Medically Unexplained and Explained Physical Symptoms in the General Population: Association with Prevalent and Incident Mental Disorders

Abstract

BackgroundClinical studies have shown that Medically Unexplained Symptoms (MUS) are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY), MUS or both, in the general population, what the incidence rates are, and whether there is a difference between PHY and MUS in this respect.AimTo study the prevalence and incidence rates of mood, anxiety and substance use disorders in groups with PHY, MUS and combined MUS and PHY compared to a no-symptoms reference group in the general population.MethodData were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face survey of the general population aged 18-64 years. We selected subjects with explained physical symptoms only (n=1952), with MUS only (n=177), with both MUS and PHY (n=209), and a reference group with no physical symptoms (n=4168). The assessment of common mental disorders was through the Composite International Diagnostic Interview 3.0. Multivariate logistic regression analyses were used to examine the association between group membership and the prevalence and first-incidence rates of comorbid mental disorders, adjusted for socio-demographic characteristics.ResultsMUS were associated with the highest prevalence rates of mood and anxiety disorders, and combined MUS and PHY with the highest prevalence rates of substance disorder. Combined MUS and PHY were associated with a higher incidence rate of mood disorder only (OR 2.9 (95%CI:1.27,6.74)).ConclusionIn the general population, PHY, MUS and the combination of both are related to mood and anxiety disorder, but odds are highest for combined MUS and PHY in relation to substance use disorder. Combined MUS and PHY are related to a greater incidence of mood disorder. These findings warrant further research into possibilities to improve recognition and early intervention in subjects with combined MUS and PHY.

Predictors of persistent medically unexplained physical symptoms: Findings from a general population study

“…All definitions in Table 1 were predefined, and as strict as possible defined to support unambiguous interpretation. Definitions are in line with previously published papers using data from NEMESIS-2 (33,53). Given that the data had already been collected by independent researchers, results could not be influenced by the authors.…”

Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study

“…CBT is recommended in the Dutch multidisciplinary guideline for MUS and somatoform disorders and can be offered by the GP or in the specialized mental health care, if the GP considers the patient to be too complex or when the patient–doctor relationship is perturbed 40. In addition to the CBT for MUS and somatoform disorder, specialist psychiatric attention may be required for other mental health problems associated with physical symptoms (unexplained or explained) 2,42. Given that all people with physical symptoms (explained or unexplained) show more entry into primary care, but only people with MUS show more entry into specialized mental health care, MUS is apparently of higher influence than explained physical symptoms on the decision of the GP whether or not to refer to specialized mental health care.…”

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis

“…Individuals with chronic medical conditions frequently suffer from comorbid depression or anxiety disorders [13][14][15][16][17]. This comorbidity can easily lead to disability, such as in the workplace [18,19], and high health care costs [20].…”

“…Therefore, we cannot draw conclusions about this. This is an interesting subject for further research, because the combination of anxiety disorders and chronic medical conditions is highly prevalent [13,93]; the presence of an anxiety disorder leads to a higher likelihood of disability in chronic medical conditions [15], and a more negative perception of the influence of the chronic medical condition [94]. It has also been suggested that the presence of physical symptoms negatively influences the course of the anxiety disorder [22].…”