychosomatic Research, 2013Co-Authors: Alexander Konnopka, Hanshelmut Konig, Claudia Kaufmann, Dirk Heider, Beate Wild, Joachim Szecsenyi, Wolfgang Herzog, Sven Heinrich, Rainer SchaefertAbstract:article i nfo Objective: To analyse the association of direct and indirect costs in patients with medically unexplained Symptoms (MUS) with Somatic Symptom severity (SSS). Methods:A cross-sectional cost analysis forretrospective 6 monthswas conducted in 294primary care patients with MUS. Health care utilisation and loss of productivity were measured by questionnaires. SSS was measured using the "Patient Health Questionnaire 15" (PHQ-15). Direct and indirect costs and the association of costs with SSS were analysed via multiple linear regression analysis. Results: Patients with MUS had average 6-month direct costs of 1098 EUR and indirect costs of 7645 EUR. For direct costs, outpatient physician visits were the most expensive single cost category (36%), followed by pharmaceuticals (25%) and hospital stays (19%). Indirect costs were predominantly caused by productivity reduction at work (56%) followed by early retirement (29%) and acute sickness absence (14%). As compared to mild SSS, moderate SSS was not significantly associated with direct, but with indirect costs (+2948 EUR; p b .001); severe SSS was associated with increased direct cost (+658 EUR; p = .001) and increased indirect costs (+4630 EUR; p b .001). Age was positively associated with direct cost (+15 EUR for each additional year; p = .015) as well as indirect cost (+104 EUR for each additional year; p b .001). Conclusions: MUS are associated with relevant direct and even much higher indirect costs that strongly depend on SSS.
Benjamin Gierk - One of the best experts on this subject based on the ideXlab platform.
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Monitoring Somatic Symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the Somatic Symptom Scale – 8 (SSS-8)
General Hospital Psychiatry, 2017Co-Authors: Benjamin Gierk, Sebastian Kohlmann, Bernd Lowe, Marion Hagemann-goebel, Yvonne NestoriucAbstract:Abstract Objective The SSS–8 is a brief questionnaire for the assessment of Somatic Symptom burden. This study examines its sensitivity to change and the minimal clinically important difference (MCID) in patients with mental disorders. Method 55 outpatients with mental disorders completed the SSS-8 and measures of anxiety, depression, and disability before and after receiving treatment. Effect sizes and correlations between the change scores were calculated. The MCID was estimated using a one standard error of measurement threshold and the change in disability as an external criterion. Results There was a medium decline in Somatic Symptom burden for the complete sample (n = 55, dz = 0.53) and a large decline in a subgroup with very high Somatic Symptom burden at baseline (n = 11, dz = 0.94). Decreases in Somatic Symptom burden were associated with decreases in anxiety (r = 0.68, p Conclusion The SSS-8 is sensitive to change. A 3-point decrease reflects a clinically important improvement. Due to its brevity and sound psychometric properties, the SSS-8 is useful for monitoring Somatic Symptom burden.
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development and validation of the Somatic Symptom disorder b criteria scale ssd 12
Psychosomatic Medicine, 2016Co-Authors: Annekristin Toussaint, Benjamin Gierk, Kurt Kroenke, Winfried Rief, Peter Henningsen, Alexandra M Murray, Katharina Voigt, Annabel Herzog, Bernd LoweAbstract:To develop and validate a new self-report questionnaire for the assessment of the psychological features of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Somatic Symptom disorder.The Somatic Symptom Disorder-B Criteria Scale (SSD-12) was developed in several steps from an initial pool of 98 items. The SSD-12 is composed of 12 items; each of the three psychological subcriteria is measured by four items. In a cross-sectional study, the SSD-12 was administered to 698 patients (65.8% female, mean [standard deviation] age = 38.79 [14.15] years) from a psychoSomatic outpatient clinic. Item and scale characteristics as well as measures of reliability and validity were determined.The SSD-12 has good item characteristics and excellent reliability (Cronbach α =.95). Confirmatory factor analyses suggested that a three-factorial structure that reflects the three psychological criteria interpreted as cognitive, affective, and behavioral aspects (n = 663, Comparative Fit Index > 0.99, Tucker-Lewis Index > 0.99, Root Mean Square Error of Approximation = 0.06, 90% confidence interval = 0.01-0.08). SSD-12 total sum score was significantly associated with Somatic Symptom burden (r = 0.47, p <.001) and health anxiety (r = 0.71, p <.001), and moderately associated with general anxiety (r = 0.35, p <.001) and depressive Symptoms (r = 0.22, p <.001). Patients with a higher SSD-12 psychological Symptom burden reported higher general physical and mental health impairment and significantly higher health care use.The SSD-12 is the first self-report questionnaire that operationalizes the new psychological characteristics of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Somatic Symptom disorder. Initial assessment indicates that the SSD-12 has sufficient reliability and validity to warrant further testing in both research and clinical settings.
