Somatic distress among Syrian refugees with residence permission in Germany: analysis of a cross-sectional register-based study

Background Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aimed to examine the prevalence, co-occurrence, and risk factors of somatic distress among Syrian refugees in Germany. Methods This study analyzes the second measurement point (N = 116) of a prospective register-based survey among 200 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale (BISS); subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress), and self-reported outcomes of somatic distress (Patient Health Questionnaire (PHQ-15)), depression (PHQ-9), generalized anxiety disorder (GAD-7), and post-traumatic symptoms (Essen Trauma Inventory (ETI)). Results Almost half of the respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate-to-severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, and self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all of the common mental disorders studied. Conclusions The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers.

Somatic Distress, Mental Health and Psychological Resilience Among Cancer Patients During the Pandemic: A Cross-Sectional Study

Objective The current researches during COVID-19 have not yet addressed somatic distress among cancer patients. The aims of this study are to investigate the somatic distress and psychological symptoms levels of cancer patients, and analyze the influencing factors on somatic distress during the pandemic. Methods This cross-sectional study included consecutively selected 216 eligible cancer patients. The Patient Health Questionnaire-15, Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5, The Depression, Anxiety and Stress Scale-21, the Brief Resilience Scale, the Stressful Life Events List due to Pandemic and, demographic and clinical characteristics form were administered to the participants with face to face interviewing. Results The moderate to severe somatic distress rate was % 38 and probable PTSD rate was 20.4%. Depression, anxiety and stress symptoms were 36.1%, 49.1% and 45.4%, respectively, from mild to extremely severe at any level. There were substantial association between somatic symptoms severity and high PTSD, anxiety, depression, and stress symptoms levels. Low educations levels, high anxiety levels, high experience stressful life events, and low psychological resilience predicted high somatic distress levels. Conclusion This study demonstrates the high risk of somatic distress, PTSD, depression, anxiety and stress in patients with cancer during the pandemic. In addition, somatic distress may indicate high levels of psychological symptoms, high experience stressful life events, and low psychological resilience. It underscores the need to assess psychological status during the pandemic, especially those with high level somatic symptoms.

Prediction of effectiveness of potassium-competitive acid blocker and serotonin noradrenaline reuptake inhibitor on abnormal sensation in the throat: use of patient-reported outcome measures (PROMs)

Purpose To determine patients with abnormal sensation in the throat (AST) who would respond to potassium-competitive acid blocker (P-CAB) or serotonin noradrenaline reuptake inhibitor (SNRI) treatment. Methods AST patients were randomly divided into two groups. Thirty-one and 21 patients received P-CAB and SNRI treatment, respectively. GETS-J, the Japanese version of Glasgow Edinburgh Throat Scales (GETS), consisted of three subscales of throat symptoms (globus sensation, pain/swelling of the throat, and dysphagia) and somatic distress due to the disease, Frequency Scale for the Symptoms of Gastro-esophageal reflux disease (FSSG), and Hospital Anxiety and Depression Scale (HADS) were used before and after treatments. Responders to treatments were defined as those who showed 50% or more decrease in symptom scores or somatic distress. Results Pre-treatment GETS-J pain/swelling scores and FSSG acid reflux scores were higher in P-CAB responders and decreased after treatment. Receiver operating characteristic curve for pain/swelling subscale had an area under the curve (AUC) of 0.792 to predict P-CAB responders and a score of 11 provided the best combination of sensitivity (62.5%) and specificity (80%). Somatic distress and HADS anxiety scores, but no other GETS-J symptom scores, decreased after SNRI treatment. Pre-treatment globus scores were lower in SNRI responders. AUC value for globus subscale to predict SNRI responders was 0.741 and a score of 6.5 provided the best combination of sensitivity (70%) and specificity (73%). Conclusions Pain/swelling is a characteristic symptom in AST patients who respond to P-CAB treatment. SNRI treatment would be effective for somatic distress in cases with mild symptoms.

