Physical Symptoms in Primary CarePredictors of Psychiatric Disorders and Functional Impairment
Kurt Kroenke, MD;
Robert L. Spitzer, MD;
Janet B. W. Williams, DSW;
Mark Linzer, MD;
Steven R. Hahn, MD;
Frank V. deGruy III, MD;
David Brody, MD
Arch Fam Med. 1994;3(9):774-779.
Abstract
Objective
To examine how the type and number of physical symptoms reported by primary care patients are related to psychiatric disorders and functional impairment.
Design
Outpatient mental health survey.
Setting
Four primary care clinics.
Patients
One thousand adult clinic patients, of whom 631 were selected randomly or consecutively and 369 by convenience.
Main Outcome Measures
Psychiatric disorders as determined by the Primary Care Evaluation of Mental Disorders procedure; the presence or absence of 15 common physical symptoms and whether symptoms were somatoform (ie, lacked an adequate physical explanation); and functional status as determined by the Medical Outcomes Study Short-form General Health Survey.
Results
Each of the 15 common symptoms was frequently somatoform (range, 16% to 33%). The presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by at least twofold to threefold, and somatoform symptoms had a particularly strong association with psychiatric disorders. The likelihood of a psychiatric disorder increased dramatically with increasing numbers of physical symptoms. The prevalence of a mood disorder in patients with 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 9 or more symptoms was 2%, 12%, 23%, 44%, and 60%, respectively, and the prevalence of an anxiety disorder was 1%, 7%, 13%, 30%, and 48%, respectively. Finally, each physical symptom was associated with significant functional impairment; indeed, the number of physical symptoms was a powerful correlate of functional status.
Conclusions
The number of physical symptoms is highly predictive for psychiatric disorders and functional impairment. Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder.
Author Affiliations
From the Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kroenke); the Biometrics Research Department, New York State Psychiatric Institute, and the Department of Psychiatry, Columbia University, New York, NY (Drs Spitzer and Williams); the Departments of Medicine, New England Medical Center, Boston, Mass (Dr Linzer), and Albert Einstein College of Medicine, Bronx, NY (Dr Hahn); the Department of Family Practice, University of South Alabama, Mobile (Dr deGruy); and the Department of Medicine, Mercy Catholic Medical Center, Darby, Pa (Dr Brody).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Development and Validation of a Modified Version of the Edmonton Symptom Assessment Scale in a Flemish Palliative Care Population
Claessens et al.
AM J HOSP PALLIAT CARE 2011;28:475-482.
ABSTRACT
Tricyclic antidepressants and headaches: systematic review and meta-analysis
Jackson et al.
BMJ 2010;341:c5222-c5222.
ABSTRACT
| FULL TEXT
Physical, Psychological, and Functional Comorbidities of Multisymptom Illness in Australian Male Veterans of the 1991 Gulf War
Kelsall et al.
Am J Epidemiol 2009;170:1048-1056.
ABSTRACT
| FULL TEXT
Diagnostic Accuracy of Predicting Somatization From Patients' ICD-9 Diagnoses
Smith et al.
Psychosom. Med. 2009;71:366-371.
ABSTRACT
| FULL TEXT
Multiple Pain Complaints in Patients With Major Depressive Disorder
Vaccarino et al.
Psychosom. Med. 2009;71:159-162.
ABSTRACT
| FULL TEXT
Functional Somatic Symptoms and Psychological States: An Electronic Diary Study
Burton et al.
Psychosom. Med. 2009;71:77-83.
ABSTRACT
| FULL TEXT
Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial
Sumathipala et al.
Br. J. Psychiatry 2008;193:51-59.
ABSTRACT
| FULL TEXT
Prevalence and risk factors for abdominal bloating and visible distention: a population-based study
Jiang et al.
Gut 2008;57:756-763.
ABSTRACT
| FULL TEXT
What is the Evidence for the Efficacy of Treatments for Somatoform Disorders? A Critical Review of Previous Intervention Studies
Sumathipala
Psychosom. Med. 2007;69:889-900.
ABSTRACT
| FULL TEXT
Narrative Review: The Pathophysiology of Fibromyalgia
Abeles et al.
ANN INTERN MED 2007;146:726-734.
ABSTRACT
| FULL TEXT
Outcome and Impact of Mental Disorders in Primary Care at 5 years
Jackson et al.
Psychosom. Med. 2007;69:270-276.
ABSTRACT
| FULL TEXT
Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection
Kroenke et al.
ANN INTERN MED 2007;146:317-325.
ABSTRACT
| FULL TEXT
Predictors of Premature Antidepressant Discontinuation in Functional Gastrointestinal Disorders
Sayuk et al.
Psychosom. Med. 2007;69:173-181.
ABSTRACT
| FULL TEXT
High prevalence of somatic symptoms and depression in women with disabling chronic headache
Tietjen et al.
