Lentis Psychiatric Institute, Center for Old Age Psychiatry and Somatic Care, E61, 9471 KE Zuidlaren, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Hanzeplein 1, Groningen, 9700 RB, the Netherlands.
Hiroshima University, 1 Chome-7-1 Kagamiyama, Higashihiroshima, Hiroshima 739-8521, Japan.
Compr Psychiatry. 2024 Nov;135:152527. doi: 10.1016/j.comppsych.2024.152527. Epub 2024 Aug 26.
Patients with persistent somatic symptoms (PSS) often receive either somatic or psychiatric care, depending on whether symptoms are respectively medically explained (MES) or unexplained (MUS). This separation may not be as clinically relevant as previously assumed; however, research on data-driven subgroups within cohorts of older patients with PSS is not available. Our goal is to identify more clinically relevant homogeneous subgroups beyond the distinction of MUS and MES among older patients with PSS by using a data-driven approach. We performed two Latent Profile Analyses (LPAs), one focused on 6 somatic health measures, the other on 6 psychosocial measures, using data from a case-control study with participants (>60 years) with MUS (N = 118) or MES (N = 154), recruited from the general public, general practices and secondary healthcare. We identified two somatic-health based (strong, vulnerable) and four mental-health based (strong, vulnerable, lonely, non-acceptance) profiles. We found no statistically significant overlap between the somatic - and mental health profiles (κ = 0.019). Health related quality of life negatively associated with the mentally - and somatically vulnerable profiles. We conclude that singular focus on MUS/MES distinction in the care for older PSS patients may lead to undertreatment of the most vulnerable patients. Integrated care is recommended when treating persistent somatic symptoms in later life, regardless of the (un)explained origin of the symptoms.
患有持续性躯体症状 (PSS) 的患者通常会接受躯体或精神科护理，具体取决于症状是否分别得到医学解释 (MES) 或未得到解释 (MUS)。这种分离可能并不像之前假设的那样具有临床相关性；然而，针对 PSS 老年患者队列中基于数据的亚组的研究尚不可用。我们的目标是通过使用数据驱动的方法，在 PSS 老年患者中除了 MUS 和 MES 的区别之外，确定更具临床相关性的同质亚组。我们进行了两次潜在剖面分析 (LPA)，一次侧重于 6 项躯体健康指标，另一次侧重于 6 项心理社会指标，使用来自一项病例对照研究的数据，该研究的参与者 (>60 岁) 来自普通人群、普通诊所和二级医疗保健，患有 MUS (N=118) 或 MES (N=154)。我们确定了两个基于躯体健康的 (强、脆弱) 和四个基于心理健康的 (强、脆弱、孤独、不接受) 特征。我们发现躯体健康和心理健康特征之间没有统计学上的显著重叠 (κ=0.019)。健康相关生活质量与心理和躯体脆弱特征呈负相关。我们得出结论，在为老年 PSS 患者提供护理时，单纯关注 MUS/MES 区别可能会导致对最脆弱患者的治疗不足。无论症状的 (未)解释来源如何，在治疗晚年持续性躯体症状时都建议采用综合护理。
