Risk of somatic symptom disorder in people with major medical disorders: Cross-sectional results from the population-based Hamburg City Health Study

Background: Somatic Symptom Disorder (SSD) is characterized by excessive thoughts, emotions, and behaviors related to physical symptoms irrespective of their etiology. Estimates of SSD frequency assessed via self-report questionnaires range between 6.7% (general population) and 53% (specialized setting). This study aims to examine the frequency of risk of SSD and associated factors in people with Major Medical Disorders (MMD) using cross-sectional data from the population-based Hamburg City Health Study.

Methods: Risk of SSD was operationalized using the Somatic Symptom Scale-8, the Somatic Symptom Disorder-B Criteria Scale-12, and one item on symptom persistence. People at risk of SSD and not at risk were compared regarding biopsychosocial factors. Factors associated with risk of SSD were identified by hierarchical multiple logistic regression analysis.

Results: N = 1944 people (mean age 64.8 ± 8 years, 43.8% female) reported at least one MMD. Of those, 6.8% [95%, CI 5.6-7.9%] were at risk of SSD and reported greater healthcare utilization and lower health-related quality of life. Logistic regression identified higher age (p=.032), lower education (p=.002), number of somatic comorbidities (p<.001), and elevated neuroticism (p<.001) and depression (p<.001) scores as factors associated with risk of SSD, with an explained variance of Nagelkerke R²=0.45.

Conclusion: The observed frequency of risk of SSD in people with MMD does not point towards an excessive symptom burden in this sample. However, those at risk experience significant psychosocial burdens and increased healthcare utilization, highlighting a vulnerable subgroup prone to SSD.