• Alan J Carson, Jon Stone, Christian Holm Hansen, Rod Duncan, Jonathon Cavanagh, Keith Matthews, G Murray, and Michael Sharpe.
• Department of Psychiatry, University of Edinburgh, Edinburgh, UK Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK.
• J. Neurol. Neurosurg. Psychiatr.. 2015 Mar 1;86(3):295-301.

ObjectiveSomatic symptoms unexplained by disease are common in all medical settings. The process of identifying such patients requires a clinical assessment often supported by clinical tests. Such assessments are time-consuming and expensive. Consequently the observation that such patients tend to report a greater number of symptom has led to the use of self-rated somatic symptom counts as a simpler and cheaper diagnostic aid and proxy measure for epidemiological surveys. However, despite their increasing popularity there is little evidence to support their validity.MethodsWe tested the score on a commonly used self-rated symptom questionnaire- the Patient Health Questionnaire (PHQ 15) (plus enhanced iterations including an additional 10 items on specific neurological symptoms and an additional 5 items on mental state) for diagnostic sensitivity and specificity against a medical assessment (with 18 months follow-up) in a prospective cohort study of 3781 newly attending patients at neurology clinics in Scotland, UK.ResultsWe found 1144/3781 new outpatients had symptoms that were unexplained by disease. The patients with symptoms unexplained by disease reported higher symptoms count scores (PHQ 15: 5.6 (95% CI 5.4 to 5.8) vs 4.2 (4.1 to 4.4) p<0.0001). However, the PHQ15 performed little better than chance in its ability to identify patients with symptoms unexplained by disease. The findings with the enhanced scales were similar.ConclusionsSelf-rated symptom count scores should not be used to identify patients with symptoms unexplained by disease.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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