Lessons learned from applying established cut-off values of questionnaires to detect somatic symptom disorders in primary care: a cross-sectional study

Victoria von Schrottenberg; Anne Toussaint; Alexander Hapfelmeier; Clara Teusen; Bernhard Riedl; Peter Henningsen; Jochen Gensichen; Antonius Schneider; Klaus Linde

doi:10.3389/fpsyt.2023.1289186

Lessons learned from applying established cut-off values of questionnaires to detect somatic symptom disorders in primary care: a cross-sectional study

Front Psychiatry. 2024 Jan 18:14:1289186. doi: 10.3389/fpsyt.2023.1289186. eCollection 2023.

Authors

Victoria von Schrottenberg¹, Anne Toussaint², Alexander Hapfelmeier^{1

3}, Clara Teusen¹, Bernhard Riedl¹, Peter Henningsen⁴, Jochen Gensichen⁵, Antonius Schneider¹, Klaus Linde¹

Affiliations

¹ Department Clinical Medicine, Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
² Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ Institute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
⁴ Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany.
⁵ Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany.

Abstract

Introduction: Based on two diagnostic accuracy studies in high-prevalence settings, two distinctly different combinations of cut-off values have been recommended to identify persons at risk for somatic symptom disorder (SSD) with the combination of the Patient-Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder-B Criteria Scale (SSD-12). We investigated whether the reported sensitivity and specificity of both recommended cut-off combinations are transferable to primary care.

Methods: In a cross-sectional study, 420 unselected adult primary care patients completed PHQ-15 and SSD-12. Patients scoring ≥9 and ≥ 23 (recommended cut-off combination #1) or ≥ 8 and ≥ 13 (recommended cut-off combination #2) were considered test-positive for SSD, respectively. To assess the validity of the reported sensitivity and specificity in different low- to high-prevalence settings, we compared correspondingly expected proportions of test positives to the proportion observed in our sample.

Results: Based on combination #1, 38 participants (9%) were found to be test positive, far fewer than expected, based on the reported values for sensitivity and specificity (expected minimum frequency 30% with a true prevalence ≥1%). This can only be explained by a lower sensitivity and higher specificity in primary care. For combination #2, 98 participants (23%) were test positive, a finding consistent with a true prevalence of SSD of 15% or lower.

Discussion: Our analyzes strongly suggest that the sensitivity and specificity estimates reported for combination #1 are not applicable to unselected primary care patients and that the cut-off for the SSD (≥23) is too strict. Cut-off combination #2 seems more applicable but still needs to be tested in studies that compare screening findings by questionnaires with validated diagnostic interviews as reference standards in primary care populations.

Keywords: PHQ-15; SSD-12; primary healthcare; questionnaires; sensitivity and specificity; somatic symptom disorder.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the German Research Foundation (DFG-Deutsche Forschungsgemeinschaft, https://www.dfg.de/) under Grant [GrK 2621].