Complexity assessed by the INTERMED in patients with somatic symptom disorder visiting a specialized outpatient mental health care setting: a cross-sectional study
Abstract
Background Somatic symptom disorders (SSD), a new classification in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition is associated with problematic diagnostic procedures and treatment that lead to complex care. In somatic health care, the INTERMED has been used to assess levels of complexity; however, in SSD this instrument has not yet been applied.Objective This study aims to explore complexity in patients with SSD using the INTERMED, hereby contributing to an increased comprehension of this new patient group.Method In this cross-sectional study, the INTERMED was used to assess complexity in outpatients with SSD at the Clinical Centre of Excellence for Body, Mind, and Health (The Netherlands), along biologic, psychologic, social, and health care domains. This was done retrospectively with patient files from consecutive patients from 2011 until 2015.Results In the total SSD sample (N = 187), 63% was female, the mean age (standard deviation) was 42 (±12.4) years, with an average educational level. The mean INTERMED score was 23.5 indicating high overall complexity in this population. A high proportion of our sample (69%) scored as highly complex (>20). High complexity was associated with higher depression and anxiety scores, but not with a higher number of physical symptoms.Conclusions This study demonstrates that patients with SSD form a high-complex group, with higher scores compared with literature about multiple sclerosis, rheumatoid arthritis, or patient waiting for a liver transplant. INTERMED outcomes indicate a need for extensive diagnostic procedures and integrated multidisciplinary care for patients with SSD. Attention should especially be paid to mental disorders (depression and anxiety), given their association with high complexity.
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The patients had high complexity levels at biological and psychological symptom levels, suffered from comorbidity, complex treatment histories, and high levels of social vulnerability.
“The patients had high complexity levels at biological and psychological symptom levels (64), suffered from comorbidity, complex treatment histories, and high levels of social vulnerability.”
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- Authors
- van Eck van der Sluijs, J. F., de Vroege, L., van Manen, A. S., Rijnders, C. A. T., & van der Feltz-Cornelis, C. M.
- Affiliations
- GGz Breburg (NL)
- Venue
- Psychosomatics
- Publisher
- Elsevier BV
- Published
- 2017-07
- Volume
- 58
- Issue
- 4
- Pages
- 427-436
- ISSN
- 0033-3182 (ISSN-L)
- OpenAlex
- W2590518489
- Cited by
- 31
- References
- 42
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 3 · 2020: 9 · 2019: 3 · 2018: 3 · 2017: 1
- FWCI
- 3.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatics (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- somatic symptom disorder, INTERMED, care complexity, psychiatric outpatients, depression, anxiety, somatic symptoms, multidisciplinary care, diagnostic procedures
- MeSH terms
- Medically Unexplained Symptoms, Adult, Cross-Sectional Studies, Female, Hospitals, Psychiatric, Humans, Male, Netherlands, Outpatients, Surveys and Questionnaires, Retrospective Studies, Severity of Illness Index, Somatoform Disorders, Reproducibility of Results
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