Trajectories of persistent physical symptoms in primary care: A secondary analysis of the PsicAP randomized clinical trial comparing CBT versus treatment as usual

The course of persistent physical symptoms (PPS) is heterogeneous, yet little is known about distinct symptom trajectories and their baseline predictors across treatment conditions in primary care. This study aimed to identify PPS trajectories and their associated baseline characteristics in patients receiving treatment as usual (TAU) or transdiagnostic group cognitive behavioral therapy (TDG-CBT). Latent Class Growth Analysis (LCGA) was used to identify trajectories of PPS (PHQ-15) over 12 months in 497 participants from the PsicAP randomized clinical trial (TAU: n = 242; TDG-CBT: n = 255). Baseline predictors of trajectory membership were examined using multinomial logistic regression. Three trajectories were identified within each treatment group: recovery, moderate chronic, and severe chronic. Recovery (class 1) was more frequent in TDG-CBT (54.9%) than in TAU (28.9%), whereas moderate chronic (class 2) and severe chronic (class 3) were more common in TAU ( class 2 = 49.2%, class 3 = 21.9%) than in TDG-CBT ( class 2 = 32.6%, class 3 = 12.6%). In TAU, chronic trajectories were associated with being female, having a partner, and higher baseline depressive symptoms. In TDG-CBT, chronic trajectories were associated with not having a partner, lower income, higher depressive and panic symptoms, and antidepressant use. TDG-CBT nearly doubles the likelihood of recovery and reduces chronic symptom trajectories compared with TAU. Baseline clinical severity and socioeconomic vulnerability may help identify patients at risk of chronic symptom courses and guide more tailored treatment strategies. • Distinct 12-month PPS trajectories were identified: recovery, moderate chronic, and severe chronic. • Distributions of the trajectories differed between TAU and TDG-CBT. • In TAU, chronicity linked to being a woman, partnership, depressive symptoms. • In TDG-CBT, chronicity linked to no partner, low income, depression, panic. • Trajectory identification and baseline factors may guide tailored PPS interventions.