Yonder: Medically unexplained symptoms, dysmenorrhoea, mental health stigma, and YouTube

Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature

MUS. ‘Medically unexplained symptoms’ can be an uncomfortable and challenging diagnostic label for doctors and patients alike. It represents some of the most technically difficult and yet rewarding aspects of being a GP, such as dealing with uncertainty and taking a holistic, person-centred approach. In a Qualitative Health Research study, Canadian researchers sought to explore the experiences of individuals who had fallen into the umbrella of this diagnostic label.¹ They identified three experiential stages: searching for a diagnosis, living with uncertain symptoms, and finally, acceptance of their condition. Importantly, in light of the current strain on general practice in the NHS, the emphasis placed on the importance of relationship-based care is highly relevant and the challenge to maintain continuity seems to be particularly important for this population.

Dysmenorrhoea. This can be a debilitating condition for many women with the potential to significantly reduce quality of life as well as lead to absence from education and employment. Having identified an absence of patient-reported outcome measures in dysmenorrhoea, a group of researchers recently sought to develop a new measure that could be used in clinical trials.² Open-ended interviews with 52 women who suffered from dysmenorrhoea revealed that pain in the pelvic region was the most important symptom and despite rescue medication use, it often had a significant impact on many aspects of their lives. Interview data guided the production of a conceptual eDiary that includes assessment of menstrual bleeding severity, pain severity, use of analgesia, impact on school/work activities, physical activities, social activities, and sleep. Cognitive testing of the draft diary showed it was well understood by the participants. The research team will now complete psychometric testing and once the measure has been validated, it could be an important new dysmenorrhoea assessment tool and be used to help test future interventions.

Mental health stigma. With the NHS set to be high on the agenda in the forthcoming UK general election, the Liberal Democrat party have identified mental health as a key priority area and announced their support for radically increased funding in this area. Many GPs have been calling for this investment for years and have long recognised the increasing burden of psychiatric illness in society. In a recent systematic review, researchers led by the esteemed Professor Graham Thornicroft sought to understand the impact of mental health-related stigma on help-seeking for psychiatric problems. The study, published in Psychological Medicine, identified 144 articles with 90 189 participants.³ The team produced a conceptual model outlining multiple factors that contribute to this detrimental effect along with some that help to ameliorate it. Ethnic minorities, males, youths, and those in military and health professions were identified as being those most deterred by stigma and the authors suggest they should be particularly targeted in future interventions to promote help-seeking.

YouTube. Underage drinking is a significant public health issue that continues to receive much attention across the Western world. Exposure to alcohol-related marketing and advertising is acknowledged as an important contributing factor and the rise of social media has caused this to grow further in recent years. In the US, recommendations have recently outlined how alcohol marketing strategies must be self-regulated and how their content should be managed responsibly. An Alcohol & Alcoholism study sought to determine whether companies were implementing the new guidance.⁴ They identified the 16 alcohol brands most popular with young people and used fictitious YouTube profiles (with ages 14, 17, and 19 years) to attempt to access and view YouTube promotional channels they had sponsored. Worryingly, every profile, regardless of age, was able to access all 16 official YouTube channels. Although underage drinking is a complex social issue requiring a thoughtful and multifaceted approach, tighter regulation of online advertising is clearly an important step that needs to be taken.