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

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.

Somatic symptom profiles in the general population: A latent class analysis in a Danish population-based health survey

“…Problems with the assumption were identified by investigating and comparing the bivariate residuals in the three models with the lowest BIC and in the model with a 1-class solution; high residuals indicated violation of the assumption. Based on the bivariate residuals and prior knowledge of associations between symptoms, 8 we decided for which symptoms local dependency should be allowed. Second, to identify the number of classes, the iterative process was reconducted in a model including direct effects between the identified locally dependent symptoms.…”

“…7 However, it can be questioned if this method identifies the persons at the highest risk of poor health and hence leads to blurred or distorted results. 8,9 For example, in a recent study, we found that the associations between symptoms and health status depended on both the specific symptoms and the co-occurrence of symptoms. 8 This emphasized the need for a better and more precise identification of persons at risk for poor health based on their symptom reporting than merely counting symptoms.…”

“…8,9 For example, in a recent study, we found that the associations between symptoms and health status depended on both the specific symptoms and the co-occurrence of symptoms. 8 This emphasized the need for a better and more precise identification of persons at risk for poor health based on their symptom reporting than merely counting symptoms. This knowledge would improve the quality of epidemiological research on risk factors, prevention, and prognosis of somatic symptoms and hence create basis for better patient management.…”

“…8,15 Briefly, we used information from a cross-sectional health and life-style survey "The Regional Health Survey 2006/2007" conducted in the Capital Region of Denmark. Municipalitystratified random samples of the general population aged 25-79 years were drawn from the Danish Civil Registration System using computer-generated random numbers.…”

“…The list covered the most frequent symptoms reported in other studies 16 and included three MS symptoms, three gastrointestinal (GI) symptoms, four cardiopulmonary (CP) symptoms, four general symptoms (eg, tiredness and headache), two urinary tract symptoms, and three other symptoms (Table 1). 8 In the analyses, we focused on those being considerably bothered by the symptoms and All presented numbers except age are the frequency (N) and proportion (%) of participants with the given characteristic. For age, the presented numbers are mean (SD).…”