Do ‘numbers’ count?

The article by Tomenson et al ¹ raised some interesting questions. The study concluded that total somatic symptom score predicted health status and healthcare use. We would like to highlight that another important parameter that could have been included is the duration of the symptoms. The measures that were used in the trials studied were all different and assessed current or lifetime symptoms and not duration or severity of symptoms. This could have an impact on healthcare use. Other drawbacks relate to care pathways and age of participants. In low- and middle-income countries, where there are many coexisting healthcare systems, relying only on allopathic setups may be difficult. Hence, traditional health systems would be an important aspect that could have been taken into consideration. The mean age range in the studies included in Tomenson et al’s analysis was highly variable (18-75 years) and could result in both medically explained and unexplained symptoms or both existing in the same individual. Measuring bothersome somatic symptoms or those that interfered with functioning, which again varied across the different instruments, may alone not indicate severity. The intensity of symptoms can have a bearing on severity as has been demonstrated by Kroneke et al. ² Another important component on health status and healthcare use would be the concept of abnormal illness behaviour. ³ Abnormal illness behaviour could also determine significant healthcare use. Tomenson et al have made efforts to consider health anxiety as a variable, which could again influence health status. Thus, it is not only the number of somatic symptoms that account for health outcome but other variables mentioned above too. Future research should focus on both current and lifetime symptoms, number, duration and severity of symptoms, and abnormal illness behaviour to better understand health status and healthcare use.