Neurology 2007;68:134-140.
ABSTRACT
| FULL TEXT
Understanding Comorbidity With Depression and Anxiety Disorders
Aina and Susman
J Am Osteopath Assoc 2006;106:S9-S14.
ABSTRACT
| FULL TEXT
Multi-symptom illnesses, unexplained illness and Gulf War Syndrome
Ismail and Lewis
Phil Trans R Soc B 2006;361:543-551.
ABSTRACT
| FULL TEXT
Managing future Gulf War Syndromes: international lessons and new models of care
Engel et al.
Phil Trans R Soc B 2006;361:707-720.
ABSTRACT
| FULL TEXT
Comorbid Depression, Chronic Pain, and Disability in Primary Care
Arnow et al.
Psychosom. Med. 2006;68:262-268.
ABSTRACT
| FULL TEXT
Primary care epidemiology: its scope and purpose
Hannaford et al.
Fam Pract 2006;23:1-7.
FULL TEXT
Somatization Increases Medical Utilization and Costs Independent of Psychiatric and Medical Comorbidity
Barsky et al.
Arch Gen Psychiatry 2005;62:903-910.
ABSTRACT
| FULL TEXT
Screening for common mental disorders: who will benefit? Results from a randomised clinical trial
Christensen et al.
Fam Pract 2005;22:428-434.
ABSTRACT
| FULL TEXT
An International Study of the Effect of Physical Ill Health on Psychiatric Recovery in Primary Care
Kisely and Simon
Psychosom. Med. 2005;67:116-122.
ABSTRACT
| FULL TEXT
Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms
Smith et al.
Psychosom. Med. 2005;67:123-129.
ABSTRACT
| FULL TEXT
The Association Between Anxiety, Depression, and Somatic Symptoms in a Large Population: The HUNT-II Study
Haug et al.
Psychosom. Med. 2004;66:845-851.
ABSTRACT
| FULL TEXT
Somatoform disorders in general practice: Prevalence, functional impairment and comorbidity with anxiety and depressive disorders
De Waal et al.
Br. J. Psychiatry 2004;184:470-476.
ABSTRACT
| FULL TEXT
Panic & Plaques: Panic Disorder & Coronary Artery Disease in Patients with Chest Pain
Katerndahl
J Am Board Fam Med 2004;17:114-126.
ABSTRACT
| FULL TEXT
Impact of Pain on Depression Treatment Response in Primary Care
Bair et al.
Psychosom. Med. 2004;66:17-22.
ABSTRACT
| FULL TEXT
The Value of Pseudoneurological Symptoms for Assessing Psychopathology in Primary Care
Interian et al.
Psychosom. Med. 2004;66:141-146.
ABSTRACT
| FULL TEXT
Depression and Pain Comorbidity: A Literature Review
Bair et al.
Arch Intern Med 2003;163:2433-2445.
ABSTRACT
| FULL TEXT
The Content of a Low-income, Uninsured Primary Care Population: Including the Patient Agenda
Mauksch et al.
J Am Board Fam Med 2003;16:278-289.
ABSTRACT
| FULL TEXT
Medically Unexplained Physical Symptoms, Anxiety, and Depression: A Meta-Analytic Review
Henningsen et al.
Psychosom. Med. 2003;65:528-533.
ABSTRACT
| FULL TEXT
Comorbid Illness in Women With Chronic Fatigue Syndrome: A Test of the Single Syndrome Hypothesis
Ciccone and Natelson
Psychosom. Med. 2003;65:268-275.
ABSTRACT
| FULL TEXT
Patient Beliefs Predict Response to Paroxetine Among Primary Care Patients with Dysthymia and Minor Depression
Sullivan et al.
J Am Board Fam Med 2003;16:22-31.
ABSTRACT
| FULL TEXT
The mental health of UK Gulf war veterans: phase 2 of a two phase cohort study
Ismail et al.
BMJ 2002;325:576-576.
ABSTRACT
| FULL TEXT
Psychological Disorders and Distress in Older Primary Care Patients: A Comparison of Older and Younger Samples
Klapow et al.
Psychosom. Med. 2002;64:635-643.
ABSTRACT
| FULL TEXT
Attachment Theory: A Model for Health Care Utilization and Somatization
Ciechanowski et al.
Psychosom. Med. 2002;64:660-667.
ABSTRACT
| FULL TEXT
Forgetting, Fabricating, and Telescoping: The Instability of the Medical History
Barsky
Arch Intern Med 2002;162:981-984.
ABSTRACT
| FULL TEXT
Psychiatric Morbidity and Impact on Hospital Length of Stay Among Hematologic Cancer Patients Receiving Stem-Cell Transplantation
Prieto et al.
JCO 2002;20:1907-1917.
