The study by Kohlmann et al corroborates the finding that somatic symptom burden (defined as the number and severity of symptoms) is high in a population of patients with chronic disease and that such burden is associated with substantial quality-of-life impairment, largely from emotional health problems (anxiety and depression). In this case, they focused their study on only patients with coronary heart disease. This population is already at higher risk for depression and anxiety disorders and also at high risk for excessive testing. Given physician distress associated with treating patients with high symptom burden that, in turn, often leads to unnecessary diagnostic testing, clinicians should use the somatic symptom burden more as a “sed rate” for emotional distress, and treat accordingly, rather than as a sign of anatomic disease requiring further testing.
O’Malley PG. Symptom Number and Severity as a Sign of Emotional Distress in Patients With Cardiovascular Disease. JAMA Intern Med. 2013;173(15):1471. doi:10.1001/jamainternmed.2013.6630