Improving the Measurement of Functional Somatic Symptoms With Item Response Theory

More than 40 questionnaires have been developed to assess functional somatic symptoms (FSS), but there are several methodological issues regarding the measurement of FSS. We aimed to identify which items of the somatization subscale of the Symptom Checklist-90 (SCL-90) are more informative and discriminative between persons at different levels of severity of FSS. To this end, item response theory was applied to the somatization scale of the SCL-90, collected from a sample of 82,740 adult participants without somatic conditions in the Lifelines Cohort Study. Sensitivity analyses were performed with all the participants who completed the somatization scale. Both analyses showed that Items 11 "feeling weak physically" and 12 "heavy feelings in arms or legs" were the most discriminative and informative to measure severity levels of FSS, regardless of somatic conditions. Clinicians and researchers may pay extra attention to these symptoms to augment the assessment of FSS.