Health Care for Persistent Somatic Symptoms Across Europe: A Qualitative Evaluation of the EURONET-SOMA Expert Discussion

Background: Persistent somatic symptoms (PSS), referred to as somatoform disorders and lately somatic symptom disorders, are frequent but often remain under-recognized and under-treated. Although European guidelines overlap, presumably, there is large diversity in their practical use and in the actual health care situation. The aim of this qualitative evaluation was to compare health care for PSS across 9 European countries, to illustrate commonalities and differences, and to discuss challenges for a pan-European research agenda.Methods: A case vignette fulfilling ICD-10 criteria of undifferentiated somatization disorder was presented to 24 experts from 9 European countries, who completed a semi-structured assessment regarding the routine management including diagnostic procedures, treatment recommendations, and country-specific health care aspects. A qualitative evaluation was conducted using the video-transcripts of the presentations. Results were validated by additional expert interviews.Results: Across all countries, primary care physicians serve as the gate keeper for further diagnostic and treatment procedures. Apart from this commonality, there is a large variability in health care routines. Experts concluded that individuals with PSS appear to be a non-identified patient group within many European health care systems. To overcome the gap between evidence-based guidelines and clinical reality needs, three key challenges were identified: (1) Defining a clinically useful, acceptable, and non-stigmatizing diagnostic term, (2) implementing guideline recommendations into routine care, (3) developing effective dissemination strategies.Conclusions: The results advocate for more research on the actual European health care situation. A systematic European research agenda with unified goals and interdisciplinary collaboration that integrates all stakeholders could answer this challenge

Psychometric analysis of the Generalized Anxiety Disorder scale (GAD-7) in primary care using modern item response theory

<div><p>Objective</p><p>The Generalized Anxiety Disorder scale (GAD-7) is one of the most frequently used diagnostic self-report scales for screening, diagnosis and severity assessment of anxiety disorder. Its psychometric properties from the view of the Item Response Theory paradigm have rarely been investigated. We aimed to close this gap by analyzing the GAD-7 within a large sample of primary care patients with respect to its psychometric properties and its implications for scoring using Item Response Theory.</p><p>Methods</p><p>Robust, nonparametric statistics were used to check unidimensionality of the GAD-7. A graded response model was fitted using a Bayesian approach. The model fit was evaluated using posterior predictive p-values, item information functions were derived and optimal predictions of anxiety were calculated.</p><p>Results</p><p>The sample included N = 3404 primary care patients (60% female; mean age, 52,2; standard deviation 19.2) The analysis indicated no deviations of the GAD-7 scale from unidimensionality and a decent fit of a graded response model. The commonly suggested ultra-brief measure consisting of the first two items, the GAD-2, was supported by item information analysis. The first four items discriminated better than the last three items with respect to latent anxiety.</p><p>Conclusion</p><p>The information provided by the first four items should be weighted more heavily. Moreover, estimates corresponding to low to moderate levels of anxiety show greater variability. The psychometric validity of the GAD-2 was supported by our analysis.</p></div

Posterior predictive p-values for the pairwise item correlations of the GAD-7.

<p>Posterior predictive p-values for the pairwise item correlations of the GAD-7.</p

Physicians’ agreement to different explanatory models for antidepressant effectiveness.

<p>Depicted is the percentage of participants who agreed, disagreed or were undecided whether they agreed to the suggested mechanisms of effectiveness for antidepressants.</p

Sociodemographic characteristics and key variables of the patient health questionnaire.

<p>Sociodemographic characteristics and key variables of the patient health questionnaire.</p

Physicians’ agreement to different explanatory models for the occurrence of side effects from antidepressants.

<p>Depicted is the percentage of participants that agreed, disagreed or were undecided whether to endorse the suggested reasons for the occurrence of side effects in antidepressants.</p

Item characteristics of the GAD-7.

<p>Item characteristics of the GAD-7.</p

Parameter estimates for a graded response model (with logistic errors).

<p>Parameter estimates for a graded response model (with logistic errors).</p

Predictors of seeking psychotherapy in primary care patients with high somatic symptom burden

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