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Sundström, A., Nordin, M., Nordin, S., Neely, A. S. & Malmberg Gavelin, H. (2025). Dimensionality, sensitivity and specificity of different versions of the Shirom-Melamed burnout questionnaire/measure in clinical and non-clinical populations. Stress and Health, 41(1), Article ID e70001.
Open this publication in new window or tab >>Dimensionality, sensitivity and specificity of different versions of the Shirom-Melamed burnout questionnaire/measure in clinical and non-clinical populations
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2025 (English)In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 41, no 1, article id e70001Article in journal (Refereed) Published
Abstract [en]

The Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/SMBM) is a self-report instrument frequently used for assessing degree of burnout and screening for stress-related exhaustion disorder. The aim of the present study was three-fold. First, to examine reliability and construct validity of different versions of SMBM with 6–22 items in a clinical context. Second, to examine the criterion validity by assessing sensitivity and specificity and determining clinical cut-offs for these versions of the SMBM, and third to examine the prevalence of burnout in a general population and primary care sample using the proposed cut-offs. Two Swedish samples were used for the first two purposes: a clinical sample of patients diagnosed with exhaustion disorder (n = 149), and a matched sample of healthy controls (n = 60). For the third purpose a sample from the general population (n = 3406), and a primary care clinical sample (n = 326) was used. The modified versions of the SMBM showed good internal consistency, construct validity, dimensionality and model fit on the clinical exhaustion disorder sample, as well as configural measurement invariance across clinical and non-clinical samples. The sensitivity (94.6%–95.3%) and specificity (93.3%–95.0%) in identifying cases with exhaustion disorder based on the cut-off of 4.0 for the 19-, 16- and 11-items versions, and on the cut-off of 3.75 for the 6-item version was high. The prevalence of burnout was 81.2% in the primary care sample and 16.6% in the general population sample. The findings indicate that the SMBM is a useful instrument for screening for exhaustion disorder and burnout.

Place, publisher, year, edition, pages
John Wiley & Sons, 2025
Keywords
burnout, clinical, construct validity, SMBM, SMBQ, stress-related illness
National Category
Public Health, Global Health and Social Medicine Psychiatry
Identifiers
urn:nbn:se:umu:diva-234881 (URN)10.1002/smi.70001 (DOI)001401035100001 ()39834010 (PubMedID)2-s2.0-85215570218 (Scopus ID)
Funder
AFA Insurance, 190082AFA Insurance, 150175Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-01111
Available from: 2025-02-10 Created: 2025-02-10 Last updated: 2025-04-30Bibliographically approved
Köteles, F. & Nordin, S. (2025). Somatic and mental distress as predictors of number of symptoms associated with environmental factors in an adult general population: cross-sectional and longitudinal findings. Journal of Psychosomatic Research, 192, Article ID 112098.
Open this publication in new window or tab >>Somatic and mental distress as predictors of number of symptoms associated with environmental factors in an adult general population: cross-sectional and longitudinal findings
2025 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 192, article id 112098Article in journal (Refereed) Published
Abstract [en]

Objective: Hypotheses were tested of associations between indicators of somatic and mental distress and number of different types of environmental intolerances, referred to as symptoms attributed to environmental factors (SAEFs), and these indicators predicting development of additional SAEFs in a general population. The SAEFs regarded chemicals, buildings, electromagnetic fields and sounds.

Methods: Data were used from a Swedish population-based sample of 2336 adults. Cross-sectional and 3-year longitudinal analyses were conducted based on validated questionnaire instruments assessing somatic symptom distress, perceived stress, anxiety and depression.

Results: Prevalence percentage of the SAEFs ranged from 2.1 % to 13.4 %; 16.2 % had one SAEF, 4.9 % had two SAEFs, and 1.2 % had three or four SAEFs. Cross-sectionally, Kendall rank correlation analyses and ANOVAs showed that somatic symptom distress (rtau-b = 0.214), perceived stress (rtau-b = 0.137), anxiety (rtau-b = 0.145) and depression (rtau-b = 0.100) increased with number of SAEF. In the longitudinal analysis, all four indicators were found to be predictors of an increase in number of SAEFs three years later (odds ratios = 1.021–1.049 for each scale step), with somatic symptom distress as the strongest predictor.

Conclusion: The results suggest that all four types of SAEFs are associated with all four indicators of negative affectivity, and that the level of these indicators is associated with number of SAEFs and predict development of additional SAEFs. Among the studied indicators, somatic symptom distress appears to be particularly associated with development of multiple SAEFs, perhaps driven by the motive to find a cause for bothersome symptoms (misattribution).

