Functional somatic symptoms, i.e., physical complaints that cannot be sufficiently explained by an objectifiable biomedical abnormality, become increasingly more prevalent in girls than in boys ...during adolescence. Both parents and adolescents report more functional somatic symptoms in girls, but their reports correspond only limitedly. It remains unknown whether parent-adolescent discordance contributes to the higher symptom prevalence in girls. This study investigated parent-adolescent discordance in reported functional somatic symptoms throughout adolescence, examined the longitudinal association of parent-adolescent discordance with symptom prevalence in early adulthood and focused on sex differences in these processes. Participants included 2229 adolescents (50.7% female) from four assessments (age 11 to 22 years) of the TRAILS population cohort. Parents and adolescents reported significantly more symptoms in girls than in boys during adolescence. Variance analyses showed that throughout adolescence, parents reported fewer symptoms than girls self-reported and more than boys self-reported. Regression analyses using standardized difference scores showed that lower parent-report than self-report was positively associated with symptom prevalence in early adulthood. Polynomial regression analyses revealed no significant interaction between parent-reported and adolescent self-reported symptoms. Associations did not differ between boys and girls. The findings show that lower parent-reported than self-reported symptoms predict future symptom prevalence in both sexes, but this discordance was more observed in girls. The higher functional somatic symptom prevalence in girls might be partly explained by parental underestimation of symptoms.
To systematically review of the available literature to (1) examine the association between death anxiety and hypochondriasis and (2) examine the association between death anxiety and medically ...unexplained symptoms (MUS).
A systematic literature search was conducted in Embase, PsycINFO, Pubmed and Ovid databases and reference lists of selected articles. Articles were included when the research population concerned people with hypochondriasis and/or MUS in who death anxiety was assessed by a validated research method. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted relevant characteristics and data. The data were descriptively analysed.
Of the 1087 references identified in the search, six studies on the association between death anxiety and hypochondriasis and three studies on the association between death anxiety and MUS met inclusion criteria. All studies found a positive association of death anxiety with hypochondriasis and/or MUS. The design of all studies was cross-sectional and the overall quality of the studies was low. The influence of age or sex on these associations was not analysed in any of the studies. Given the diversity in setting, population, study design, and methods used, a meta-analysis was not possible.
All studies found a positive association of death anxiety with hypochondriasis and/or MUS. Acknowledging that death anxiety may play a prominent role in hypochondriasis/MUS populations, future research should address (potentially modifiable) determinants of death anxiety in these populations.
•A search on the association death anxiety with hypochondriasis and/or medically unexplained symptoms yielded nine studies.•Although methodological quality was generally low, results were robust.•All studies found a positive association of death anxiety with hypochondriasis and/or MUS.•Future research should address (potentially modifiable) determinants of death anxiety in these populations.
Tinnitus, the perception of a sound without a corresponding external source, may be associated with decreased Self-Rated Health (SRH). Most research on tinnitus has been done in clinical populations. ...We aimed to study factors associated with SRH in individuals reporting tinnitus from the general population.
In this cross-sectional study, we used data of participants of the Lifelines population-based cohort who answered the question: “Do you hear soughing or whistling in your ear or ears?” (N=124,490). SRH was assessed using the RAND-36 item on SRH. Linear regression was used to study associations between SRH and impairment of hearing, physical and mental health, lifestyle, personality, and demographic features, in the group reporting always tinnitus (N=8,011). Models were also run in the entire study cohort, to test whether tinnitus was associated with SRH after adjustment for these variables.
Of all participants, 6.4% reported always hearing tinnitus, with 83.7% of these reporting good to excellent SRH. The strongest positive associations with SRH in the group reporting always tinnitus were found for younger age, higher education levels, good sleep quality, more social contacts, absence of irritable bowel syndrome and fibromyalgia, high competence, and low impulsivity. In the total population, tinnitus was negatively associated with SRH, while adjusting for demographic features, physical and mental health history, lifestyle, and personality.
Our findings contribute to increased understanding of resilience towards the negative consequences of tinnitus. In their early encounters with tinnitus patients, clinicians could focus on self-help regarding sleep hygiene and stimulate social activities.
•84% of 8,011 cohort participants with tinnitus reported good self-rated health (SRH).•Predictors of SRH in tinnitus were comorbidity, personality, sleep, social contacts.•Tinnitus was negatively associated with SRH in the general population.
Functional Somatic Symptoms (FSS) are symptoms for which an underlying pathology cannot be found. High negative affect (NA) has been linked to the etiology of FSS, but little is known about the role ...of Positive Affect (PA).