Somatic distress among Syrian refugees in Germany: analysis of a cross-sectional register-based study

Background: Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aim to examine the prevalence, co-occurrence and risk factors of somatic distress among Syrian refugees in Germany.Methods: The study design was a register-based cross-sectional survey of 116 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale – BISS; subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress) and self-reported outcomes of somatic distress (Patient Health Questionnaire 15), depression (Patient Health Questionnaire – 9), generalized anxiety disorder (GAD – 7), and post-traumatic symptoms (Essen Trauma Inventory).Results: Almost half of respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate to severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all common mental disorders studied.Conclusions: To date, there was no data on the specific patterns of somatic distress among Syrian refugees in Germany. The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers.

GDF15: A Hormone Conveying Somatic Distress to the Brain

GDF15 has recently gained scientific and translational prominence with the discovery that its receptor is a GFRAL-RET heterodimer of which GFRAL is expressed solely in the hindbrain. Activation of this receptor results in reduced food intake and loss of body weight and is perceived and recalled by animals as aversive. This information encourages a revised interpretation of the large body of previous research on the protein. GDF15 can be secreted by a wide variety of cell types in response to a broad range of stressors. We propose that central sensing of GDF15 via GFRAL-RET activation results in behaviors that facilitate the reduction of exposure to a noxious stimulus. The human trophoblast appears to have hijacked this signal, producing large amounts of GDF15 from early pregnancy. We speculate that this encourages avoidance of potential teratogens in pregnancy. Circulating GDF15 levels are elevated in a range of human disease states, including various forms of cachexia, and GDF15-GFRAL antagonism is emerging as a therapeutic strategy for anorexia/cachexia syndromes. Metformin elevates circulating GDF15 chronically in humans and the weight loss caused by this drug appears to be dependent on the rise in GDF15. This supports the concept that chronic activation of the GDF15-GFRAL axis has efficacy as an antiobesity agent. In this review, we examine the science of GDF15 since its identification in 1997 with our interpretation of this body of work now being assisted by a clear understanding of its highly selective central site of action.

Mental health and psychosocial support for families of missing persons in Sri Lanka: a retrospective cohort study

BackgroundThe International Committee of the Red Cross (ICRC) has developed its ‘Accompaniment model’ to address the multi-faceted needs of relatives of people who go missing during armed conflict. In Sri Lanka an Accompaniment Programme was launched in 2015 for the relatives of the more than 16,000 missing persons who remain unaccounted for. Method1,783 relatives who took part in the mental health and psychosocial support (MHPSS) component of the ICRC’s Accompaniment Programme in Sri Lanka between April 2016 and August 2017 were offered eight peer-support group sessions, individual home visits, referrals to local services, and commemoration events to pay tribute to their missing relatives. Symptoms of anxiety and depression (using the HADS scale), somatic distress (using the BSI scale) and daily functioning (ICRC scale) were assessed before and after the MHPSS intervention. ResultsPrior to receiving support, Tamil and Muslim ethnicity, ≥60 years of age and civilian status were predictors of severe symptoms of anxiety; Tamil ethnicity, ≥50 years of age and being the mother of a missing person were predictors of severe symptoms of depression; and ≥50 years of age and severe symptoms of anxiety and depression were predictors of severe somatic pain. After receiving support, the vast majority of the relatives of missing persons showed reduced levels of anxiety (81%), depression (79%) and somatic pain (77%), as well as increased functioning (75%). Predictors of improvement following support were severe levels of distress at baseline and Tamil and Muslim ethnicity. In addition, attending at least three group sessions was a predictor of decreased anxiety, age group 51-60 was a predictor of decreased depression, female gender was a predictor of decreased somatic distress, and referrals were a predictor of increased functioning. ConclusionThe MHPSS component of the ICRC’s Accompaniment Programme is a promising approach to helping families to cope with not knowing the fate and whereabouts of their missing relatives, to reduce distress, to break their social isolation and to resume more functional lives. However, further research is needed, possibly through a controlled trial, to better establish the effectiveness of this approach.