Keywords
Anxiety, Depression, Idiopathic environmental intolerance, Negative affect, Somatic symptoms, Stress
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-238710 (URN)10.1016/j.jpsychores.2025.112098 (DOI)001452413000001 ()40112447 (PubMedID)2-s2.0-105000144673 (Scopus ID)
Funder
AFA Insurance, 190082
Available from: 2025-05-23 Created: 2025-05-23 Last updated: 2025-05-23Bibliographically approved
Norberg, M., Liv, P., Näslund, U., Wester, P., Andersson, E. M. & Nordin, S. (2025). The path for men from young adulthood results of cognitive tests to subclinical atherosclerosis at age 60: the mediating role of socioeconomic status, lifestyle and cardiovascular disease risk factors–results from a VIPVIZA study. Reviews in Cardiovascular Medicine, 26(3), Article ID 26312.
Open this publication in new window or tab >>The path for men from young adulthood results of cognitive tests to subclinical atherosclerosis at age 60: the mediating role of socioeconomic status, lifestyle and cardiovascular disease risk factors–results from a VIPVIZA study
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2025 (English)In: Reviews in Cardiovascular Medicine, ISSN 1530-6550, Vol. 26, no 3, article id 26312Article in journal (Refereed) Published
Abstract [en]

Background: The role of cognitive abilities in the development of arteriosclerotic disease is still not fully understood. The purpose of the present study was to evaluate the mediating role of lifestyle, socioeconomic status (SES) and conventional cardiovascular disease (CVD) risk factors in the association between cognitive ability at age 19 and subclinical atherosclerosis at age 60 years.

Methods: An observational study design was employed. Data on the results from cognitive tests of conscripts tested at age 19 were collected for 1009 men. At the age of 60, they were included in the trial VIsualiZation of asymptomatic Atherosclerotic disease for optimum cardiovascular prevention, which was conducted as part of the Västerbotten Intervention Program (VIPVIZA). VIPVIZA is a randomised controlled trial, aimed at primary prevention of CVD in Västerbotten County, Sweden. Prior to any intervention, they underwent carotid ultrasonography and CVD risk factor assessment. Lifestyle habits and marital status were self-reported, and education and urban or rural residency were registered. Crude associations between cognitive ability at age 19 and the risk of CVD, assessed with the European Systematic Coronary Risk Evaluation 2 (SCORE2), as well as subclinical atherosclerosis, as demonstrated by the presence of carotid plaques (no plaque, plaque unilateral, or plaque bilateral), were evaluated. A path-analytic model tested mediating factors from cognitive ability in young adulthood to subclinical atherosclerosis at age 60.

Results: Results from cognitive tests at age 19 were in separate unadjusted analyses inversely and linearly associated with SCORE2 and with subclinical atherosclerosis. The association with carotid plaque at age 60 was mainly indirect and mediated by adult SES, which in turn had its main effect through adherence to healthy lifestyle habits via CVD risk of carotid plaques.

Conclusions: Cognitive ability at age 19 is a factor that is upstream of adult SES and our study indicates that cognitive ability at a young age has long-term consequences via SES and lifestyle habits for CVD risk and atherosclerosis.

Place, publisher, year, edition, pages
IMR Press, 2025
Keywords
atherosclerosis, cardiovascular risk, cognitive ability, lifestyle, socioeconomic status
National Category
Cardiology and Cardiovascular Disease Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-238454 (URN)10.31083/RCM26312 (DOI)40160597 (PubMedID)2-s2.0-105002055602 (Scopus ID)
Available from: 2025-05-06 Created: 2025-05-06 Last updated: 2025-05-06Bibliographically approved
Hybelius, J., Kosic, A., Salomonsson, S., Wachtler, C., Wallert, J., Nordin, S. & Axelsson, E. (2025). Understanding general somatic symptom burden: insights from a systematic review of factor analyses pertaining to the patient health questionnaire 15 (PHQ- 15) and somatic symptom scale 8 (SSS- 8). International Journal of Behavioral Medicine, Article ID f1580.
Open this publication in new window or tab >>Understanding general somatic symptom burden: insights from a systematic review of factor analyses pertaining to the patient health questionnaire 15 (PHQ- 15) and somatic symptom scale 8 (SSS- 8)
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2025 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, article id f1580Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

Background: Factor analyses have indicated that somatic symptom burden can be separated into local symptom domain factors (e.g., cardiopulmonary, fatigue, gastrointestinal, pain) and a general propensity toward being symptomatic. This study aimed to determine what specific physical symptoms, and correlates, that are most strongly associated with this general factor.

