Psychological distress of adult patients consulting a center for rare and undiagnosed diseases: a cross-sectional study

Abstract

Background: Centers for rare diseases serve as contact points for patients with complex, often undiagnosed complaints and persistent somatic symptoms of heterogeneous origin. Little is known about psychological distress of patients consulting these centers.

Objectives: To better understand psychological distress of adult patients presenting at a center for rare diseases by determining the proportion of patients screening positive for depressive, anxiety, and somatic symptom disorders (SSD) and to identify factors associated with increased psychopathology.

Methods: Cross-sectional data from the routine care registry of the Martin Zeitz Center for Rare Diseases (MZCSE) at the University Medical Center Hamburg-Eppendorf in Germany was retrieved and analyzed. We included all adult patients presenting between October 01,2020 and September 30,2021, who gave written informed consent.

Measures: Sociodemographic variables, medical history and healthcare utilization, as well as validated measures to screen for a depressive disorder (PHQ-8), an anxiety disorder (GAD-7), and SSD (PHQ-15, SSD-12).

Results: N = 167 patients were included (age 44.5 ± 14.3 years, 64.7% female). A total of 40.7% of the patients screened positive for a depressive disorder (PHQ-8 ≥ 10), 27.5% for an anxiety disorder (GAD-7 ≥ 10) and 45.0% screened positive for SSD (PHQ-15 ≥ 9 & SSD-12 ≥ 23). Factors associated with increased psychopathology included the number of symptoms, the number of different specialties consulted before and past psychotherapy.

Conclusions: Patients presenting at centers for rare diseases are likely to experience high rates of psychological distress. Systematically screening patients with rare and undiagnosed diseases for mental disorders can help to detect those at risk at an early stage and initiate adequate psychological care.

Keywords: Center for rare diseases; Mental health; Persistent somatic symptoms; Psychological distress; Rare diseases.

Fig. 1

Case numbers in the different stages of the routine patient flow at the MZCSE between 01/10/2020 and 30/09/2021

Fig. 2

Overlap between a positive screening for a depressive disorder, an anxiety disorder, and SSD in an area-proportional Venn-Diagramm. (Legend: N = 167; Depression: PHQ8 ≥ 10, Anxiety: GAD7 ≥ 10, SSD: PHQ15 ≥ 9 & SSD12 ≥ 23)