Sensitivities and specificities of questionnaires and clinical signs and symptoms to predict daily life impairment after SARS-CoV-2 infection varied across different health sectors.

BACKGROUND

To investigate the impact of patient selection in different health sectors on sensitivities and specificities of psychosomatic questionnaires and clinical signs and symptoms (CSS) for predicting daily life impairment (DLI) in individuals after SARS-CoV-2 infection.

METHODS

Secondary data analysis of three independent cross-sectional surveys in general population (n = 2828), fourteen primary care practices (n = 204), and rehabilitation hospital (n = 161). DLI and symptoms were captured using questionnaires. PHQ-15 (Patient Health Questionnaire-15) and SSD-12 (Somatic Symptom Disorder-12), PHQ-2 (Patient Health Questionnaire-2), GAD-2 (Generalized Anxiety Disorder-2), and FAS (Fatigue Assessment Scale) were used to assess somatic symptom disorder (SSD), depression, anxiety and fatigue. Diagnostic indices were calculated to predict DLI.

RESULTS

The sensitivities of questionnaires and CSS increased, and specificities decreased from general population to practices and hospital. SSD-12 had a higher diagnostic odds ratio (dOR; 95 % confidence interval) (17.4; 12.6-24.0) in population than in practices (8.4; 3.6-19.7) or hospital (8.1; 1.7-31.7). FAS > 22 had higher dOR (15.0; 11.8-19.1) in population than in practices (5.3; 2.8-9.8) or hospital (4.8; 1.4-16.3). The pattern (population / practice / hospital) was similar in depression (9.2; 7.0-12.0 / 8.0; 3.6-18.1 / 12.2; 1.5-96.2) and anxiety (8.0; 6.0-10.8 / 2.4; 1.0-5.6 / 3.0; 0.6-14.1). Areas under the curves of questionnaires were highest in population, followed by hospital, and consistently lower for practices.

CONCLUSION

There is a large variation in sensitivities and specificities to predict DLI. The extent to which SSD or psychosomatic comorbidity contributes to DLI varied across the health sectors in which patients are diagnosed and treated.