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

Leiden University, Leyden, South Holland, Netherlands
The British Journal of Psychiatry (Impact Factor: 7.99). 07/2004; 184(6):470-6. DOI: 10.1192/bjp.184.6.470
Source: PubMed


General practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment.
To quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders.
Two-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25-80 years), followed by a standardised diagnostic interview (SCAN 2.1).
The prevalence of somatoform disorders was 16.1% (95% CI 12.8-19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive.
Our findings underline the importance of a comprehensive diagnostic approach to psychiatric disorders in general practice.

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    • ". The diagnostic overlap may be due in part to shared diagnostic criteria, such as sleep disturbances, loss of energy and impaired concentration [1] [5] [18]. In addition, treatment methods overlap in that antidepressants and cognitive–behavioral therapy are efficacious for depression, anxiety and somatization [19] [20] [21] [22]. "
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    ABSTRACT: To examine the extent of depression, anxiety, somatization, and comorbidity between depression and anxiety in patients with temporomandibular disorders (TMD) by adding the Symptom Checklist-90 Revised self-report questionnaire for anxiety to the Research Diagnostic Criteria for TMD. A total of 207 Israeli TMD patients were included in this retrospective study. Data included levels of depression, anxiety, somatization, and comorbidity in the study group as a whole, in chronic pain TMD patients compared to acute pain TMD patients, and in chronic pain TMD patients according to their Graded Chronic Pain Scale score. Spearman correlation was used to assess the level of correlation between depression, anxiety, and somatization. Fisher exact test or Pearson chi-square test was used to compare the categorical variables. When depression, anxiety, somatization, and comorbidity were analyzed in a multidimensional approach, there were statistically significant differences between subgroups as to depression and somatization only. No statistically significant differences were found as to anxiety and comorbidity. Multidimensional assessment enabled differentiation between findings of depression, anxiety, somatization, and comorbidity in subgroups of TMD patients. The findings of no statistically significant differences between subgroups of TMD patients as to anxiety and comorbidity support previous studies on TMD and anxiety, which suggest a less significant role of anxiety in chronic TMD patients as compared to depression and somatization.
    05/2015; 29(2):135-43. DOI:10.11607/ofph.1297
    • "Three quarters of somatizing patients for whom psychiatric consultation was requested by a general practitioner (GP) in a consultation trial, turned out to have undetected depression or anxiety disorder [21]. De Waal and colleagues found that 50% of the primary care patients with an anxiety and/or depressive disorder also had a comorbid somatoform disorder [22]. This suggests that this combination of symptoms and syndromes poses a clinical challenge for the GP. "
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    ABSTRACT: Patient encounters for medically unexplained physical symptoms are common in primary health care. Somatization ('experiencing and reporting unexplained somatic symptoms') may indicate concurrent or future disability but this may also partly be caused by psychiatric disorders. The aim of this study was to examine the cross-sectional and longitudinal association between somatization and disability in primary care patients with and without anxiety or depressive disorder. Data were obtained from 1545 primary care patients, participating in the longitudinal Netherlands Study of Depression and Anxiety (NESDA). Somatization was assessed using the somatization scale of the Four-Dimensional Symptom Questionnaire (4DSQ). Disability was determined by the WHO Disability Assessment Schedule 2.0 (WHO-DAS II). The relationships between somatization and both the total and subdomain scores of the WHO-DAS II were measured cross-sectionally and longitudinally after one year of follow-up using linear regression analysis. We examined whether anxiety or depressive disorder exerted a modifying effect on the somatization-disability association. Cross-sectionally and longitudinally, somatization was significantly associated with disability. Somatization accounted cross-sectionally for 41.8% of the variance in WHO-DAS disability and, longitudinally, for 31.7% of the variance in disability after one year of follow-up. The unique contribution of somatization to disability decreased to 16.7% cross-sectionally and 15.7% longitudinally, when anxiety and/or depressive disorder was added to the model. Somatization contributes to the presence of disability in primary care patients, even when the effects of baseline demographic and health characteristics and anxiety or depressive disorder are taken into account. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of psychosomatic research 03/2015; 79(2). DOI:10.1016/j.jpsychores.2015.03.001 · 2.74 Impact Factor
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    • "Unfortunately, the suggestion of a somatoform disorder is sometimes interpreted as an implication that the patient's symptoms are of lesser importance or validity, which in Judith's case would be incorrect. Impairment from a somatoform disorder increases with the addition of anxiety and depression symptoms (De Waal et al., 2004). Somatoform disorders are often a response to significant stress, such as trauma, profound dislocation, the threat of losing a key relationship, or a sense of personal failure with no evident way to remedy it. "
    03/2015; 11(1). DOI:10.14713/pcsp.v11i1.1886
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