ABSTRACT
| FULL TEXT
Is This Patient Clinically Depressed?
Williams et al.
JAMA 2002;287:1160-1170.
ABSTRACT
| FULL TEXT
The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke et al.
Psychosom. Med. 2002;64:258-266.
ABSTRACT
| FULL TEXT
Optimising antidepressant use in clinical practice: towards criteria for antidepressant selection
MENDLEWICZ
Br. J. Psychiatry 2001;179:s1-s3.
ABSTRACT
| FULL TEXT
What is Chronic Fatigue Syndrome? Heterogeneity Within an International Multicentre Study
Wilson et al.
Aust N Z J Psychiatry 2001;35:520-527.
ABSTRACT
| FULL TEXT
Studying Symptoms: Sampling and Measurement Issues
Kroenke
ANN INTERN MED 2001;134:844-853.
ABSTRACT
| FULL TEXT
Physical Symptoms and Physician-Experienced Difficulty in the Physician-Patient Relationship
Hahn
ANN INTERN MED 2001;134:897-904.
ABSTRACT
| FULL TEXT
Symptom Management in Older Primary Care Patients: Feasibility of an Experimental, Written Self-Disclosure Protocol
Klapow et al.
ANN INTERN MED 2001;134:905-911.
ABSTRACT
| FULL TEXT
Medical Symptoms without Identified Pathology: Relationship to Psychiatric Disorders, Childhood and Adult Trauma, and Personality Traits
Katon et al.
ANN INTERN MED 2001;134:917-925.
ABSTRACT
| FULL TEXT
Depression Screening Is Not Enough
Kroenke
ANN INTERN MED 2001;134:418-420.
FULL TEXT
Traumatic Life Events in Primary Care Patients: A Study in an Ethnically Diverse Sample
Holman et al.
Arch Fam Med 2000;9:802-810.
ABSTRACT
| FULL TEXT
Social, Cultural, and Clinical Dimensions of Traumatic Experiences of Primary Care Patients
Palinkas
Arch Fam Med 2000;9:812-813.
FULL TEXT
Comparison of symptoms in Japanese and American depressed primary care patients
Waza et al.
Fam Pract 1999;16:528-533.
ABSTRACT
| FULL TEXT
Functional Somatic Syndromes
Barsky and Borus
ANN INTERN MED 1999;130:910-921.
ABSTRACT
| FULL TEXT
Effects of Physician Awareness of Symptom-Related Expectations and Mental Disorders: A Controlled Trial
Jackson et al.
Arch Fam Med 1999;8:135-142.
ABSTRACT
| FULL TEXT
Stability of Somatization Disorder and Somatization Symptoms Among Primary Care Patients
Simon and Gureje
Arch Gen Psychiatry 1999;56:90-95.
ABSTRACT
| FULL TEXT
From Consultation--Liaison Psychiatry to Psychosocial Advocacy: Maintaining Psychiatry's Scope
Smith
Aust N Z J Psychiatry 1998;32:753-761.
ABSTRACT
The Value of Screening for Psychiatric Disorders in Rheumatology Referrals
O'Malley et al.
Arch Intern Med 1998;158:2357-2362.
ABSTRACT
| FULL TEXT
Multisomatoform Disorder
Fava et al.
Arch Gen Psychiatry 1998;55:756-757.
FULL TEXT
Narratives of Somatizing and Non somatizing Patients in a Primary Care Setting
Elderkin-Thompson et al.
J Health Psychol 1998;3:407-428.
ABSTRACT
Rheumatic Findings in Gulf War Veterans
Grady et al.
Arch Intern Med 1998;158:367-371.
ABSTRACT
| FULL TEXT
A 37-Year-Old Man With Multiple Somatic Complaints
Barsky
JAMA 1997;278:673-679.
ABSTRACT
Concerns and Expectations in Patients Presenting With Physical Complaints: Frequency, Physician Perceptions and Actions, and 2-Week Outcome
Marple et al.
Arch Intern Med 1997;157:1482-1488.
ABSTRACT
Developing a Strategy for Managing Behavioral Health Care Within the Context of Primary Care
Fisher and Ransom
Arch Fam Med 1997;6:324-333.
ABSTRACT
Multisomatoform Disorder: An Alternative to Undifferentiated Somatoform Disorder for the Somatizing Patient in Primary Care
Kroenke et al.
Arch Gen Psychiatry 1997;54:352-358.
ABSTRACT
Mental Diagnoses in Primary Care: The Next Generation
deGruy
Arch Fam Med 1995;4:208-210.
ABSTRACT
Unnrecognized Mental Illness in Primary Care: Another Day and Another Duty in the Life of a Primary Care Physician
Glasser and Stearns
Arch Fam Med 1994;3:862-864.
ABSTRACT
|
