Mapping the Healthcare Pathway to Multidisciplinary Assessment of 12-25 Year Olds With Somatic Symptom Disorder (PSOMA)

Mapping the Healthcare Pathway to Specialised Multidisciplinary Assessment of 12-25 Year Olds With Somatic Symptom Disorder: a Monocentric Descriptive Study Based on Interviews Assisted by a Biographical Grid

This study aims to describe the course of successive care events that follow individuals with somatic symptom disorder until they are assessed by a specialized multidisciplinary team. Data is collected during interviews with subjects aged 12 to 25 years old accompanied by their parents. A biographical grid is used to retrospectively identify all care events that occurred from first symptoms until multidisciplinary assessment. Life events and symptoms are collected as well to explore how history of healthcare consumption is linked to other trajectories. A qualitative analysis of the recorded interviews aims to describe the subjective experience of this healthcare pathway.

Study Overview

• Status: Not yet recruiting
• Conditions: Somatoform Disorders; Medically Unexplained Symptoms; Somatic Symptoms
• Intervention / Treatment: Other: Face-to-face interviews assisted by a biographical grid

Detailed Description

Somatic symptom disorders (SSD), previously labelled Somatoform disorders, are known to challenge healthcare professionals and systems, as those common conditions reducing quality of life often lead to excessive referrals and investigations before adequate diagnosis and management. Although studies have proved multiple interventions to be effective and cost-effective in various clinical settings, little is known about the accurate healthcare utilization associated with SSD. Such analysis faces the complexity of SSD detection and labelling due to heterogeneous clinical presentations and disputed cross-disciplinary classifications. Even though healthcare is known to be a core theme of patient experience of SSD, the investigators lack data describing the trajectory of care and the expectations, perceived help and triggering events associated with healthcare services use. A better understanding of the healthcare pathway those patients follow will help implement evidence-based treatment effectively.

The aim of this study is to trace back the pathway of care that individuals follow before they eventually undergo a specialised multidisciplinary assessment.

This descriptive study relies on data retrospectively collected from patients and their parents during face-to-face interviews assisted by a biographical grid. Inclusion criteria for patients are to be aged 12 to 25 years old and to be diagnosed with SSD by a specialised multidisciplinary team. Variables measured to describe the healthcare pathway are chosen according to professional experience and literature review. They are collected alongside concomitant life events both to reduce memory bias and to explore determinants and effects of healthcare consumption as a secondary outcome. The subjective experience of this healthcare pathway described by patients and their parents is analysed qualitatively in the verbatim of the audio recorded interview.

• Study Type: Observational
• Enrollment (Estimated): 36

Contacts and Locations

• Study Contact: Name: Marie Benhammani-Godard; Phone Number: 0033158411190; Email: marie.godard@aphp.fr
• Study Contact Backup: Name: Maude LUDOT-GREGOIRE, MD, PhD; Phone Number: +33 1 58 41 24 26; Email: maude.ludot@aphp.fr

Study Locations

• France
  • IDF
    • Paris, IDF, France, 75014
      • Maison de Solenn Maison des Adolescents, Cochin Hospital
      • Principal Investigator: Maude LUDOT-GREGOIRE, MD
      • Contact: Maude LUDOT-GREGOIRE, MD, PhD; Phone Number: +33 1 58 41 24 26; Email: maude.ludot@aphp.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Participants are selected among patients assessed in the recruiting centre, whatever their course after assessment.

The recruiting centre is an adolescent clinic which is part of a public teaching hospital in Paris, France. The centre provides inpatient and outpatient care delivered by a multidisciplinary team. Patients aged 11 to 18 can be referred to this centre by a healthcare professional or can directly access to care, regardless of their living area.

For each patient included, parents are asked to participate to research interviews to help map the healthcare pathway their child followed.

Description

Inclusion Criteria:

Criteria relating to the population studied:

• Age between 12 and 25 years old
• Diagnosis of somatic symptom disorder and derivatives (DSM 5) after specialized multidisciplinary evaluation by the team of the Maison des Adolescents of Cochin hospital (Maison de Solenn).

Criteria relating to the additional population participating in the research:

- Being a parent of a subject who has received the diagnosis of somatic symptom disorder and derivatives (DSM 5) after specialized multidisciplinary evaluation at the Maison des Adolescents of Cochin Hospital (Maison de Solenn).

Exclusion Criteria:

Criteria relating to the population studied:

• Age less than 12 years or greater than 25 years at the time of assessment,
• Subject presenting ongoing psychiatric decompensation, that is to say a state of mental health breaking with their baseline state and requiring rapid care which does not allow a research interview to be carried out.

