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

Jeffrey L. Jackson, Kurt Kroenke

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

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 functioning, 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. Key words: somatization, primary care, multisomatoform disorder, outcomes.

Original languageEnglish
Pages (from-to)430-434
Number of pages5
JournalPsychosomatic Medicine
Volume70
Issue number4
DOIs
StatePublished - May 2008

Fingerprint

Primary Health Care
Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
Somatoform Disorders
Health
Patient Satisfaction
Databases
Physicians
Population
Medically Unexplained Symptoms
Surveys and Questionnaires

Keywords

  • Multisomatoform disorder
  • Outcomes
  • Primary care
  • Somatization

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology
  • Psychology(all)

Cite this

Prevalence, impact, and prognosis of multisomatoform disorder in primary care : A 5-year follow-up study. / Jackson, Jeffrey L.; Kroenke, Kurt.

In: Psychosomatic Medicine, Vol. 70, No. 4, 05.2008, p. 430-434.

Research output: Contribution to journalArticle

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abstract = "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 functioning, 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. Key words: somatization, primary care, multisomatoform disorder, outcomes.",
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N2 - 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 functioning, 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. Key words: somatization, primary care, multisomatoform disorder, outcomes.

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