Female Sex and Femininity Independently Associate with Common Somatic Symptom Trajectories

Overview

Journal Psychol Med

Publisher Cambridge University Press

Specialty Psychology

Date 2020 Nov 10

PMID 33168107

Citations 3

Authors

Aranka V Ballering

Klaas J Wardenaar

Tim C Olde Hartman

Judith G M Rosmalen

Affiliations

Soon will be listed here.

Abstract

Background: Multiple predictors have been associated with persistent somatic symptoms. However, previous studies problematically defined the persistence of symptoms, conflated participants' sex and gender, and focused on patient populations. Therefore, we studied associations between predictors, especially sex and gender, and longitudinal patterns of somatic symptoms in the general adult population. We also assessed whether predictors for persisting symptoms differ between sexes.

Method: To identify developmental trajectories of somatic symptoms, assessed by the SCL-90 SOM, we used latent class trajectory modeling in the Dutch Lifelines Cohort Study [ = 150 494; 58.6% female; median time to follow-up: 46.0 (min-max: 22.0-123.0) months]. To identify predictors of trajectories, we applied multiple logistic regression analyses. Predictors were measured by surveys at baseline and a composite gender index was previously developed.

Results: A five-class linear LCGA model fitted the data best: 93.7% of the population had a stable symptom trajectory, whereas 1.5% and 4.8% of the population had a consistently increasing or decreasing symptom trajectory, respectively. Female sex predicted severe, stable symptom severity (OR 1.74, 95% CI 1.36-2.22), but not increasing symptom severity (OR 1.15, 95% CI 0.99-1.40). Femininity was protective hereof (OR 0.60, 95% CI 0.44-0.82 and OR 0.66, 95% CI 0.51-0.85, respectively). Merely a few predictors of symptom severity, for instance hours of paid employment and physical functioning, differed in strength between sexes. Yet, effect sizes were small.

Conclusion: Female sex and femininity predict symptom trajectories. No large sex differences in the strength of additional predictors were found, thus it may not be clinically useful to distinguish between predictors specific to male or female patients of persistent somatic symptoms.

Citing Articles

Discordance between Adolescents and Parents in Functional Somatic Symptom Reports: Sex Differences and Future Symptom Prevalence.

Hogendoorn E, Ballering A, van Dijk M, Rosmalen J, Burke S J Youth Adolesc. 2023; 52(10):2182-2195.

PMID: 37354312 PMC: 10371884. DOI: 10.1007/s10964-023-01810-w.

Sex and gender differences in primary care help-seeking for common somatic symptoms: a longitudinal study.

Ballering A, Olde Hartman T, Verheij R, Rosmalen J Scand J Prim Health Care. 2023; 41(2):132-139.

PMID: 36995265 PMC: 10193899. DOI: 10.1080/02813432.2023.2191653.

Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study.

Ballering A, van Zon S, Olde Hartman T, Rosmalen J Lancet. 2022; 400(10350):452-461.

PMID: 35934007 PMC: 9352274. DOI: 10.1016/S0140-6736(22)01214-4.

References

De Gucht V, Fischler B, Heiser W . Personality and affect as determinants of medically unexplained symptoms in primary care; A follow-up study. J Psychosom Res. 2004; 56(3):279-85. DOI: 10.1016/S0022-3999(03)00127-2. View

Castro Y, Carbonell J, Anestis J . The influence of gender role on the prediction of antisocial behaviour and somatization. Int J Soc Psychiatry. 2011; 58(4):409-16. DOI: 10.1177/0020764011406807. View

Lennon H, Kelly S, Sperrin M, Buchan I, Cross A, Leitzmann M . Framework to construct and interpret latent class trajectory modelling. BMJ Open. 2018; 8(7):e020683. PMC: 6042544. DOI: 10.1136/bmjopen-2017-020683. View

Loikas D, Karlsson L, von Euler M, Hallgren K, Schenck-Gustafsson K, Bastholm Rahmner P . Does patient's sex influence treatment in primary care? Experiences and expressed knowledge among physicians--a qualitative study. BMC Fam Pract. 2015; 16:137. PMC: 4603906. DOI: 10.1186/s12875-015-0351-5. View