Criteria relating to the additional population participating in the research:

None

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Adolescents; Patients aged 12 to 25 years old and diagnosed with SSD by a specialised multidisciplinary team	Other: Face-to-face interviews assisted by a biographical grid; Face-to-face interviews assisted by a biographical grid. Healthcare event of the adolescent : medical specialist appointment; general practitioner appointment; emergency services use; hospital admission; diagnostic test; medication use; non-pharmacological treatment; nursing or physical therapy; alternative care Biographical of the adolescent : Education eventClass/levelSchoolAttendanceSpecial arrangementsGradesOff school education; Family eventSeparation/unionBirth/deathLeave/ArrivalLocation/MovingDisease/accident; Peer eventsFriendshipsLove interestsBullying; Leisure & interests eventsActivityFrequency
Parents; Parents of an adolescent included	Other: Face-to-face interviews assisted by a biographical grid; Face-to-face interviews assisted by a biographical grid. Healthcare event of the adolescent : medical specialist appointment; general practitioner appointment; emergency services use; hospital admission; diagnostic test; medication use; non-pharmacological treatment; nursing or physical therapy; alternative care Biographical of the adolescent : Education eventClass/levelSchoolAttendanceSpecial arrangementsGradesOff school education; Family eventSeparation/unionBirth/deathLeave/ArrivalLocation/MovingDisease/accident; Peer eventsFriendshipsLove interestsBullying; Leisure & interests eventsActivityFrequency

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Occurrence of healthcare events	Successive healthcare events of individuals with somatic symptom disorder, from first symptoms to specialised multidisciplinary assessment	Day of inclusion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Raise of healthcare events occurrence	Raise of healthcare events occurrence following the occurrence of somatic symptoms. From first symptoms to specialised multidisciplinary assessment	Day of inclusion
Raise of life events occurrence	From first symptoms to specialised multidisciplinary assessment	Day of inclusion
Decrease of healthcare events occurrence	Decrease of healthcare events occurrence following the occurrence of somatic symptoms. From first symptoms to specialised multidisciplinary assessment	Day of inclusion
Decrease of life events occurrence	From first symptoms to specialised multidisciplinary assessment	Day of inclusion
Modification of somatic symptoms occurrence	From first symptoms to specialised multidisciplinary assessment	Day of inclusion
Modification of life events occurrence	Modification of life events occurrence following healthcare. From first symptoms to specialised multidisciplinary assessment	Day of inclusion
Qualitative analysis of the transcribed interviews	Identification of themes emerging from the qualitative analysis of the transcribed interviews	Up to 24 months

Collaborators and Investigators

• Sponsor: Assistance Publique - Hôpitaux de Paris
• Collaborators: URC-CIC Paris Descartes Necker Cochin
• Investigators: Principal Investigator: Maude LUDOT-GREGOIRE, MD, PhD, Maison des Adolescents - Cochin Hospital - AP-HP

Publications and helpful links

General Publications

• Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018 Mar;2(3):223-228. doi: 10.1016/S2352-4642(18)30022-1. Epub 2018 Jan 30.
• Joustra ML, Janssens KA, Bultmann U, Rosmalen JG. Functional limitations in functional somatic syndromes and well-defined medical diseases. Results from the general population cohort LifeLines. J Psychosom Res. 2015 Aug;79(2):94-9. doi: 10.1016/j.jpsychores.2015.05.004. Epub 2015 May 16.
• van Dessel N, den Boeft M, van der Wouden JC, Kleinstauber M, Leone SS, Terluin B, Numans ME, van der Horst HE, van Marwijk H. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014 Nov 1;2014(11):CD011142. doi: 10.1002/14651858.CD011142.pub2.
• Wortman MSH, Lokkerbol J, van der Wouden JC, Visser B, van der Horst HE, Olde Hartman TC. Cost-effectiveness of interventions for medically unexplained symptoms: A systematic review. PLoS One. 2018 Oct 15;13(10):e0205278. doi: 10.1371/journal.pone.0205278. eCollection 2018.
• Gosselin A, Desgrees du Lou A, Lelievre E; PARCOURS Study Group. How to use sequence analysis for life course epidemiology? An example on HIV-positive Sub-Saharan migrants in France. J Epidemiol Community Health. 2018 Jun;72(6):507-512. doi: 10.1136/jech-2017-209739. Epub 2018 Feb 2.
• Kachaner A, Harim M, Combier A, Trouvin AP, Avouac J, Ranque B, Piot MA. Management perspectives from patients with fibromyalgia experiences with the healthcare pathway: a qualitative study. Front Med (Lausanne). 2023 Dec 1;10:1231951. doi: 10.3389/fmed.2023.1231951. eCollection 2023.
• Hinton D, Kirk S. Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature. Health Soc Care Community. 2016 Jan;24(1):12-26. doi: 10.1111/hsc.12184. Epub 2015 Feb 16.
• Ludot M, Merlo M, Ibrahim N, Piot MA, Lefevre H, Carles ME, Harf A, Moro MR. ["Somatic symptom disorders" in adolescence. A systematic review of the recent literature]. Encephale. 2021 Dec;47(6):596-604. doi: 10.1016/j.encep.2021.04.007. Epub 2021 Sep 16. French.

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): March 1, 2028
• Study Completion (Estimated): March 1, 2028

Study Registration Dates

• First Submitted: August 30, 2024
• First Submitted That Met QC Criteria: August 30, 2024
• First Posted (Actual): September 3, 2024

Study Record Updates

• Last Update Posted (Actual): March 16, 2026
• Last Update Submitted That Met QC Criteria: March 13, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Adolescent; Medically unexplained symptoms; Health Care Utilization; Healthcare pathway; Young Adult; Somatoform disorder; Somatic symptoms; Healthcare trajectory; Care episodes
• Additional Relevant MeSH Terms: Mental Disorders; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Treatment Adherence and Compliance; Health Behavior; Medically Unexplained Symptoms; Somatoform Disorders; Patient Acceptance of Health Care
• Other Study ID Numbers: APHP240890; 2024-A01371-46 (Other Identifier: France : Ministry of Health)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No