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Invited Commentary
Pediatrics
July 23, 2020

It’s Time to View Severe Medically Unexplained Symptoms as Red-Flag Symptoms of Depression and Anxiety

Author Affiliations
  • 1Department of Medicine, Michigan State University, East Lansing
JAMA Netw Open. 2020;3(7):e2011520. doi:10.1001/jamanetworkopen.2020.11520

The study by Saunders and colleagues1 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.

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