Psychotherapeutische und ärztliche Inanspruchnahme bei persistierenden somatischen Symptomen: 4-Jahres-Katamnese des Netzwerks für somatoforme und funktionelle Störungen (Sofu-Net)

Zusammenfassung

Hintergrund Das gestufte, koordinierte und interdisziplinäre Gesundheitsnetzwerk für somatoforme und funktionelle Störungen (Sofu-Net) wurde entwickelt, um Patienten mit somatoformen und funktionellen Störungen leitliniengerecht zu versorgen. Diese Studie evaluiert die klinische Symptomatik der Patienten, ihre psychotherapeutische und ärztliche Inanspruchnahme sowie deren Prädiktoren zur 4-Jahres-Katamnese einer kontrollierten Wirksamkeitsstudie.

Methodik 219 Patienten mit Risiko für somatoforme Störungen aus den Sofu-Net Praxen (n=119) und den Kontrollpraxen (n=100) wurden nach 4 Jahren mittels strukturierter Interviews erneut befragt. Outcomes zur 4-Jahres-Katamnese waren die klinische Symptomatik, die psychotherapeutische und ärztliche Inanspruchnahme.

Ergebnisse 127 Patienten (n=74 Sofu-Net, n=53 Kontrollpraxen) wurden nachbefragt. Im Vergleich zur Kontrollgruppe wurden die Sofu-Net Patienten signifikant häufiger in Psychotherapie vermittelt (55,4 vs. 35,8%). Ein jüngeres Alter und häufigere Hausarztgespräche anlässlich psychosozialer Probleme sagten die psychotherapeutische Inanspruchnahme vorher. In der Ausprägung der klinischen Symptomatik und im Ausmaß der ärztlichen Inanspruchnahme konnte kein Unterschied zwischen den beiden Gruppen festgestellt werden. Wichtige Prädiktoren waren die Anzahl somatischer Erkrankungen, erhöhte Krankheitsangst, weibliches Geschlecht, erhöhte depressive Symptomatik sowie eine niedrige körperliche und psychische Lebensqualität.

Diskussion Langfristig gelang durch die koordinierte und interdisziplinäre Netzwerkstruktur eine erfolgreichere Vermittlung von Risikopatienten in die Psychotherapie. Die Rolle des Hausarztes erwies sich dabei als wichtig. Allerdings ging dies weder mit einer Verbesserung des klinischen Zustandes der Patienten noch mit einer Abnahme der ambulanten ärztlichen Inanspruchnahme einher.

Abstract

Background The stepped, coordinated, interdisciplinary Health Network for Somatoform and Functional Disorders (Sofu-Net) was developed to provide guideline-based care for patients with somatoform and functional disorders. This controlled cluster cohort study evaluated patients’ mental and somatic health care use, clinical outcomes, and their predictors at 4-years follow-up.

Method 219 patients at risk for somatoform disorders from Sofu-Net practices (n=119) and control practices (n=100) were resurveyed after 4 years using structured interviews. Outcomes were mental and somatic health care use, somatic symptom burden and depressive symptoms.

Results 127 patients (n=74 Sofu-Net, n=53 controls) were followed up. Compared with the control group, Sofu-Net patients were significantly more likely to be referred to psychotherapy (55.4 vs. 35.8%). Younger age and more frequent GP consultations on the occasion of psychosocial problems predicted mental health care use. No difference was found between the two groups in the severity of clinical symptoms or in the extent of somatic health care use. Significant predictors were the number of somatic diseases, increased fear of illness, female gender, increased depressive symptomatology, low physical and mental quality of life.

Discussion In the long term, the coordinated and interdisciplinary network structure succeeded in more successfully referring high-risk patients to psychotherapy. The role of the primary care physician proved to be important. However, this was not accompanied by an improvement in the patients’ clinical condition or a decrease in outpatient physician utilization.

Schlüsselwörter

Somatoforme Störungen - Gesundheitsnetzwerk - funktionelle Störungen - hausärztliche Versorgung - Psychotherapie

Key words

somatoform disorders - collaborative stepped care - functional disorders - primary care - psychotherapy

