van Gils Anne, Burton Christopher, Bos Elisabeth H, Janssens Karin A M, Schoevers Robert A, Rosmalen Judith G M
University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands.
University of Aberdeen, Centre of Academic Primary Care, Aberdeen, United Kingdom.
J Psychosom Res. 2014 Jul;77(1):34-9. doi: 10.1016/j.jpsychores.2014.04.006. Epub 2014 Apr 30.
Medically unexplained or functional somatic symptoms (FSSs) constitute a major health problem because of their high prevalence and the suffering and disability they cause. Psychosocial stress is widely believed to be a precipitating or perpetuating factor, yet there is little empirical evidence to support this notion. Prior studies mainly focused on comparing groups, which has resulted in the obscuring of temporal complexity and individual differences. The aim of this study is to elucidate the relationship between stress and FSSs over time within individual patients.
Twenty patients (17 females, ages 29-59) with multiple, persistent FSSs were included in the study. They used electronic diaries to report stress and FSSs twice daily over the course of 12 weeks. For each individual data set, Vector autoregressive (VAR) modelling was used to investigate possible associations between daily average stress and FSSs scores.
In six subjects (30%), an increase in stress was followed by an increase in one or more FSSs. In three subjects (15%), an increase in FSSs was followed by an increase in stress. Additionally, negative and mixed associations were found. Only two subjects (10%) showed no cross-lagged association between stress and FSSs in either direction. We did not find specific types of symptoms to be more stress-related than others.
Although stress does not seem to be a universal predictor of FSSs, an increase in stress precedes an increase in symptoms in some individuals. Identifying these individuals using time-series analysis might contribute to a more patient-tailored treatment.
医学上无法解释的或功能性躯体症状（FSSs）因其高患病率以及所导致的痛苦和残疾而构成一个主要的健康问题。社会心理压力被广泛认为是一个促发或持续存在的因素，然而几乎没有实证证据支持这一观点。先前的研究主要集中在比较不同组，这导致了时间复杂性和个体差异的模糊。本研究的目的是阐明个体患者中压力与FSSs随时间的关系。
本研究纳入了20名患有多种持续性FSSs的患者（17名女性，年龄29 - 59岁）。他们在12周的时间里每天使用电子日记报告两次压力和FSSs。对于每个个体数据集，使用向量自回归（VAR）模型来研究每日平均压力与FSSs得分之间可能的关联。
在6名受试者（30%）中，压力增加后一种或多种FSSs增加。在3名受试者（15%）中，FSSs增加后压力增加。此外，还发现了负向和混合关联。只有2名受试者（10%）在压力与FSSs的两个方向上均未显示交叉滞后关联。我们没有发现特定类型的症状比其他症状与压力的相关性更强。
虽然压力似乎并非FSSs的普遍预测因素，但在一些个体中，压力增加先于症状增加。使用时间序列分析识别这些个体可能有助于实现更针对患者的治疗。