Method: A systematic review was based on factor analyses of the Patient Health Questionnaire 15 (PHQ-15) and Somatic Symptom Scale 8 (SSS-8).

Results: There was heterogeneity in the included studies, in terms of the exact specification of the factor structure, and to some extent regarding item inclusion for factor analysis. Among 11 analyses of the PHQ-15, the highest mean and median factor loadings on the general symptom burden factor were seen for fatigue (M = 0.65) followed by dizziness (0.63). Among three analyses of the SSS-8, the mean was highest for chest pain and shortness of breath (0.69), followed by fatigue (0.62). The PHQ-15 general factor exhibited variable, but usually moderate to strong, associations with anxiety and depression symptoms, health anxiety, somatosensory amplification, and functional somatic syndromes.

Conclusions: Cardiopulmonary symptoms and fatigue appear to be especially closely associated with general somatic symptom burden. The close associations between this general factor and indicators of poor mental health and functional somatic syndromes allow for numerous interpretations; both causal and due to overlapping definitions.

Place, publisher, year, edition, pages
Springer, 2025
Keywords
Factor analysis, Patient health questionnaire, Persistent physical symptoms, Somatic symptom burden, Systematic review
National Category
Applied Psychology Epidemiology Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-238381 (URN)10.1007/s12529-025-10365-y (DOI)001472887000001 ()40268773 (PubMedID)2-s2.0-105003294558 (Scopus ID)
Available from: 2025-05-05 Created: 2025-05-05 Last updated: 2025-05-05
Sundström, A., Löfgren, E., Nordqvist, J. & Nordin, S. (2024). Affective and cognitive symptoms associated with burnout in a general population: are there sex-related differences?. Cogent Psychology, 11(1), Article ID 2352959.
Open this publication in new window or tab >>Affective and cognitive symptoms associated with burnout in a general population: are there sex-related differences?
2024 (English)In: Cogent Psychology, E-ISSN 2331-1908, Vol. 11, no 1, article id 2352959Article in journal (Refereed) Published
Abstract [en]

Burnout is an increasing public health problem. Although research indicate that cognitive and affective factors are related to burnout, there is a lack of knowledge about the extent to which specific cognitive and affective symptoms are related to burnout, and whether there are sex-related differences. An aim of this study was to identify specific self-reported cognitive and affective symptoms that are particularly associated with burnout, both in the population in general and in men and women separately. Another aim was to examine the risk of burnout for specific symptoms and total number of symptoms in the general population and in men and women separately. Cross-sectional data were used from a large population-based questionnaire study consisting of 3406 participants (18–79 years) randomly selected from a general population in northern Sweden. Eleven cognitive and affective symptoms were assessed with a subsection of the Environmental Hypersensitivity Symptom Inventory, and the 22-item Shirom-Melamed Burnout Questionnaire (SMBQ) was used to assess burnout. The findings suggest that burnout is associated with a rather large number of cognitive and affective symptoms, in particular feeling tired/lethargic, having concentration difficulties, sleep disturbance, feeling depressed and being absent minded. Women with burnout (SMBQ score ≥ 4) reported higher prevalence of feeling tired/lethargic and sleep disturbance. The results add to the understanding of affective and cognitive symptomatology in burnout, which might have implications for early identification and prevention of burnout and exhaustion disorder.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2024
Keywords
Exhaustion disorder, exhaustion, stress, SMBQ, epidemiology, symptomatology
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-224670 (URN)10.1080/23311908.2024.2352959 (DOI)001229081300001 ()2-s2.0-85193752445 (Scopus ID)
Funder
AFA Insurance, 190082
Available from: 2024-05-22 Created: 2024-05-22 Last updated: 2025-04-24Bibliographically approved
Nordin, S., Finell, E. & Nordin, M. (2024). Coping, perceived environmental exposure control and mental distress in persons with symptoms attributed to environmental factors in a general population survey. Cogent Psychology, 11(1), Article ID 2424613.
Open this publication in new window or tab >>Coping, perceived environmental exposure control and mental distress in persons with symptoms attributed to environmental factors in a general population survey
2024 (English)In: Cogent Psychology, E-ISSN 2331-1908, Vol. 11, no 1, article id 2424613Article in journal (Refereed) Published
Abstract [en]

