Patients presenting with somatic complaints in general practice: depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors

Abstract

BackgroundMental disorders in primary care patients are frequently associated with physical complaints that can mask the disorder. There is insufficient knowledge concerning the role of anxiety, depression, and somatoform disorders in patients presenting with physical symptoms. Our primary objective was to determine the prevalence of depression, anxiety, and somatoform disorders among primary care patients with a physical complaint. We also investigated the relationship between cumulated psychosocial stressors and mental disorders.MethodsWe conducted a multicentre cross-sectional study in twenty-one private practices and in one academic primary care centre in Western Switzerland. Randomly selected patients presenting with a spontaneous physical complaint were asked to complete the self-administered Patient Health Questionnaire (PHQ) between November 2004 and July 2005. The validated French version of the PHQ allowed the diagnosis of mental disorders (DSM-IV criteria) and the analyses of exposure to psychosocial stressors.ResultsThere were 917 patients exhibiting at least one physical symptom included. The rate of depression, anxiety, and somatoform disorders was 20.0% (95% confidence interval [CI] = 17.4% to 22.7%), 15.5% (95% CI = 13.2% to 18.0%), and 15.1% (95% CI = 12.8% to 17.5%), respectively. Psychosocial stressors were significantly associated with mental disorders. Patients with an accumulation of psychosocial stressors were more likely to present anxiety, depression, or somatoform disorders, with an increase of 2.2 fold (95% CI = 2.0 to 2.5) for each additional stressor.ConclusionsThe investigation of mental disorders and psychosocial stressors among patients with physical complaints is relevant in primary care. Psychosocial stressors should be explored as potential epidemiological causes of mental disorders.

The prevalence of common mental and substance use disorders in general practice: a literature review and discussion paper

“…This study attributed the high rate of depression to the on-going military conflict. Haftgoli et al (2010) applied PHQ to general practice patients with a physical complaint. The prevalence ranged from 14.4% for patients without any major psychosocial stressor to 96.8% in those exposed to five or more stressors (health, relationships, financial, etc.).…”

“…Boundaries of syndromal diagnoses are relatively 'soft' and therefore include much overlap and co-morbidity (Mergl et al, 2007;Regier et al, 1990). More than 50% of patients with common mental disorders visit general practitioners with physical, rather than psychological or emotional, complaints (Haftgoli et al, 2010;Hartman et al, 2008). Furthermore, 75% of patients presenting with depression have also anxiety and/ or somatisation (Lowe et al, 2008).…”

Körperbeschwerden nach politischer Inhaftierung und deren Zusammenhang mit Ängstlichkeit und Depressivität

“…Depressive Patienten haben eine um das 4,43-fache erhöhte Wahrscheinlichkeit (95% KI; 2,73-7,19) an einer somatoformen Störung zu leiden [Mergl et al, 2007]. Haftgoli et al [2010] berichten, dass Patienten mit mindestens einer kör-perlichen Beschwerde erhöhte Raten für Depression (20%) und Ängstlichkeit (15%) aufwiesen. Ein systematisches Review zeigt Hinweise, dass körperliche Schmerzen außerdem eine längere Zeitspanne der Remission bei Patienten mit einer Depression vorhersagen [Bair et al, 2003].…”

“…Mög-licherweise kumulieren sich aufgrund einer durch die Inhaftierung gesetzten psychischen Vulnerabilität bei den Betroffenen mehrere psychosoziale Stressoren und führen zu den dargestellten hohen Ausprägungen der untersuchten Variablen [Haftgoli et al, 2010]. Ebenso kann tendenziell eine Aggravation der Betroffenen nicht ausgeschlossen werden, da diese unabhängig vom Erhalt der sogenannten «Opferrente» (die an andere Kriterien geknüpft ist) auch im Rahmen der Entschä-digungspraxis den Nachweis einer psychischen bzw.…”

Collaborative stepped care for somatoform disorders: A pre–post-intervention study in primary care

“…These disorders are prevalent in 3.5% to 10% of the general population [3], and in up to 20% of patients in primary care settings [4,5]. Medically unexplained symptoms and somatoform disorders substantially reduce patients' well-being and quality of life [1,6]. Moreover, similarly to depressive and anxiety disorders, somatoform disorders are associated with high health care costs caused by frequent consultations, repeated diagnostic procedures and work incapacity [7,8].…”