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Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease’
  1. A Carson1,
  2. J Stone1,
  3. C Hibberd1,
  4. G Murray2,
  5. R Duncan3,
  6. R Coleman4,
  7. C Warlow1,
  8. R Roberts5,
  9. A Pelosi6,
  10. J Cavanagh7,
  11. K Matthews5,
  12. R Goldbeck4,
  13. C Hansen1,
  14. M Sharpe1
  1. 1School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK
  2. 2School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK
  3. 3Institute of Neurology, Southern General Hospital, Glasgow, UK
  4. 4Aberdeen Royal Infirmary, Aberdeen, Aberdeen, UK
  5. 5Ninewells Hospital, University of Dundee, Dundee, UK
  6. 6Hairmyres Hospital, East Kilbride, UK
  7. 7Sackler Institute of Psychobiological Research, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Alan Carson, Division of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK; a.carson{at}


Objectives To determine the disability, distress and employment status of new neurology outpatients with physical symptoms unexplained by organic disease and to compare them with patients with symptoms explained by organic disease.

Methods As part of a cohort study (the Scottish Neurological Symptoms Study) neurologists rated the extent to which each new patient's symptoms were explained by organic disease. Patients whose symptoms were rated as ‘not at all’ or only ‘somewhat’ explained by disease were considered cases, and those whose symptoms were ‘largely’ or ‘completely’ explained by disease were considered controls. All patients completed self-ratings of disability, health status (Medical Outcomes Study Short Form 12-Item Scale (SF-12)) and emotional distress (Hospital Anxiety and Depression Scale) and also reported their employment and state financial benefit status.

Results 3781 patients were recruited: 1144 (30%) cases and 2637 (70%) controls. Cases had worse physical health status (SF-12 score 42 vs 44; difference in means 1.7 (95% CI –2.5 to 0.9)) and worse mental health status (SF-12 score 43 vs 47; difference in means –3.5 (95% CI –4.3 to to 2.7)). Unemployment was similar in cases and controls (50% vs 50%) but cases were more likely not to be working for health reasons (54% vs 37% of the 50% not working; OR 2.0 (95% CI 1.6 to 2.4)) and also more likely to be receiving disability-related state financial benefits (27% vs 22%; (OR 1.3, 95% CI 1.1 to 1.6)).

Conclusions New neurology patients with symptoms unexplained by organic disease have more disability-, distress- and disability-related state financial benefits than patients with symptoms explained by disease.

  • Clinical neurology
  • hysteria
  • psychiatry
  • somatisation disorder
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  • See Editorial commentary, p 710

  • Linked article 237172

  • Funding Chief Scientist Office, Scotland, NHS Quality Improvement Scotland.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Muti-centre Research Ethics Committe Scotland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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