Coping strategies, perceived environmental exposure control and mental distress appear to be important concepts in persons with symptoms associated with environmental factors (SAEF), but their interplay is not well documented. The objective was to investigate (i) use of coping strategies, (ii) prevalence of perceived exposure control, (iii) whether the control is associated with mental distress and SAEF type, and (iv) whether coping strategies are associated with mental distress in SAEF regarding chemicals (SAEF-C), buildings (SAEF-B), electromagnetic fields (SAEF-EMF) and sounds (SAEF-S) in a general population. Cross-sectional population-based data (n = 391) and validated questionnaire instruments were used to assess symptoms of anxiety, depression, burnout and sleep disturbance, applying analysis of covariance and hierarchical regression analysis. The most used problem- and emotion-focused coping strategies were avoiding environments and accepting the situation, respectively. A majority of those with SAEF-C (71.7%), SAEFF-EMF (75.9%) and SAEF-S (64.1%), but not SAEF-B (36.4%) were able to control the adverse exposure, and low level of control was associated with anxiety, depression, burnout and sleep disturbance in all four SAEF types. Use of the strategies avoidance and eating/drinking/smoking were associated with depression, and reprioritizing with burnout. An implication of the results is that suitable coping strategies and perceived control may be considered as part of treatment of SAEF.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Idiopathic environmental intolerance, anxiety, depression, burnout, sleep disturbance, population-based, Environmental Psychology, Health Psychology, Mental Health
National Category
Psychology Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-232388 (URN)10.1080/23311908.2024.2424613 (DOI)001349353600001 ()2-s2.0-85209558875 (Scopus ID)
Funder
AFA Insurance, 190082
Available from: 2024-11-29 Created: 2024-11-29 Last updated: 2025-02-20Bibliographically approved
Köteles, F. & Nordin, S. (2024). Do somatic symptom distress and attribution predict symptoms associated with environmental factors?. Journal of Psychosomatic Research, 179, Article ID 111637.
Open this publication in new window or tab >>Do somatic symptom distress and attribution predict symptoms associated with environmental factors?
2024 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 179, article id 111637Article in journal (Refereed) Published
Abstract [en]

Objective: Not much is known on the development of symptoms associated with environmental factors (SAEF), also known as (idiopathic) environmental intolerances. Findings from qualitative studies suggest that appearance of symptoms might be the first step, followed by the acquisition of a specific attribution. The current study investigated cross-sectional and longitudinal (three years) associations between attribution and symptoms with respect to symptoms associated with chemical substances, certain indoor environments (buildings), sounds, and electromagnetic fields (EMFs).

Methods: We used data from the first two waves of the population-based Västerbotten Environmental Health Study (n = 2336). Participants completed the Patient Health Questionnaire Somatic Symptom Scale (PHQ-15), the Environmental Symptom-Attribution Scale, and answered single questions on the four aforementioned SAEFs.

Results: Using binary logistic regression analyses, all four SAEFs showed significant cross-sectional associations with somatic symptom distress and the respective attribution. In the longitudinal analysis, development of SAEF-Sound and SAEF-Chemicals were predicted by both somatic symptom distress and attribution. SAEF-EMFs was predicted only by attribution, whereas neither somatic symptom distress nor attribution forecasted SAEF-Buildings.

Conclusion: Overall, these findings suggest that attribution (i.e., a specific expectation) plays a substantial role in the development and maintenance of many SAEFs.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Chemical sensitivity, Electrohypersensitivity, Sick building syndrome
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-222231 (URN)10.1016/j.jpsychores.2024.111637 (DOI)001206230600001 ()2-s2.0-85186328451 (Scopus ID)
Funder
Afa Sjukförsäkringsaktiebolag, 190082
Available from: 2024-03-15 Created: 2024-03-15 Last updated: 2025-04-24Bibliographically approved
Andersson, E. M., Liv, P., Nordin, S., Näslund, U. & Lindvall, K. (2024). Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?. Social Science and Medicine, 341, Article ID 116530.
Open this publication in new window or tab >>Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?
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2024 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 341, article id 116530Article in journal (Refereed) Published
Abstract [en]

Background: Pictorial communication about subclinical atherosclerosis can improve cardiovascular disease (CVD) risk, but whether it leads to long-term shifts in self-rated CVD risk (risk perception) and beliefs about possibility to influence personal risk (efficacy beliefs) is unknown.