The aim of this study was to test if PA is related to current and future lower levels of FSS. We also examined the interactions between PA and NA, and PA and sex on FSS.
Data from the Dutch Tracking Adolescents' Individual Lives Survey (TRAILS) cohort were used (N = 1247 cases, 60% females, mean age T5 = 22.2, T6 = 25.6). PA was measured with the PANAS schedule and FSS with the Adult Self Report questionnaire (ASR). A Principal Component Analysis (PCA) was performed on the physical complaints subscale of the ASR. Regression analyses with bootstrapping were performed to assess the associations and interactions.
PA had a significant negative association with current FSS when adjusted for NA, age, sex and socioeconomic status (B = −0.004; BCa 95% CI = −0.006; −0.002), but the association was not significant longitudinally. No interactions were found. In secondary analysis, PA was significantly related to the component “General Physical Symptoms” (B = −0.019; BCa 95% CI = −0.0028; −0.011) but not to the component “Gastrointestinal Symptoms” (B = −0.008; BCa 95% CI = −0.016;0.001) in the cross-sectional analysis.
In conclusion, high PA was significantly related to current lower levels of FSS, but the effect was small. Further research on individual variations in affect is needed to obtain more insight in their contribution to FSS.
•Positive Affect was related to current levels of Functional somatic Symptoms.•Positive Affect did not predict changes in Functional somatic Symptoms over time.•Sex did not interact with Positive Affect to predict Functional Somatic Symptoms.•Positive and Negative Affect did not interact to predict Functional Somatic Symptoms.•Positive Affect was more related to general physical symptoms than gastrointestinal.
Childhood trauma is known to increase the risk of suicidal ideation and behaviours, and has also been linked to hypothalamic pituitary adrenal (HPA) axis dysregulation measured in cortisol levels. ...Recent evidence has shown that adverse childhood experiences are associated with lower cortisol reactivity to stress and diminished cortisol levels upon awakening in individuals vulnerable to suicide. The present study aimed to investigate whether less traumatic long term difficulties during childhood produced a similar effect on suicidal ideation/behaviour and cortisol levels in a general population sample. Participants (N = 1094; mean age 53 years, 53.7% female) from a large cohort study completed retrospective measures of long-term difficulties during childhood and adolescent years and a measure of history of suicidal thoughts, plans and actions together with a measure of current psychological distress. 24-hour urinary free cortisol samples were collected over two days. The results showed that experiencing childhood long-term difficulties were associated with 21% higher odds of reporting suicidal thoughts or plans in adulthood. Early childhood and adolescent difficulties were equally important predictors of suicide thoughts and plans. However, childhood difficulties were not found to be associated with adult urinary free cortisol, nor were adulthood suicidal thoughts, plans and behaviour associated with adult urinary free cortisol levels. Future research should explore the extent to which childhood difficulties and stressors are related to other indicators of HPA axis functioning. The current findings have implications for clinicians and for the development of future suicide prevention interventions.
•Childhood difficulties increase the risk of suicidal thoughts or plans in adulthood.•Effect of childhood difficulties identified in general population sample.•Childhood difficulties not associated with adult urinary free cortisol levels.•Adulthood suicidal thoughts not associated with adult urinary cortisol.
Poor sleep is associated with the experience of more somatic symptoms and a proinflammatory state, whereas a proinflammatory state may also result in the experience of more somatic symptoms. However, ...existing studies ignore individual differences in these associations. We aimed to study relations between sleep, inflammatory markers, and somatic symptoms at a within-individual level.
Time series of daily data on sleep, somatic symptoms, and inflammation markers in 10 healthy individuals (age, 19-58 years; three men) for 63 days were analyzed. Bidirectional lagged ( t - 1) and contemporaneous ( t ) relations between sleep duration, inflammatory markers (C-reactive protein, interferon-α, interleukin 1RA), and somatic symptoms were analyzed using 24-hour urine and diary data. Unified structural equation modeling was used to analyze the association between sleep duration, the three inflammatory markers, and the amount of somatic symptoms at the individual level.
Associations were found between sleep and at least one of three inflammatory markers in four individuals, both positive (three associations) and negative (five associations) and contemporaneous (four associations) and lagged (four associations). Sleep was related to somatic symptoms in four individuals, both positive ( n = 2) and negative ( n = 2) and contemporaneous ( n = 3) and lagged ( n = 1). Inflammatory markers were associated with somatic symptoms in three individuals, both positive (three associations) and negative (one association) and contemporaneous (three associations) and lagged (one associations). Two individuals showed no associations between sleep, inflammatory markers, and somatic symptoms.
We observed a large variability in presence, strength, and direction of associations between sleep, inflammatory markers, and somatic symptoms.
