Somatic Symptoms: Prevalence, Co-Occurrence and Associations with Self-Perceived Health and Limitations Due To Physical Health - A Danish Population-Based Study.

Marie Eliasen,Jeanette F Ebstrup,Sine Skovbjerg,Svend Kreiner,Torben Jørgensen,Chalotte H Poulsen,Per K Fink,Cathrine J Lau,Claudio Moretti

doi:10.1371/journal.pone.0150664

Abstract

A high number of somatic symptoms have been associated with poor health status and increased health care use. Previous studies focused on number of symptoms without considering the specific symptoms. The aim of the study was to investigate 1) the prevalence of 19 somatic symptoms, 2) the associations between the symptoms, and 3) the associations between the somatic symptoms, self-perceived health and limitations due to physical health accounting for the co-occurrence of symptoms. Information on 19 somatic symptoms, self-perceived health and limitations due to physical health was achieved from a population-based questionnaire survey of 36,163 randomly selected adults in the Capital Region of Denmark in 2006/07. Chain graph models were used to transparently identify and describe the associations between symptoms, self-perceived health and limitations due to physical health. In total, 94.9% of the respondents were bothered by one or more of the 19 somatic symptoms. The symptoms were associated in a complex structure. Still, recognisable patterns were identified within organ systems/body parts. When accounting for symptom co-occurrence; dizziness, pain in legs, respiratory distress and tiredness were all strongly directly associated with both of the outcomes (γ>0.30). Chest pain was strongly associated with self-perceived health, and other musculoskeletal symptoms and urinary retention were strongly associated with limitations due to physical health. Other symptoms were either moderate or not statistically associated with the health status outcomes. Opposite, almost all the symptoms were strongly associated with the two outcomes when not accounting for symptom co-occurrence. In conclusion, we found that somatic symptoms were frequent and associated in a complex structure. The associations between symptoms and health status measures differed between the symptoms and depended on the co-occurrence of symptoms. This indicates an importance of considering both the specific symptoms and symptom co-occurrence in further symptom research instead of merely counting symptoms.

Highlights

The experience of somatic symptoms such as headache, musculoskeletal pain and tiredness is common in the general population [1,2,3,4,5]
A high number of somatic symptoms has been associated with increased health care use [6], poor health status [6], poor functional status [7,8], and sickness absence [4,9] independently of the aetiology of the symptoms
We found that somatic symptoms were frequent in the general population and were correlated in a complex structure but still with some recognisable patterns

Summary

Introduction

The experience of somatic symptoms such as headache, musculoskeletal pain and tiredness is common in the general population [1,2,3,4,5]. The number of symptoms explained a substantial part of the variance [7] These results emphasise that both the specific symptoms and the cooccurrence of symptoms should be accounted for in symptom research instead of merely counting the symptoms or looking at a few specific symptoms [5,10]. Investigating and accounting for this symptom system can give a better insight of the co-occurrence of somatic symptoms and their association with health status measures as can the use of different measures of the health status. This insight can help in guiding further epidemiological somatic symptom research

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Discussion

Conclusion