Psychosomatic profile in patients with systemic sclerosis: results from an observational study

Abstract

Objectives: The aim of the present study was to test whether the occurrence of psychosomatic syndromes in patients with systemic sclerosis (SSc) may influence psychopathological distress and well-being.

Methods: A total of 276 outpatients with SSc were consecutively enrolled. Mental disorders were assessed using the Mini-International Neuropsychiatric Interview (MINI), while psychosomatic syndromes were assessed using the Semi-Structured Interview for Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R-SSI). Psychological distress and well-being were assessed using the Mental Pain Questionnaire (MPQ), the Symptom Questionnaire (SQ), the Psychological Well-Being (PWB) scales, the 5-item World Health Organization Well-Being Index (WHO-5), the Euthymia Scale (ES), and the Pictorial Representation of Illness and Self Measure (PRISM). Latent Class Analysis (LCA) was performed on the 14 items of the DCPR-R-SSI. The LCA solution identified two distinct latent patient groups with distinct clinical profiles: LC1, comprising 255 patients (92.4%), and LC2, comprising 21 patients (7.6%).

Results: DCPR-R allostatic overload, demoralization, irritable mood, type a behavior, and alexithymia primarily discriminated between the two distinct latent groups of patients. The probabilities of observing these syndromes were higher among the patients belonging to the LC2 group. Depression was found to be associated with belonging to the LC2 group, as well as with higher scores on the MPQ and the SQ scales for depression, anxiety, anger-hostility, and somatization (p < 0.05). In addition, lower scores were observed on the PWB scales for environmental mastery, positive relationships with others, purpose in life, and self-acceptance, as well as on the WHO-5, ES, and PRISM measures of feeling at peace (p < 0.05).

Conclusion: Psychosomatic syndromes may help define distinct clusters among patients with SSc, reflecting specific clinical profiles that should be considered during patient assessment and when proposing tailored interventions.

Keywords: DCPR; psychological distress; resilience; systemic sclerosis; well-being.

Figure 1

Pictorial representation of illness and self measure (PRISM).

Figure 2

Probability of the DCPR diagnoses occurrence: 2 latent groups identified via the LCA notes: Each psychosomatic syndrome is labelled with an A letter as manifest variable. Pr 0.0999 refers to LC2 group. Pr 0.9001 refers to LC1 group.