Mental distress and health-related quality of life among somatic inpatients: social gradients and hospital mental health implications based on the SomPsyNet study population

Purpose Proactive integrated consultation-liaison psychosomatics and psychiatry in somatic hospitals may improve patients’ mental health beyond inpatient stay. The «SomPsyNet» project targets SOMatic inpatients and aims to prevent PSYchosocial distress by establishing a structured care NETwork based on a Stepped and Collaborative Care Model (SCCM). We used a hospital-based epidemiological perspective to quantify prevalence and social gradients in mental distress and health-related quality of life (HRQoL).

We enrolled inpatients from three tertiary somatic hospitals, estimating how sociodemographic factors were associated with clinically relevant depressive symptoms, anxiety symptoms, somatic symptom distress, overall mental distress (≥1 measure above cut-off), mental, physical, and generic HRQoL, as well as somatic symptom burden.

Out of 3,179 participants, 37% showed mental distress. Mental, physical, and generic HRQoL were substantially impaired, while somatic symptom burden was moderate. Younger age and lower income were associated with higher odds of mental distress, lower mental HRQoL, and greater somatic symptom burden (all p-for-trend<0.05), yet younger patients showed better physical HRQoL, and higher income was associated with better generic HRQoL (p-for-trend<0.05). Having no Swiss citizenship or having an employment situation affected by disability, accident, or illness, was associated with worse outcomes across most (p’s<0.01) or all (p’s<0.05) indicators, respectively. Other factors showed less consistent associations.

A substantial proportion of somatic inpatients in the hospitals studied experienced mental distress and showed impaired HRQoL. Findings identified priority groups for hospital public mental health and inform resource planning for stepped, collaborative care and culturally/linguistically adapted services in acute somatic settings. Statements and Declarations Declaration of Competing Interest & Funding Independent of the Project: G.M. & R.S. received funding in the context of a Horizon Europe project from the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 22.00094. Further, G.M. & R.S. received funding from Wings Health Inc. in the context of a proof-of-concept study. G.M. received funding from the Swiss Heart Foundation under project no. FF21101, from the Research Foundation of the International Psychoanalytic University (IPU) Berlin under projects no. 5087 and 5217, from the Swiss National Science Foundation (SNSF) under project no. 100014_135328, from the German Federal Ministry of Education and Research under budget item 68606, and from the Hasler Foundation under project no. 23004. G.M. is co-founder and holds stock in Therayou AG, which is active in the field of digital and blended mental healthcare. G.M. receives royalties from publishing companies as author, including a book published by Springer, and an honorarium from Lundbeck for speaking at a symposium. Furthermore, G.M. is compensated for providing psychotherapy to patients, acting as a supervisor, serving as a self-experience facilitator (‘Selbsterfahrungsleiter’), and for postgraduate training of psychotherapists and supervisors. R.S. is co-editor of the German AWMF S3-Guidelines on Functional Complaints, and contributed to the German guidelines on irritable bowel syndrome, and on Lyme Borreliosis. R.S. is chairman of the Basel Institute for Psychosomatic Medicine (BIPM) and founder and managing director of the Psychosomatic and Psychosocial Services GmbH, that develops and implements psychosomatic and psychosocial training and continuing education programs. The authors declare no other potential conflict of interests. The research activities were fully independent and there were no intellectual or financial proprietary claims. Competing Interest Statement Declaration of Competing Interest & Funding Independent of the Project: G.M. & R.S. received funding in the context of a Horizon Europe project from the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 22.00094. Further, G.M. & R.S. received funding from Wings Health Inc. in the context of a proof-of-concept study. G.M. received funding from the Swiss Heart Foundation under project no. FF21101, from the Research Foundation of the International Psychoanalytic University (IPU) Berlin under projects no. 5087 and 5217, from the Swiss National Science Foundation (SNSF) under project no. 100014_135328, from the German Federal Ministry of Education and Research under budget item 68606, and from the Hasler Foundation under project no. 23004. G.M. is co-founder and holds stock in Therayou AG, which is active in the field of digital and blended mental healthcare. G.M. receives royalties from publishing companies as author, including a book published by Springer, and an honorarium from Lundbeck for speaking at a symposium. Furthermore, G.M. is compensated for providing psychotherapy to patients, acting as a supervisor, serving as a self-experience facilitator ("Selbsterfahrungsleiter"), and for postgraduate training of psychotherapists and supervisors. R.S. is co-editor of the German AWMF S3-Guidelines on Functional Complaints, and contributed to the German guidelines on irritable bowel syndrome, and on Lyme Borreliosis. R.S. is chairman of the Basel Institute for Psychosomatic Medicine (BIPM) and founder and managing director of the Psychosomatic and Psychosocial Services GmbH, that develops and implements psychosomatic and psychosocial training and continuing education programs. The authors declare no other potential conflict of interests. The research activities were fully independent and there were no intellectual or financial proprietary claims. Clinical Trial NCT04269005 Clinical Protocols https://pubmed.ncbi.nlm.nih.gov/37996236/ Funding Statement Funding: This work was supported by GFCH (grant number: PGV01_087). GFCH had no impact on the design of this study and did not influence the collection, execution, analyses, interpretation of the data, or the decision to submit the article/ contribution for publication. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethikkommission Nordwest- und Zentralschweiz (Hebelstrasse 53, 4056 Basel) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The datasets being held by the SomPsyNet project are not readily available due to their sensitive nature. In the case of inquiries by third parties that wish to reuse data SomPsyNet data after an embargo period, the following procedure is planned. Researchers interested in the data may submit a project synopsis addressed to the publications committee of the SomPsyNet project and will have to obtain authorization from the responsible ethics committee as ordained in the Ordinance of 20 September 2013 on Human Research with the exception of Clinical Trials (The Swiss Federal Council, 2013) (Human Research Ordinance, HRO). The publication committee will review the project synopsis and will answer the formal requests of applicants. Only upon collection of all important consents and upon approval of the responsible ethics committee(s), the requested data will be transferred to the applicants. Third parties must confirm and provide evidence to comply with all relevant Swiss and cantonal laws and regulations (especially regarding data protection and Human Research), as well as all obligations and regulations set out in the documents and contracts related to SomPsyNet. Fees may apply to cover expenses related to data reuse. Requests to access the datasets should be directed to Gunther Meinlschmidt, gunther.meinlschmidt{at}unibas.ch. Any future changes to the data sharing plan will be noted in Data Availability Statements and updated in the registry record.