|
|
 | True |
Incorrect
Symptom
severity ratings may correlate poorly with the severity of the
underlying anatomical or physiological disturbance. In fact, high
symptom severity ratings have been shown to be one marker
for a potential underlying depressive or anxiety disorder.
On the 0 to
10 scale which these patients completed, a severity rating of
6 or higher may make it up to twice as likely that the patient
also has a comorbid depressive or anxiety disorder. Other predictors
of psychiatric comorbidity include recent stress, high symptom
counts, and poor self-rated health. These four predictors
have been labeled the "S4 model" and have been validated
in three separate studies of medical outpatients, (Jackson
et al.,1998; Jackson
et al., 2001; Kroenke
et al.,1997a) which are summarized in Table 7.1 below.
| Table
7.1: S4 Model: Predictors of Depressive or Anxiety Disorders
|
|---|
| Variable
| Study
A[Kroenke 25 ]
| Study
B [Jackson and Kroenke, 2001]
| Study
C [Jackson et al., 1998]
|
|---|
| Number
of subjects |
500
|
250
|
185
|
| Study
population | Primary
care patients present-ing with somatic complaints | Primary
care patients present-ing with somatic complaints | New
patients referred to rheumatology clinic |
| Individual
predictor * | Odds
Ratio for Depressive or Anxiety Disorder † |
|
Stress in past week |
4.9
|
6.7
|
3.3
|
| Symptom
count > 5 |
3.1
|
4.0
|
4.5
|
| Self-rated
health as low |
2.7
|
2.2
|
3.4
|
| Severity
of symptom > 5 |
2.0
|
1.2
|
1.6
|
| Number
of predictors | Percent
with Depressive or Anxiety Disorder |
|
0
|
8
|
2
|
0
|
|
1
|
16
|
19
|
16
|
|
2
|
43
|
39
|
37
|
|
3
|
69
|
72
|
70
|
|
4
|
94
|
--
|
94
|
|
*
The four S4 predictors are (1) recent stress (yes/no);
(2) symptom count greater than 5 on PRIME-MD checklist
of 15 somatic symptoms; (3) self-rated overall health
of poor or fair on a 5-point scale (excellent, very
good, good, fair, poor); (4) self-rated severity of
presenting somatic symptom of 6 or greater on 0 (none)
to 10 (unbearable) scale.
†
All odds ratios are significant (i.e., lower bounds
of 95% confidence interval exceeds 1.0) except for
severity of symptom in Study B.
Table
reproduced with permission from Kroenke et al, J Clin
Psychiatry, 2003.
|
|
|
