Screening for somatisation in an Asian children’s hospital emergency setting

Abstract

In recent years, self-harm is the leading cause of morbidity and mortality among adolescents in Singapore. 1,2 This is just the tip of the iceberg as youths with undiagnosed mental health disorders often present to the healthcare system with non-psychiatric symptoms. 3 These psychosomatic symptoms do not have an organic pathology but are often unrecognised and overmedicalised. Early recognition and interventions can prevent progression to more serious psychiatric disorders. 4,5 Emergency physicians are typically ill-equipped to manage adolescents with psychosocial and mental health distress. Face-to-face psychosocial evaluation is time consuming and close to impossible in the busy emergency department (ED). However, psychosocial evaluation remains crucial because the ED is often their last safety net for seeking help. 6 We describe the development of a self-administered Youth Well-Being (YWB) questionnaire (Appendix in online Supplementary Material) tool for efficient adolescent psychosocial evaluation, and how this tool is used efficiently in the Paediatric ED of KK Women's and Children's Hospital (KKH), Singapore.The YWB questionnaire is modelled after the HEADS-ED, which is the ED version of the wellestablished Home, Education, peer group Activities, Drugs, Sexuality and Suicidality interview instrument (HEADSS). 7 HEADSS is a systematic approach to psychosocial assessment of adolescents. 8 The aim of our study is to efficiently identify psychosocial distress and to facilitate early intervention.A multidisciplinary workgroup was convened in 2019 to develop the YWB questionnaire and the workflow for its use. The team comprised physicians trained in paediatric emergency medicine, adolescent medicine and paediatric psychiatry, as well as paediatric advanced practitioner nurses, clinical psychologists and medical social workers. A clinical guideline on the workflow for the administration of the questionnaire in the ED was also established. Based on clinical audit review of questionnaire responses documented in the electronic medical records, qualitative feedback from the ED medical and nursing team, and patient focus group discussion via the SingHealth Patient Advocacy Network (SPAN)@KKH, iterative changes were made to the questionnaire design and workflow.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey

“…Drawn from only a handful of hospitals in Sweden, caution must be used in generalising the findings to other countries. However, the problem of suboptimal clinical management of patients with somatisation has been identified in other countries [8][9][10], and we believe the knowledge gap we identified in this sample of Swedish physicians is relevant for other countries, especially those with similar healthcare systems.…”

“…Patients undergo excessive investigations and repeated diagnostic surgeries without any medical explanation of the symptoms being identified [7]. This dilemma has been described as both a diagnostic and a healthcare cost problem internationally [8][9][10].…”