Irma J. Bonvanie

Self-Help for Medically Unexplained Symptoms: A Systematic Review and Meta-Analysis

Objective Medically unexplained symptoms (MUS), which are highly prevalent in all fields of medicine, are considered difficult to treat. The primary objective of this systematic review and meta-analysis was to assess the efficacy of self-help for adults with MUS. Methods Four electronic databases were searched for relevant studies. Randomized controlled trials comparing self-help to usual care or waiting list in adults with MUS were selected. Studies were critically appraised using the Cochrane “risk of bias assessment tool.” Standardized mean differences (Hedges g) were pooled using a random-effects model. Outcomes were symptom severity and quality of life (QoL) directly posttreatment and at follow-up. Results Of 582 studies identified, 18 studies met all inclusion criteria. Studies were heterogeneous with regard to patient populations, intervention characteristics, and outcome measures. Compared with usual care or waiting list, self-help was associated with lower symptom severity (17 studies, n = 1894, g = 0.58, 95% confidence interval = 0.32–0.84, p < .001) and higher QoL (16 studies, n = 1504, g = 0.66, 95% confidence interval = 0.34–0.99, p < .001) directly posttreatment. Similar effect sizes were found at follow-up. A high risk of bias was established in most of the included studies. However, sensitivity analyses suggested that this did not significantly influence study results. Funnel plot asymmetry indicated potential publication bias. Conclusions Self-help is associated with a significant reduction in symptom severity and improvement of QoL. The methodological quality of included studies was suboptimal, and further research is needed to confirm the findings of this meta-analysis.

Psychological Interventions for Children with Functional Somatic Symptoms: A Systematic Review and Meta-Analysis

OBJECTIVE To analyze the effectiveness of psychological treatments on symptom load and associated disability in children with functional somatic symptoms, and to explore potential moderators of effects. STUDY DESIGN Cochrane, PubMed, PsycINFO, EMBASE, and CINAHL were searched for randomized controlled trials published in peer-reviewed journals. Randomized controlled trials studying the effect of a psychological treatment on symptom load and disability in children with functional somatic symptoms were selected. Data on symptom load, disability, and school absence directly post-treatment and at follow-up were extracted by 2 assessors. Studies were appraised with the Cochrane risk of bias tool. Standardized mean differences were pooled in a random-effects model. Heterogeneity in effect-sizes was explored by use of meta-regressions. PROSPERO Registration ID: CRD42015029667. RESULTS Out of 4098 identified records, 27 studies were included in this review of which 21 were included in meta-analyses. Psychological treatments reduced symptom load (Hedges g = -0.61), disability (Hedges g = -0.42), and school absence (Hedges g = -0.51) post-treatment in children suffering from various functional somatic symptoms. Effects were maintained at follow-up. Type and duration of symptoms, age, and treatment dose did not explain heterogeneity in effect-sizes between studies. Effect-sizes should be interpreted with caution because of the variety in outcome measures, unexplained heterogeneity in found effects and potential publication bias. CONCLUSIONS Psychological interventions reduce symptom load, disability, and school absence in children with functional somatic symptoms. Future research should clarify which patient and treatment characteristics modify outcomes.

Risk and Protective Factors and Course of Functional Somatic Symptoms in Young People

Abstract Functional somatic symptoms (FSS), i.e., physical symptoms without a known medical explanation, are commonly encountered in the pediatric health care system. In severe cases, the symptoms are preoccupying and lead to repeated medical consultations and multiple negative diagnostic testing with the risk of iatrogenic harm. Untreated, these disabling symptoms can seriously interfere with the young persons healthy physical, psychological, and social development. This chapter outlines current knowledge on the risk and protective factors as well as the course of FSS and corresponding main clinical presentations in young people. The main focus will be on the psychiatric conceptualization of FSS, i.e., conversion or dissociative disorders and the former somatoform disorders, now mainly replaced by somatic symptoms and related disorders and bodily distress disorder in the psychiatric classification systems. A generic explanatory model for symptom development is provided which can be useful in relation to both assessment and treatment of these conditions.

Self-help for medically unexplained symptoms : a systematic review and meta-analysis

Objective Medically unexplained symptoms (MUS), which are highly prevalent in all fields of medicine, are difficult to treat. Psychological treatments have shown modest effects, but these are costly, time consuming, and not easily accessible. Self-help interventions might overcome these barriers. The primary aim of this systematic review and meta-analysis was to assess the efficacy of self-help interventions for adults with MUS. Method Relevant studies were identified by searching electronic databases (PubMed, Embase, PsycINFO, and CINAHL from inception to May 2014) and scanning reference lists of included articles and related reviews. Two researchers independently selected randomised controlled trials comparing self-help to usual care or waiting list in adults with MUS. Data were extracted independently by two researchers using standardised forms. Standardised mean differences (Hedges’ g) were pooled using a random-effects model. Studies were critically appraised using the Cochrane ‘risk of bias assessment tool’. Outcomes were symptom severity and quality of life directly post-treatment and at follow-up. Results Out of 582 studies identified, 18 studies met all inclusion criteria. Studies were heterogeneous with regard to patient populations, intervention characteristics, and outcome measures. Compared to usual care or waiting list, self-help was associated with lower symptom severity (17 studies, n=1894, g=0.58, 95% CI 0.32–0.84, p<0.001) and higher QoL (16 studies, n=1504, g=0.66, 95% CI 0.34–0.99, p<0.001) directly post-treatment. Similar effect sizes were found at follow-up. A high risk of bias was established in the majority of included studies. However, sensitivity analyses suggested that this did not significantly influence study results. Funnel plot asymmetry indicated potential publication bias. Conclusion Self-help is associated with a significant reduction in symptom severity and improvement of QoL. Due to the suboptimal methodological quality of the majority of included studies, further research is needed to confirm the findings of this study. For future studies we recommend the use of uniform and validated measurement instruments, inclusion of follow-up assessments, and performance of intention-to-treat analyses.