Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients

Carson, A. J., Stone, J., Hansen, C. H., Duncan, R., Cavanagh, J. , Matthews, K., Murray, G. and Sharpe, M. (2015) Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients. Journal of Neurology, Neurosurgery and Psychiatry, 86(3), pp. 295-301. (doi: 10.1136/jnnp-2014-308234)

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Abstract

Objective: Somatic symptoms unexplained by disease are common in all medical settings. The process of identifying such patients requires a clinical assessment often supported by clinical tests. Such assessments are time-consuming and expensive. Consequently the observation that such patients tend to report a greater number of symptom has led to the use of self-rated somatic symptom counts as a simpler and cheaper diagnostic aid and proxy measure for epidemiological surveys. However, despite their increasing popularity there is little evidence to support their validity.<p></p> Methods: We tested the score on a commonly used self-rated symptom questionnaire- the Patient Health Questionnaire (PHQ 15) (plus enhanced iterations including an additional 10 items on specific neurological symptoms and an additional 5 items on mental state) for diagnostic sensitivity and specificity against a medical assessment (with 18 months follow-up) in a prospective cohort study of 3781 newly attending patients at neurology clinics in Scotland, UK.<p></p> Results: We found 1144/3781 new outpatients had symptoms that were unexplained by disease. The patients with symptoms unexplained by disease reported higher symptoms count scores (PHQ 15: 5.6 (95% CI 5.4 to 5.8) vs 4.2 (4.1 to 4.4) p<0.0001). However, the PHQ15 performed little better than chance in its ability to identify patients with symptoms unexplained by disease. The findings with the enhanced scales were similar.<p></p> Conclusions: Self-rated symptom count scores should not be used to identify patients with symptoms unexplained by disease.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cavanagh, Professor Jonathan
Authors: Carson, A. J., Stone, J., Hansen, C. H., Duncan, R., Cavanagh, J., Matthews, K., Murray, G., and Sharpe, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:Journal of Neurology, Neurosurgery and Psychiatry
Publisher:BMJ Publishing Group
ISSN:0022-3050
ISSN (Online):1468-330X

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