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.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Smith RC. It’s Time to View Severe Medically Unexplained Symptoms as Red-Flag Symptoms of Depression and Anxiety. JAMA Netw Open. 2020;3(7):e2011520. doi:10.1001/jamanetworkopen.2020.11520
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: