Course and prediction of somatoform disorder and medically unexplained symptoms in primary care

doi:10.1016/j.genhosppsych.2011.05.002

General Hospital Psychiatry

Volume 33, Issue 4, July–August 2011, Pages 318-326

https://doi.org/10.1016/j.genhosppsych.2011.05.002 Get rights and content

Abstract

Theory/objective

Somatoform disorder (SFD) is associated with considerable psychosocial impairment. However, only a few studies have dealt with the course of this clinical subgroup. Therefore, the objective was to identify predictors for the various courses of SFD and medically unexplained symptoms (MUS).

Method

We screened 620 consecutive patients in primary care using the Patient Health Questionnaire (PHQ-15). Afterwards, 308 patients were studied in more detail using a diagnostic interview and a set of questionnaires. One year later, we were able to interview 277 participants a second time.

Result

After 1 year, 48.8% of the respondents had a remitted SFD. The following variables proved to be significant predictors of MUS: current depressive episode, negative life events, number of MUS at baseline, attributional style, autonomic sensations and catastrophizing cognitions. The course of SFD could be predicted through current depressive or anxiety disorder, negative life events, functional disability and attributional style.

Conclusion

Somatoform disorder has a favorable course. The predictors of the courses of SFD and MUS we found can be integrated into previous explanatory models. The coping with MUS or SFD can be seen as a mediating factor.

Section snippets

Setup

The screening and the baseline interviews took place between February and September 2008 at two primary care practices in Mainz, Germany. Both practices are part of the regular German health system with two GPs working at each practice. The follow-up interviews were carried out between February and October 2009.

Sample procedure

The objective of this survey was to analyze in detail the high-risk group of SFD in primary care. Correspondingly, it was designed as a two-stage follow-up study. The index study was

Sample characteristics

The sample characteristics are illustrated in Table 2. Of the 277 patients who had participated in the diagnostic interview and the follow-up, 200 (72.2%) were female. The mean age was 47.7 years (S.D.=16.4, range 18–87 years). The majority of participants shared a household with one (37.5%), two (13.7%) or more (15.8%) persons. Only one third (32.5%) of the participants lived alone. A total of 58.1% had a school education of 12 years or more, a percentage that is about twice as high as in the

Discussion

The objective of this study was to examine the course of SFD and to extract predictors that could forecast the courses of SFD and MUS 1 year later.

Broadly consistent with previous data [7], [17], [31], 48.8% of somatoform patients had a remitted SFD. Although the number of newly ill patients (13; 4.7%) was relatively low, the prevalence and the incidence rates were nevertheless comparable to other studies [31], [32]. Also in our study, women seemed to have a definitely higher risk of illness

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Since the publication of this systematic review several additional studies have been performed, both in general populations as in primary care [12–15]. Results differed from Olde Hartman’s, as in these studies even 43 to 68% of participants had persistent symptoms after 1 year [12–14] or 2 years [15] of follow-up. Although the described studies provide some information about the course of MUPS, several aspects still need to be elucidated.
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Negative affect as mediator between emotion regulation and medically unexplained symptoms
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Research on emotion regulation (ER) in medically unexplained physical symptoms (MUS) is rare.
The goal of this study was to compare ER skills between MUS-patients without comorbid depression, MUS-patients with comorbid depression (MUS + MDD), patients with major depressive disorder (MDD), and healthy controls. Additionally, we examined the mediating effect of depression and anxiety on the relationship between ER and somatization.
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Psychiatry and Primary CareCourse and prediction of somatoform disorder and medically unexplained symptoms in primary care

Abstract

Theory/objective

Method

Result

Conclusion

Section snippets

Setup

Sample procedure

Sample characteristics

Discussion

J Psychosom Res

Gen Hosp Psychiatry

Clin Psychol Rev

Lancet

J Psychosom Res

J Psychosom Res

J Psychosom Res

J Psychosom Res

Psychosomatics

J Psychosom Res

J Psychosom Res

Psychosomatics

Pain

Psychosomatics

Compr Psychiatry

J Psychosom Res

Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition

Psychosomatics

Somatoform disorders in general practice. Prevalence, functional impairment and comorbidity with anxiety and depressive disorders

Br J Psychiatry

Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition

Depress Anxiety

Patient with persistent medically unexplained symptoms in general practice: characteristics and quality of care

Fam Pract

Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review

J Psychosom Res

Somatisierungsstörung und Hypochondrie. [Somatization disorder and hypochondriasis]

Psychological mechanisms of medically unexplained symptoms

Psychol Bull

Psychiatry and Primary Care
Course and prediction of somatoform disorder and medically unexplained symptoms in primary care