Dimensional analysis of depressive, anxious and somatic symptoms presented by primary care patients

What is it about?

Abstract BACKGROUND: A study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC. METHOD: Primary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach. RESULTS: A total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948]. CONCLUSIONS: These data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms. KEYWORDS: Anxiety; ICD-11; bi-factor model; depression; primary care; somatization

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Why is it important?

This study provides evidence to better understand the clinical presentation of mental health problems in PHC and to integrate in the ICD-11 PHC a dimensional approach to sensitize primary care workers to recognize the manifestations of multiple somatic symptoms not explained by known physical pathology as an expression of an underlying latent phenomenon which would explain the common occurrence of depression, anxiety and somatization. This dimensional approach could contribute to the recognition of mental health problems, which is a first step towards the reduction of the treatment gap. Consistent with previous studies, our findings suggest that depression, anxiety and somatization are different presentations of a common latent phenomenon. Thus, this study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially AD, as central among patients who present multiple somatic symptoms.