Purpose: To study the impact of personalized color-coded and age-related risk communication about atherosclerosis and motivational conversation, compared to traditional risk factor-based communication, on risk perception and efficacy beliefs. Also, whether risk perception increases with message severity.

Method: The effect of the pragmatic RCT Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) was analyzed using a linear mixed effects model with risk perception and efficacy believes at 1-year and 3-year follow up as dependent variables. Participants’ (n = 3532) CVD risk perception and efficacy beliefs were assessed with visual analog scales (0–10). Fixed effects were group (intervention vs control), time point (1 year or 3 years) and interaction between group and time point. Further, the models were adjusted for corresponding baseline measurement of the dependent variable and a baseline × time point interaction. Effect of pictorial color-coded risk in the intervention group was investigated using a corresponding mixed effects model, but with pictorial risk group (message severity) as exposure instead of intervention group.

Results: After one year, the intervention group rated their CVD risk as higher (m = 0.46, 95% CI 0.32–0.59), with an effect also after 3 years (m = 0.57, 95% CI 0.43–0.70). The effect was consistent in stratified analyses by sex and education. Overall, no effect on efficacy beliefs was observed. In the intervention group, differences in CVD risk perception were found between participants with different color-coded risk messages on atherosclerosis status.

Conclusion: Personalized, color-coded and age-related risk communication about atherosclerosis had an effect on risk perception with an effect also after 3 years, whereas overall, no effect on efficacy beliefs was observed.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Atherosclerosis, Cardiovascular disease, Pictorial communication, Prevention, Response efficacy, Risk perception, Self efficacy, Vascular age
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-218586 (URN)10.1016/j.socscimed.2023.116530 (DOI)001166046000001 ()38169179 (PubMedID)2-s2.0-85181833982 (Scopus ID)
Funder
Region Västerbotten, ALFVLL-298001Region Västerbotten, AALFVLL- 643391Swedish Research Council, 521-2013-2708Swedish Research Council, 2016–01891Swedish Research Council, 2017–02246Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481Swedish Society of MedicineThe Swedish Stroke AssociationSwedish Insurance SocietyVisare NorrThe Swedish Heart and Lung Association
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2024-08-26Bibliographically approved
Andersson, E. M., Lindvall, K., Wennberg, P., Johansson, H. & Nordin, S. (2024). From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification. BMC Psychology, 12(1), Article ID 47.
Open this publication in new window or tab >>From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification
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2024 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 12, no 1, article id 47Article in journal (Refereed) Published
Abstract [en]

Background: Non-adherence in the general population to preventive guidelines on cardiovascular disease calls for an interdisciplinary approach acknowledging psychological factors of relevance for risk communication and lifestyle modification. Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals, but there is limited understanding of how this relates to mechanisms of importance for behavioural change. Longitudinal studies on associations between patients’ reactions and lifestyle modification are missing. The population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. 

Methods: In the present study we assessed cognitive and emotional reactions to the intervention, and how these reactions are associated to lifestyle modification. The participants’ evaluation of the risk communication was assessed in the intervention group (n=1749). Lifestyle modification was assessed with a lifestyle index based on physical activity, diet, smoking and alcohol consumption at baseline and after 3 years. Associations between cognitive and emotional response and lifestyle modification were tested with analyses of covariance in a subset of participants (n=714-857).

Results: The intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. Severity of atherosclerosis was associated with emotional reactions, but emotions of strong negative valence were uncommon. Cognitive response and emotional arousal evoked by the intervention were positively associated with lifestyle modification, whereas negative emotions in isolation were not. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification.