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assessing Somatic Symptom burden a psychometric comparison of the patient health questionnaire 15 phq 15 and the Somatic Symptom scale 8 sss 8
Journal of Psychosomatic Research, 2015Co-Authors: Benjamin Gierk, Sebastian Kohlmann, Anne Toussaint, Inka Wahl, C A Brunahl, Alexandra M Murray, Bernd LoweAbstract:Abstract Objective The Patient Health Questionnaire—15 (PHQ-15) is a frequently used questionnaire to assess Somatic Symptom burden. Recently, the Somatic Symptom Scale—8 (SSS-8) has been published as a short version of the PHQ-15. This study examines whether the instruments' psychometric properties and estimates of Symptom burden are comparable. Methods PsychoSomatic outpatients (N = 131) completed the PHQ-15, the SSS-8 and other questionnaires (PHQ-9, GAD-7, WI-7, SF-12). Item characteristics and measures of reliability, validity, and Symptom severity were determined and compared. Results The reliabilities of the PHQ-15 and SSS-8 were α = 0.80 and α = 0.76, respectively and both scales were highly correlated (r = 0.83). The item characteristics were comparable. Both instruments showed the same pattern of correlations with measures of depression, anxiety, health anxiety and health-related quality of life (r = 0.32 to 0.61). On both scales a 1-point increase was associated with a 3% increase in health care use. The percentile distributions of the PHQ-15 and the SSS-8 were similar. Using the same thresholds for Somatic Symptom severity (5, 10, and 15 points), both instruments identified nearly identical subgroups of patients with respect to health related quality of life. Conclusion The PHQ-15 and the SSS-8 showed similar reliability and validity but the comparability of severity classifications needs further evaluation in other populations. Until then we recommend the use of the previously established thresholds. Overall, the SSS-8 performed well as a short version of the PHQ-15 which makes it preferable for assessment in time restricted settings.
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the Somatic Symptom scale 8 sss 8 a brief measure of Somatic Symptom burden
JAMA Internal Medicine, 2014Co-Authors: Benjamin Gierk, Sebastian Kohlmann, Kurt Kroenke, Lena Spangenberg, Markus Zenger, Elmar Brahler, Bernd LoweAbstract:Importance Somatic Symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of Somatic Symptom burden, but its reliability, validity, and usefulness have not yet been tested. Objective To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8. Design, Setting, and Participants A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years. Main Outcomes and Measures The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire–2 depression scale, Generalized Anxiety Disorder–2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores. Results The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general Somatic Symptom burden. Somatic Symptom burden as measured by the SSS-8 was significantly associated with depression ( r = 0.57 [95% CI, 0.54 to 0.60]), anxiety ( r = 0.55 [95% CI, 0.52 to 0.58]), general health status ( r = −0.24 [95% CI, −0.28 to −0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) Somatic Symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits. Conclusions and Relevance The SSS-8 is a reliable and valid self-report measure of Somatic Symptom burden. Cutoff scores identify individuals with low, medium, high, and very high Somatic Symptom burden.
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The Somatic Symptom Scale–8 (SSS-8): A Brief Measure of Somatic Symptom Burden
JAMA Internal Medicine, 2014Co-Authors: Benjamin Gierk, Sebastian Kohlmann, Kurt Kroenke, Lena Spangenberg, Markus Zenger, Elmar Brahler, Bernd LoweAbstract:Importance Somatic Symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of Somatic Symptom burden, but its reliability, validity, and usefulness have not yet been tested. Objective To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8. Design, Setting, and Participants A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years. Main Outcomes and Measures The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire–2 depression scale, Generalized Anxiety Disorder–2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores. Results The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general Somatic Symptom burden. Somatic Symptom burden as measured by the SSS-8 was significantly associated with depression ( r = 0.57 [95% CI, 0.54 to 0.60]), anxiety ( r = 0.55 [95% CI, 0.52 to 0.58]), general health status ( r = −0.24 [95% CI, −0.28 to −0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) Somatic Symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits. Conclusions and Relevance The SSS-8 is a reliable and valid self-report measure of Somatic Symptom burden. Cutoff scores identify individuals with low, medium, high, and very high Somatic Symptom burden.