Publication History

Received: 17 March 2021

Accepted: 03 October 2021

Article published online:
24 November 2021

• Literatur

• 1 Jacobi F, Höfler M, Strehle J. et al. Psychische Störungen in der Allgemeinbevölkerung: Studie zur Gesundheit Erwachsener in Deutschland und ihr Zusatzmodul Psychische Gesundheit (DEGS1-MH). Nervenarzt 2014; 85: 77-87
• 2 Löwe B, Spitzer RL, Williams JB. et al. Depression, anxiety and somatization in primary care: Syndrome overlap and functional impairment. Gen Hosp Psychiatry 2008; 30: 191-199
• 3 Hüsing P, Löwe B, Piontek K. et al. Somatoform disorder in primary care: T he influence of co-morbidity with anxiety and depression on health care utilization. J Affect Disord 2018; 24: 892-900
• 4 Jordan P, Shedden-Mora MC, Löwe B. Predicting suicidal ideation in primary care: an approach to identify easily assessable key variables. Gen Hosp Psychiatry 2018; 51: 106-111
• 5 Hiller W, Rief W, Brähler E. Somatization in the population: From mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 704-712
• 6 Kohlmann S, Löwe B, Shedden-Mora MC. Health care for persistent somatic symptoms across Europe: a qualitative evaluation of the EURONET-SOMA expert discussion. Front Psychiatrie 2018; 9: 646
• 7 Roenneberg C, Henningsen P, Sattel H. et al. S3-Leitlinie Funktionelle Körperbeschwerden. AWMF online. 2018
• 8 Smith RC, Gardiner JC, Luo Z. et al. Primary care physicians treat somatization. J Gen Inten Med 2009; 24: 829-832
• 9 Shedden-Mora M, Lau K, Kuby A. et al. Verbesserte Versorgung von Patienten mit somatoformen und funktionellen Störungen: Ein koordiniertes gestuftes Netzwerk (Sofu-Net). Psychiatr Prax 2015; 42: S60-S64
• 10 Härter M, Brandes A, Hillebrandt B. et al. psychenet–das Hamburger Netz psychische Gesundheit. Psychiatr Prax 2015; 42: S4-S8
• 11 Shedden-Mora M, Gross B, Lau K. et al. Collaborative stepped care for somatoform disorders: A pre – post-intervention study in primary care. J Psychosom Res 2016; 80: 23-30
• 12 Löwe B, Piontek K, Daubmann A. et al. Effectiveness of a stepped, collaborative, and coordinated health care network for somatoform disorders (Sofu-Net): A controlled cluster cohort study. Psychosom Med 2017; 79: 1016-1024
• 13 Kroenke K, Spitzer RL, Williams JB. et al. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345-359
• 14 Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002; 64: 258-266
• 15 Löwe B, Decker O, Müller S. et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical care 2008; 46: 266-274
• 16 Löwe B, Kroenke K, Herzog W. et al. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 2004; 81: 61-66
• 17 Kroenke K, Strine TW, Spitzer RL. et al. The PHQ-8 as a measure of current depression in the general population. J Affect Disord 2009; 114: 163-173
• 18 Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220-233
• 19 Pilowsky I. Dimensions of hypochondriasis. Br J Psychiatry 1967; 113: 89-93
• 20 Herzog A, Shedden-Mora MC, Jordan P. et al. Duration of untreated illness in patients with somatoform disorders. J Psychosom Res 2018; 107: 1-6
• 21 Mack S, Jacobi F, Gerschler A. et al. Self-reported utilization of mental health services in the adult German population – evidence for unmet needs? Results of the DEGS1 – Mental Health Module (DEGS1–MH). Int J Methods Psychiatr Res 2014; 23: 289-303
• 22 Weiss FD, Rief W, Kleinstäuber M. Health care utilization in outpatients with somatoform disorders: Descriptives, interdiagnostic differences, and potential mediating factors. Gen Hosp Psychiatry 2017; 44: 22-29
• 23 Weiss FD, Rief W, Martin A. et al. The heterogeneity of illness behaviors in patients with medically unexplained physical symptoms. Int J Behav Med 2016; 23: 319-326
• 24 Sarter L, Heider J, Kirchner L. et al. Cognitive and emotional variables predicting treatment outcome of cognitive behavior therapies for patients with medically unexplained symptoms: A meta-analysis. J Psychosom Res 2021; 110486
• 25 Claassen-van Dessel N, van der Wouden JC, Hoekstra T. et al. The 2-year course of medically unexplained physical symptoms (MUPS) in terms of symptom severity and functional status: results of the PROSPECTS cohort study. J Psychosom Res 2018; 104: 76-87
• 26 Tomenson B, Essau C, Jacobi F. et al. Total somatic symptom score as a predictor of health outcome in somatic symptom disorders. Br J Psychiatry 2013; 203: 373-380
• 27 Schaefert R, Kaufmann C, Wild B. et al. Specific collaborative group intervention for patients with medically unexplained symptoms in general practice: a cluster randomized controlled trial. Psychother Psychosom 2013; 82: 106-119
• 28 van der Feltz-Cornelis CM, van Oppen P, Adèr HJ. et al. Randomised controlled trial of a collaborative care model with psychiatric consultation for persistent medically unexplained symptoms in general practice. Psychother Psychosom 2006; 75: 282-289
• 29 Van Dessel N, Den Boeft M, van der Wouden JC. et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014
• 30 Rief W, Burton C, Frostholm L. et al. Core outcome domains for clinical trials on somatic symptom disorder, bodily distress disorder, and functional somatic syndromes: European network on somatic symptom disorders recommendations. Psychosom Med 2017; 79: 1008-1015
• 31 Heddaeus D, Dirmaier J, Daubmann A. et al. Clinical trial of a stepped and collaborative care model for mental illnesses and comorbidities in the Hamburg Network for Health Services Research. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2019; 62: 205-213
• 32 Patel M, James K, Moss-Morris R. et al. BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial. BMC Fam Pract 2020; 21: 1-15
• 33 Shedden-Mora MC, Kuby A, Tönnies J. et al. Stepped, Collaborative, Coordinated Care for Somatic Symptom and Related Disorders (Sofu-Net). Z Psychol 2020; 228: 119-129
• 34 Newby JM, Smith J, Uppal S. et al. Internet-based cognitive behavioral therapy versus psychoeducation control for illness anxiety disorder and somatic symptom disorder: A randomized controlled trial. J Consult Clin Psycho 2018; 86: 89
• 35 Abbass A, Town J, Holmes H. et al. Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials. Psychother Psychosom 2020; 1-8
• 36 Hofmann SG, Hayes SC. The future of intervention science: Process-based therapy. Clin Psychol Sci 2019; 7: 37-50