By Robert C. Smith, JAMA Pediatrics, July 23, 2020
The study by Saunders and colleagues in JAMA Network Open is an important contribution to the field of what I’ll call medically unexplained symptoms (MUSs). MUSs in their most severe form encompass what the authors call somatic symptom and related disorders, as well as numerous other similar terms, such as somatic symptom disorder from psychiatry and chronic pain, irritable bowel syndrome, chronic fatigue, and fibromyalgia from medicine.
From the administrative database in Ontario, the authors identified 33 272 individuals as a study cohort: inpatients with MUS-type codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision–Canada (ICD-10-CA) and outpatients with psychosomatic codes for incident visits from 2008 to 2015. Approximately one-third of the patients were aged 4 to 17 years; the remaining two-thirds of the patients were aged 18 to 24 years. The authors calculated the health care costs and use in the year before and after the incident MUS diagnosis. Health care costs and use were high and remained so at follow-up, and many patients with MUSs did not receive physician-delivered mental health care for the high rates of mental disorders that were found.
About three-fourths of these data reflect on young adults aged 18 to 24 years. It would be valuable to know whether these patients differed from the younger patients in this study and from older adults reported in the literature. This would help inform the question of a spectrum of severity based on age of incident diagnosis of MUSs or a history of suffering from severe childhood disadvantages, such as abuse and poverty. There are data indicating that chronic childhood abuse (physical, sexual, or psychological) is highly associated with MUSs in adults.
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