Patient characteristics and frequency of bodily distress syndrome in primary care: a cross-sectional study

Abstract

BackgroundBodily distress syndrome (BDS) is a newly proposed diagnosis of medically unexplained symptoms, which is based on empirical research in primary care.AimTo estimate the frequency of BDS in primary care and describe the characteristics of patients with BDS.Design and settingA cross-sectional study of primary care patients in urban and rural areas of Central Denmark Region.MethodData were obtained from GP one-page registration forms, patient questionnaires (including a checklist for BDS), and national registers.ResultsA total of 1356 primary care patients were included, of whom 230 patients (17.0%, 95% confidence intervals [CI] = 15.0 to 19.1) fulfilled the BDS criteria. BDS was more common among primary care patients aged 41–65 years (odds ratio [OR] = 1.9, 95% CI = 1.3 to 3.0) and was equally frequent among males and females (female sex, OR 0.9, 95% CI = 0.6 to 1.3). Patients with BDS were characterised by poor health-related quality of life (HRQOL) on the 12-item Short-Form Health Survey, that is, physical component summary scores <40 (OR 20.5, 95% CI = 12.9 to 32.4) and mental component summary scores <40 (OR 3.5, 95% CI = 2.2 to 5.6). Furthermore, patients with BDS were more likely to have high scores on the Symptom Checklist for anxiety (OR 2.2, 95% CI = 1.4 to 3.4) and depression (OR 5.1, 95% CI = 3.3 to 7.9), but regression analyses showed that mental morbidity did not account for the poor HRQOL.ConclusionBDS is common among primary care patients, and patients with BDS have a higher probability of poor HRQOL and mental health problems.

Persistent unexplained physical symptoms: a prospective longitudinal cohort study in UK primary care

“…[26][27][28] Worse functional disability and poor physical health at baseline are reported to be associated with the persistence of UPS or high somatic symptom scores at 12-month followup. 11,12 Physical abuse in childhood was associated with an increase in somatic symptom severity at follow-up, suggesting that childhood physical abuse may have a long-term impact on physical health, similar to reports in other studies. [29][30][31][32] Implications for research and practice The current study suggests that for many patients in primary care with several bothersome UPS their symptoms may not be transient, and that around half will continue to be affected over time.…”

“…This is in line with comparatively more recent studies which have reported that around half continue to be burdened by their symptoms, albeit these studies include populations meeting the criteria for somatoform disorders 11 or bodily distress syndrome (BDS), which is a diagnosis of functional disorders rather than symptoms. 12 Only 11% in this present study reported their symptoms as resolved; this is also much lower than rates of resolution reported by Jackson and Passamonti in the US among consecutive primary care attenders at 3-month follow-up, although they did not distinguish between those with explained and unexplained symptoms. 9 Although at baseline one-third of the cohort in this study had clinically significant scores for depression and anxiety, neither depression nor anxiety independently predicted persistent somatic symptoms at follow-up.…”

“…The follow-up rate was high (245/294, 83% [6][7][8][9][10][11][12][13][14][15][16][17][18]). Otherwise, they were similar in all other respects.…”

“…11,22,23 The authors' finding that greater overall symptom severity at baseline is associated with worse outcome at follow-up is consistent with previous research, though those studies also included populations meeting a variety of different inclusion criteria. [9][10][11][12][24][25][26] There is a growing body of literature which suggests that a greater number of symptoms, regardless of whether they are explained or unexplained, contribute to poor outcome. 9,13,26 As in this study, a recent review by Tomenson et al in which secondary analysis was conducted on studies from four different sites reported that somatic symptom score was a better predictor of follow-up health status and healthcare use than UPS.…”

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.…”