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Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study.
Psychosom Med. 2008 May; 70(4):430-4.PM

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 > or = 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.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Jackson JL
Department of Medicine, Uniformed Services University of the Health Sciences, USA. jejackson@usuhs.mil
Kroenke K
No affiliation info available

MeSH

Activities of Daily LivingAnxiety DisordersCohort StudiesComorbidityCross-Sectional StudiesDepressive DisorderFemaleFollow-Up StudiesHumansMaleMiddle AgedPanic DisorderPatient SatisfactionPersonality InventoryPrimary Health CarePrognosisPsychometricsSick RoleSomatoform DisordersUtilization Review

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18434494

Citation

Jackson, Jeffrey L., and Kurt Kroenke. "Prevalence, Impact, and Prognosis of Multisomatoform Disorder in Primary Care: a 5-year Follow-up Study." Psychosomatic Medicine, vol. 70, no. 4, 2008, pp. 430-4.
Jackson JL, Kroenke K. Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study. Psychosom Med. 2008;70(4):430-4.
Jackson, J. L., & Kroenke, K. (2008). Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study. Psychosomatic Medicine, 70(4), 430-4. https://doi.org/10.1097/PSY.0b013e31816aa0ee
Jackson JL, Kroenke K. Prevalence, Impact, and Prognosis of Multisomatoform Disorder in Primary Care: a 5-year Follow-up Study. Psychosom Med. 2008;70(4):430-4. PubMed PMID: 18434494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study. AU - Jackson,Jeffrey L, AU - Kroenke,Kurt, Y1 - 2008/04/23/ PY - 2008/4/25/pubmed PY - 2008/6/18/medline PY - 2008/4/25/entrez SP - 430 EP - 4 JF - Psychosomatic medicine JO - Psychosom Med VL - 70 IS - 4 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 > or = 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. SN - 1534-7796 UR - https://www.unboundmedicine.com/medline/citation/18434494/Prevalence_impact_and_prognosis_of_multisomatoform_disorder_in_primary_care:_a_5_year_follow_up_study_ DB - PRIME DP - Unbound Medicine ER -