Conclusions: The results demonstrate the potential of communicating asymptomatic atherosclerosis with a pictorial, colour-coded and age-related strategy, also including a motivational conversation. Furthermore, the results show the importance of CVD risk communication evoking engagement, and that an interaction between cognitive and emotional reactions might be central for sustained lifestyle modification. Our results also indicate that, in an asymptomatic population, atherosclerosis screening may strengthen disease prevention and health promotion.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Atherosclerosis, Lifestyle, Health behaviour, Prevention, Health promotion, Decision making, Cognition, Emotion 
National Category
Psychology Cardiology and Cardiovascular Disease
Identifiers
urn:nbn:se:umu:diva-218585 (URN)10.1186/s40359-023-01467-x (DOI)001148313000002 ()38268015 (PubMedID)2-s2.0-85182977469 (Scopus ID)
Funder
Region Västerbotten, Central ALFRegion Västerbotten, ALFVLL-298001Region Västerbotten, ALFVLL- 643391Swedish Research Council, 521–2013-2708Swedish Research Council, 2016- 01891Swedish Research Council, 2017–02246Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481The Swedish Stroke AssociationSwedish Insurance SocietyVisare Norr
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2025-02-10Bibliographically approved
Hybelius, J., Kosic, A., Salomonsson, S., Wachtler, C., Wallert, J., Nordin, S. & Axelsson, E. (2024). Measurement properties of the patient health questionnaire-15 and somatic symptom scale-8: a systematic review and meta-analysis. JAMA Network Open, 7(11), Article ID e2446603.
Open this publication in new window or tab >>Measurement properties of the patient health questionnaire-15 and somatic symptom scale-8: a systematic review and meta-analysis
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2024 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 7, no 11, article id e2446603Article in journal (Refereed) Published
Abstract [en]

Importance: The subjective experience of somatic symptoms is a key concern throughout the health care system. Valid and clinically useful instruments are needed.

Objective: To evaluate the measurement properties of 2 widespread patient-reported outcomes: the Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Scale-8 (SSS-8).

Data Sources: Medline, PsycINFO, and Web of Science were last searched February 1, 2024.

Study Selection: English-language studies reporting estimates pertaining to factor analysis, taxometric analysis, internal consistency, construct validity, mean scores in relevant groups, cutoffs, areas under the receiver operating characteristic curves (AUROCs), minimal clinically important difference, test-retest reliability, or sensitivity to change.

Data Extraction and Synthesis: Search hits were reviewed by independent raters. Cronbach α, Pearson r, means, and between-group effect sizes indicative of sensitivity to change were pooled in random-effects meta-analysis. Study quality was assessed using 3 instruments. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 reporting guideline.

Main Outcomes and Measures: Comprehensive overview of evidence pertaining to the measurement properties of the PHQ-15 and SSS-8.

Results: A total of 305 studies with 361 243 participants were included. Most concerned routine care (178 studies) and the general population (27 studies). In factor analyses, both scales reflected a combination of domain-specific factors (cardiopulmonary, fatigue, gastrointestinal, pain) and a general symptom burden factor. The pooled PHQ-15 α was 0.81 (95% CI, 0.80-0.82), but with low item-total correlations for items concerning menstrual problems, fainting spells, and sexual problems (item-total correlations <0.40), and the SSS-8 α was 0.80 (0.77-0.83). Pooled correlations with other measures of somatic symptom burden were 0.71 (95% CI, 0.64-0.78) for the PHQ-15 and 0.82 (95% CI, 0.72-0.92) for the SSS-8. Reported AUROCs for identification of somatoform disorders ranged from 0.63 (95% CI, 0.50-0.76) to 0.79 (95% CI, 0.73-0.85) for the PHQ-15 and from 0.71 (95% CI, 0.66-0.77) to 0.73 (95% CI, 0.69-0.76) for the SSS-8. The minimal clinically important difference on both scales was 3 points. Test-retest reliability could not be pooled and was inconsistent for the PHQ-15 (PHQ-15: r = 0.65-0.93; ICC, 0.87; SSS-8: r = 0.996, ICC = 0.89). The PHQ-15 showed tentative sensitivity to change (g = 0.32; 95% CI, 0.08-0.56), but data for the SSS-8 were lacking.

Conclusions and Relevance: In this systematic review and meta-analysis, findings supported use of the PHQ-15 and SSS-8 for the assessment of symptom burden, but users should be aware of the complex, multifactorial structures of these scales. More evidence is needed concerning longitudinal measurement properties.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024
National Category
Applied Psychology Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-232788 (URN)10.1001/jamanetworkopen.2024.46603 (DOI)001361870200007 ()39565620 (PubMedID)2-s2.0-85210109157 (Scopus ID)
Funder
Region Stockholm, FoUI-1004039
Available from: 2024-12-10 Created: 2024-12-10 Last updated: 2025-02-20Bibliographically approved
Projects
Specific reactive substances causing sensitization in sick building syndrome and chemical sensitivity? Sampling, analysis and health effects. [2010-965_Formas]; Umeå UniversityA chemosensory stress model for health symptoms in chemical environments [2011-00396_Forte]; Umeå UniversityThe effects of noise, socioeconomic status and genetics in the relationship between air pollution and dementia [2015-1099_Formas]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1699-1681

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