Current diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further ...specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment.
Psychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included.
Forty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning.
This review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors.
•Psychological factors related to Somatic Symptom Disorder need clarification.•Depression, anxiety, illness anxiety and alexithymia importance could be confirmed.•Other factors, such as, emotion regulation and avoidance behaviour are understudied.•Longitudinal data is lacking.
Medically unexplained symptoms (MUS), which are highly prevalent in all fields of medicine, are considered difficult to treat. The primary objective of this systematic review and meta-analysis was to ...assess the efficacy of self-help for adults with MUS.
Four electronic databases were searched for relevant studies. Randomized controlled trials comparing self-help to usual care or waiting list in adults with MUS were selected. Studies were critically appraised using the Cochrane "risk of bias assessment tool." Standardized mean differences (Hedges g) were pooled using a random-effects model. Outcomes were symptom severity and quality of life (QoL) directly posttreatment and at follow-up.
Of 582 studies identified, 18 studies met all inclusion criteria. Studies were heterogeneous with regard to patient populations, intervention characteristics, and outcome measures. Compared with usual care or waiting list, self-help was associated with lower symptom severity (17 studies, n = 1894, g = 0.58, 95% confidence interval = 0.32-0.84, p < .001) and higher QoL (16 studies, n = 1504, g = 0.66, 95% confidence interval = 0.34-0.99, p < .001) directly posttreatment. Similar effect sizes were found at follow-up. A high risk of bias was established in most of the included studies. However, sensitivity analyses suggested that this did not significantly influence study results. Funnel plot asymmetry indicated potential publication bias.
Self-help is associated with a significant reduction in symptom severity and improvement of QoL. The methodological quality of included studies was suboptimal, and further research is needed to confirm the findings of this meta-analysis.
A debilitating late effect for childhood cancer survivors (CCS) is cancer-related fatigue (CRF). Little is known about the prevalence and risk factors of fatigue in this population. Here we describe ...the methodology of the Dutch Childhood Cancer Survivor Late Effect Study on fatigue (DCCSS LATER fatigue study). The aim of the DCCSS LATER fatigue study is to examine the prevalence of and factors associated with CRF, proposing a model which discerns predisposing, triggering, maintaining and moderating factors. Triggering factors are related to the cancer diagnosis and treatment during childhood and are thought to trigger fatigue symptoms. Maintaining factors are daily life- and psychosocial factors which may perpetuate fatigue once triggered. Moderating factors might influence the way fatigue symptoms express in individuals. Predisposing factors already existed before the diagnosis, such as genetic factors, and are thought to increase the vulnerability to develop fatigue. Methodology of the participant inclusion, data collection and planned analyses of the DCCSS LATER fatigue study are presented.
Data of 1955 CCS and 455 siblings was collected. Analysis of the data is planned and we aim to start reporting the first results in 2022.
The DCCSS LATER fatigue study will provide information on the epidemiology of CRF and investigate the role of a broad range of associated factors in CCS. Insight in associated factors for fatigue in survivors experiencing severe and persistent fatigue may help identify individuals at risk for developing CRF and may aid in the development of interventions.
Summary Background Functional somatic symptoms (FSS), like chronic pain and overtiredness, are often assumed to be stress-related. Altered levels of the stress hormone cortisol could explain the ...association between stress and somatic complaints. We hypothesized that low cortisol levels after awakening and low cortisol levels during stress are differentially associated with specific FSS. Methods This study is performed in a subsample of TRAILS (Tracking Adolescents’ Individual Lives Survey) consisting of 715 adolescents (mean age: 16.1 years, SD = 0.6, 51.3% girls). Adolescents’ cortisol levels after awakening and during a social stress task were assessed. The area under the curve with respect to the ground (AUCg) and the area under the curve above the baseline (AUCab) were calculated for these cortisol levels. FSS were measured using the Youth Self-Report and pain questions. Based upon a factor analysis, FSS were divided into two clusters, one consisting of headache and gastrointestinal symptoms and the other consisting of overtiredness, dizziness and musculoskeletal pain. Results Regression analyses revealed that the cluster of headache and gastrointestinal symptoms was associated with a low AUCg of cortisol levels during stress ( β = −.09, p = .03) and the cluster of overtiredness, dizziness and musculoskeletal pain with a low AUCg of cortisol levels after awakening ( β = −.15, p = .008). All these analyses were adjusted for the potential confounders smoking, physical activity level, depression, corticosteroid use, oral contraceptive use, gender, body mass index and, if applicable, awakening time. Conclusion Two clusters of FSS are differentially associated with the stress hormone cortisol.
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