Using the Patient Health Questionnaire to estimate prevalence and gender differences of somatic symptoms and psychological co-morbidity in a secondary inpatient population with abdominal pain

Abstract

Background: Somatic disorders and somatic symptoms are common in primary care populations; however, little is known about the prevalence in surgical populations. Identification of inpatients with high somatic symptom burden and psychological co-morbidity could improve access to effective psychological therapies. Methods: Cross-sectional analysis ( n = 465) from a prospective longitudinal cohort study of consecutive adult admissions with non-traumatic abdominal pain, at a tertiary hospital in New South Wales, Australia. We estimated somatic symptom prevalence with the Patient Health Questionnaire-15 at three cut-points: moderate (⩾10), severe (⩾15) and ‘bothered a lot’ on ⩾3 symptoms; and psychological co-morbidity with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 at standard (⩾10) cut-points. We also examined gender differences for somatic symptoms and psychological co-morbidity. Results: Prevalence was moderate (52%), female predominance (odds ratio = 1.71; 95% confidence interval = [1.18, 2.48]), severe (20%), no gender difference (1.32; [0.83, 2.10]) and ‘bothered a lot’ on ⩾3 symptoms (53%), female predominance (2.07; [1.42, 3.03]). Co-morbidity of depressive, anxiety and somatic symptoms ranged from 8.2% to 15.9% with no gender differences. Conclusion: Somatic symptoms were common and psychological triple co-morbidity occurred in one-sixth of a clinical population admitted for abdominal pain. Co-ordinated surgical and psychological clinical intervention and changes in clinical service organisation may be warranted to provide optimal care.

Somatic symptom severity association with healthcare utilization and costs in surgical inpatients with an episode of abdominal pain

“…This non-validated self-reported questionnaire was used to record pre-admission healthcare utilization, which was reliant on participant recollection. Although non-validated, the responses of the patients were tested by a comprehensive chart review for a representative sample of the cohort, which showed that the patients’ recollection of their attendance at hospital, and their use of hospital-based tests, was very accurate 35 . The MBS was used to estimate health expenditure, as this is the national standard in Australia; however, this is not comparable to Diagnosis Related Groups or Casemix used in other countries, and thus international comparisons must be made with caution.…”

Somatic symptom severity, depression and anxiety associations with pancreatitis and undifferentiated abdominal pain in surgical inpatients

“…A cross‐sectional study of consecutive adult patients admitted to the Acute General Surgical Unit (AGSU) with any form of non‐traumatic abdominal pain. Full details of the study and the participant characteristics have been reported previously 4 …”

“…Full details of the study and the participant characteristics have been reported previously. 4 Exclusion criteria: age less than 18 years, inability to provide informed consent; or any patient admitted to other services such as general medicine. Only the index admission in the study period was used for analyses.…”

“…Somatic Symptom Severity describes the experience of somatisation: physical symptoms, most commonly pain, associated with disproportionate and persistent anxiety and distress 1 . Somatisation disorders have prevalence rates that vary in different clinical populations: 25% in primary care, 2 35% in medical inpatients 3 and 52% in surgical inpatients 4 . Somatisation disorders are associated with increased health service use: 1.5 times as many primary care visits, 3 times as many hospitalizations, and more major outpatient procedures and Emergency Department visits than patients without somatisation 5 …”

“…1 Somatisation disorders have prevalence rates that vary in different clinical populations: 25% in primary care, 2 35% in medical inpatients 3 and 52% in surgical inpatients. 4 Somatisation disorders are associated with increased health service use: 1.5 times as many primary care visits, 3 times as many hospitalizations, and more major outpatient procedures and Emergency Department visits than patients without somatisation. 5 The symptoms of somatisation may be broad, including but not limited to: lethargy, diarrhoea, dysmenorrhea and pain, 1 often leading patients to multiple medical specialists during their lifetime.…”