Prevalence, impact, and prognosis of multisomatoform disorder in primary care: A 5-year follow-up study

被引:86
作者
Jackson, Jeffrey L. [2 ]
Kroenke, Kurt [1 ]
机构
[1] Univ Indianapolis, Sch Med, Regenstrief Inst Hlth Care, Dept Med, Indianapolis, IN 46227 USA
[2] Uniformed Serv Univ Hlth Sci, Dept Med, Indianapolis, IN USA
来源
PSYCHOSOMATIC MEDICINE | 2008年 / 70卷 / 04期
关键词
somatization; primary care; multisomatoform disorder; outcomes;
D O I
10.1097/PSY.0b013e31816aa0ee
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background: To determine the prevalence, impact, and prognosis of multisomatoform disorder (MSD) over a 5-year period in a primary care population. Although somatization is prevalent in primary care, patients rarely meet Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for somatization disorder. MSD, defined as >= 3 bothersome, medically unexplained somatic symptoms, has been proposed as a more inclusive disorder. Methods: A total of 500 adults presenting to a primary care clinic with a physical symptom were screened with the Primary Care Evaluation of Mental Disorders. Symptom count was assessed with the Patient Health Questionnaire 15-item somatic symptom scale. Additional baseline measures included functional status and symptom characteristics. Follow-up surveys at 2 weeks, 3 months, and 5 years assessed fimctioning, symptom outcome, psychiatric diagnoses, and patient satisfaction. Physician surveys assessed encounter difficulty. Utilization was obtained from our health database. Results: MSD had an 8% prevalence at both baseline (n = 38/500) and at 5 years (n = 33/387). MSD persisted in 21% of those with MSD at baseline, and developed in 7% of those without MSD at baseline. MSD at baseline was a predictor of MSD at 5 years (relative risk (RR) = 2.7, 1.5-5.1). MSD patients were more likely to have comorbid mental disorders (RR = 1.5, 1.1-2.3) and be rated "difficult" by their clinicians (p = .02). They also reported worse functional status at all time points assessed (p <.001 for all), were less likely to experience symptom improvement, and had higher utilization rates (34.1 versus 23.1 visits, p = .006). Conclusions: MSD identifies a group of patients who are less likely to experience symptom improvement and have significant functional impairment and higher utilization rates.
引用
收藏
页码:430 / 434
页数:5
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