Latent class analysis of functional somatic symptoms in a population-based sample of twins

Abstract

Objective: This study aimed to investigate empirically how and in what way individuals with symptoms of functional somatic syndromes should be classified. We also aimed to look into genetic and environmental influences on the classification.

Method: A total of 28,531 twins aged 41-64 underwent screening interviews via a computer-assisted data collection system from 1998 to 2002. Nine functional somatic symptoms (abnormal tiredness, general muscular pain, recurrent abdominal discomfort, back pain, gastroesophageal reflux, recurrent headache, recurrent urinary problem, dizziness, breathlessness at rest) were assessed using structured questions in a blinded manner. Latent class analysis was applied to the data. Structural equation modeling was further performed in order to estimate the relative importance of genetic and environmental influences on class probability.

Results: Latent class analysis resulted in a five-class solution. Individuals in the first class did not show any health problems. Those assigned to the second, third, and fourth classes tended to have abnormal tiredness, gastrointestinal problems, and pain-related symptoms, respectively. Individuals in the fifth class had multiple symptoms to a greater extent than the other classes. All the five classes showed modest genetic influences (7-29% of the total variation) with gender differences except Class 3; however, the majority of influences on the class membership derived from unique environmental effects.

Conclusion: The findings suggested the necessity of redefining the existing classification criteria for functional somatic syndromes in terms of single (uncomplicated) or multiple (complicated) syndromes. Environmental influences are important for the etiology of functional somatic syndromes.

Keywords: chronic fatigue syndrome; chronic widespread pain; comorbidity; functional somatic syndromes; irritable bowel syndrome; latent class analysis.