Zijlema W, Stolk R, Lowe B, Rief W, White P, Rosmalen J . How to assess common somatic symptoms in large-scale studies: a systematic review of questionnaires. J Psychosom Res. 2013; 74(6):459-68. DOI: 10.1016/j.jpsychores.2013.03.093. View

Koch H, van Bokhoven M, Bindels P, van der Weijden T, Dinant G, Riet G . The course of newly presented unexplained complaints in general practice patients: a prospective cohort study. Fam Pract. 2009; 26(6):455-65. DOI: 10.1093/fampra/cmp067. View

Ram N, Grimm K . Growth Mixture Modeling: A Method for Identifying Differences in Longitudinal Change Among Unobserved Groups. Int J Behav Dev. 2013; 33(6):565-576. PMC: 3718544. DOI: 10.1177/0165025409343765. View

Bonvanie I, Janssens K, Rosmalen J, Oldehinkel A . Life events and functional somatic symptoms: A population study in older adolescents. Br J Psychol. 2016; 108(2):318-333. DOI: 10.1111/bjop.12198. View

Scholtens S, Smidt N, Swertz M, Bakker S, Dotinga A, Vonk J . Cohort Profile: LifeLines, a three-generation cohort study and biobank. Int J Epidemiol. 2014; 44(4):1172-80. DOI: 10.1093/ije/dyu229. View

10.

Lowe B, Spitzer R, Williams J, Mussell M, Schellberg D, Kroenke K . Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008; 30(3):191-9. DOI: 10.1016/j.genhosppsych.2008.01.001. View

11.

Krantz G, Ostergren P . Double exposure. The combined impact of domestic responsibilities and job strain on common symptoms in employed Swedish women. Eur J Public Health. 2002; 11(4):413-9. DOI: 10.1093/eurpub/11.4.413. View

12.

Dessel N, van der Wouden J, Hoekstra T, Dekker J, van der Horst H . The 2-year course of Medically Unexplained Physical Symptoms (MUPS) in terms of symptom severity and functional status: results of the PROSPECTS cohort study. J Psychosom Res. 2017; 104:76-87. DOI: 10.1016/j.jpsychores.2017.11.012. View

13.

Dirkzwager A, Verhaak P . Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Fam Pract. 2007; 8:33. PMC: 1894968. DOI: 10.1186/1471-2296-8-33. View

14.

Bekhuis E, Boschloo L, Rosmalen J, Schoevers R . Differential associations of specific depressive and anxiety disorders with somatic symptoms. J Psychosom Res. 2014; 78(2):116-22. DOI: 10.1016/j.jpsychores.2014.11.007. View

15.

Kooiman C, Bolk J, Rooijmans H, Trijsburg R . Alexithymia does not predict the persistence of medically unexplained physical symptoms. Psychosom Med. 2004; 66(2):224-32. DOI: 10.1097/01.psy.0000116714.38868.06. View

16.

Hill R, van Boxtel M, Ponds R, Houx P, Jolles J . Positive affect and its relationship to free recall memory performance in a sample of older Dutch adults from the Maastricht Aging Study. Int J Geriatr Psychiatry. 2005; 20(5):429-35. DOI: 10.1002/gps.1300. View

17.

Hart C, Saperstein A, Magliozzi D, Westbrook L . Gender and Health: Beyond Binary Categorical Measurement. J Health Soc Behav. 2019; 60(1):101-118. DOI: 10.1177/0022146519825749. View

18.

Joustra M, Janssens K, Bultmann U, Rosmalen J . Functional limitations in functional somatic syndromes and well-defined medical diseases. Results from the general population cohort LifeLines. J Psychosom Res. 2015; 79(2):94-9. DOI: 10.1016/j.jpsychores.2015.05.004. View

19.

van Eck van der Sluijs J, Have M, de Graaf R, Rijnders C, van Marwijk H, van der Feltz-Cornelis C . Predictors of Persistent Medically Unexplained Physical Symptoms: Findings From a General Population Study. Front Psychiatry. 2018; 9:613. PMC: 6262298. DOI: 10.3389/fpsyt.2018.00613. View

20.

Aaronson N, Muller M, Cohen P, Essink-Bot M, Fekkes M, Sanderman R . Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998; 51(11):1055-68. DOI: 10.1016/s0895-4356(98)00097-3. View