What psychological interventions are effective for the management of persistent physical symptoms (PPS)? A systematic review and meta-analysis.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9605409 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2044-8287 (Electronic) Linking ISSN: 1359107X NLM ISO Abbreviation: Br J Health Psychol Subsets: MEDLINE

Publication: <2012-> : Chichester : Wiley-Blackwell
Original Publication: Leicester, UK : British Psychological Society, c1996-

Psychosocial Intervention* ; Medically Unexplained Symptoms*; Adult ; Humans ; Anxiety/therapy ; Depression/therapy

Objectives: Presentation of persistent physical symptoms is associated with increased health care utilization, yet clinical outcomes often remain suboptimal. This systematic review aimed to determine whether psychological interventions are effective for the management of PPS and if so, what are the features of the interventions and at what level of care are they delivered. The review also set out to establish which symptoms in those diagnosed with PPS can be effectively managed with psychological intervention.
Methods: Studies were included if they clearly reported a psychological intervention, specified the study sample as adults with a diagnosis of persistent physical symptoms, included a comparator and as a minimum an outcome measure of somatic symptoms. Risk of bias was assessed using the EPHPP. Meta-analysis was conducted to estimate the overall effect of interventions on somatic symptoms (the primary outcome), anxiety and depression (secondary outcomes).
Results: Seventeen papers of varying quality indicated that psychological interventions can be effective for the management of somatic symptoms reported by individuals with PPS within a primary care setting. Psychological interventions were also found to be effective at reducing depression symptoms in individuals with PPS in twelve of the included studies. However, the meta-analysis results suggest that the psychological interventions utilized within eleven of the included studies did not significantly impact anxiety symptoms.
Conclusions: Psychological interventions have some success in managing somatic symptoms in PPS patients within primary care settings although their effects on other psychological symptoms is more mixed. The review highlights the importance of establishing a clearer diagnostic classification to inform treatment trajectories and the need for appropriate training and support within a multi-disciplinary team to enable the provision of such therapies.
(© 2022 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

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Keywords: anxiety; depression; meta-analysis; persistent physical symptoms; psychological interventions; somatic symptoms; systematic review

Date Created: 20220715 Date Completed: 20230109 Latest Revision: 20230412

20231215

PMC10084386

10.1111/bjhp.12613

35837827