Evidence map›Paper›PMID 40268773›Full record

SynthesisInternational journal of behavioral medicine2026

Understanding General Somatic Symptom Burden: Insights from a Systematic Review of Factor Analyses Pertaining to the Patient Health Questionnaire 15 (PHQ-15) and Somatic Symptom Scale 8 (SSS-8).

Jonna Hybelius, Amanda Kosic, Sigrid Salomonsson, Caroline Wachtler, John Wallert, Steven Nordin, Erland Axelsson

Abstract readSystematic Review
In one paragraph

Synthesis in International journal of behavioral medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Jonna HybeliusDivision of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Amanda KosicSchool of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
Sigrid SalomonssonCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Caroline WachtlerDivision of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
John WallertCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Steven NordinDepartment of Psychology, Umeå University, Umeå, Sweden.
Erland AxelssonDivision of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. erland.axelsson@ki.se.

Funding

Region Stockholm FoUI-1004039
6 · The paper itself

Abstract

backgroundFactor analyses have indicated that somatic symptom burden can be separated into local symptom domain factors (e.g., cardiopulmonary, fatigue, gastrointestinal, pain) and a general propensity toward being symptomatic. This study aimed to determine what specific physical symptoms, and correlates, that are most strongly associated with this general factor.

methodA systematic review was based on factor analyses of the Patient Health Questionnaire 15 (PHQ-15) and Somatic Symptom Scale 8 (SSS-8).

resultsThere was heterogeneity in the included studies, in terms of the exact specification of the factor structure, and to some extent regarding item inclusion for factor analysis. Among 11 analyses of the PHQ-15, the highest mean and median factor loadings on the general symptom burden factor were seen for fatigue (M = 0.65) followed by dizziness (0.63). Among three analyses of the SSS-8, the mean was highest for chest pain and shortness of breath (0.69), followed by fatigue (0.62). The PHQ-15 general factor exhibited variable, but usually moderate to strong, associations with anxiety and depression symptoms, health anxiety, somatosensory amplification, and functional somatic syndromes.

conclusionsCardiopulmonary symptoms and fatigue appear to be especially closely associated with general somatic symptom burden. The close associations between this general factor and indicators of poor mental health and functional somatic syndromes allow for numerous interpretations; both causal and due to overlapping definitions.

Indexed as

Medically Unexplained SymptomsPatient Health QuestionnaireSomatoform DisordersAnxietyDepressionFactor Analysis, StatisticalFatigueHumansFactor analysisPatient health questionnairePersistent physical symptomsSomatic symptom burdenSystematic review

Identifiers

PMID40268773
PMCPMC13160965

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.