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Published in: BMC Primary Care 1/2011

Open Access 01-12-2011 | Research article

Non-specific symptoms as clues to changes in emotional well-being

Authors: Andre Matalon, Andy Kotliroff, Gari Blumberg, John Yaphe, Eliezer Kitai

Published in: BMC Primary Care | Issue 1/2011

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Abstract

Background -

Somatic symptoms are a common reason for visits to the family physician. The aim of this study was to examine the relation between non-specific symptoms and changes in emotional well-being and the degree to which the physician considers the possibility of mental distress when faced with such patients.

Methods -

Patients who complained of two or more symptoms including headache, dizziness, fatigue or weakness, palpitations and sleep disorders over one year were identified from the medical records of a random sample of 45 primary care physicians. A control group matched for gender and age was selected from the same population. Emotional well-being was assessed using the MOS-SF 36 in both groups.

Results -

The study group and the control group each contained 110 patients. Completed MOS questionnaires were obtained from 92 patients, 48 patients with somatic symptoms and 44 controls. Sixty percent of the patients with somatic symptoms experienced decreased emotional well being compared to 25% in the control group (p = 0.00005). Symptoms of dizziness, fatigue and sleep disturbances were significantly linked with mental health impairments. Primary care physicians identified only 6 of 29 patients (21%) whose responses revealed functional limitations due to emotional problems as suffering from an emotional disorder and only 6 of 23 patients (26%) with a lack of emotional well being were diagnosed with an emotional disorder.

Conclusions -

Non-specific somatic symptoms may be clues to changes in emotional well-being. Improved recognition and recording of mental distress among patients who complain of these symptoms may enable better follow up and treatment.
Literature
1.
go back to reference Kroenke K, Harris L: Symptoms Research: A Fertile Field. Annals of Internal Medicine. 2001, 134: 801-802.CrossRefPubMed Kroenke K, Harris L: Symptoms Research: A Fertile Field. Annals of Internal Medicine. 2001, 134: 801-802.CrossRefPubMed
2.
go back to reference Kroenke K, Price R: Symptoms in the Community. Archives of Internal Medicine. 1995, 153: 2474-2480.CrossRef Kroenke K, Price R: Symptoms in the Community. Archives of Internal Medicine. 1995, 153: 2474-2480.CrossRef
3.
go back to reference Kroenke K: Studying Symptoms: Sampling and Measurement Issues. Annals of Internal Medicine. 2001, 134: 844-853.CrossRefPubMed Kroenke K: Studying Symptoms: Sampling and Measurement Issues. Annals of Internal Medicine. 2001, 134: 844-853.CrossRefPubMed
4.
go back to reference Kroenke K: Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy, and Outcome. The American Journal of Medicine. 1989, 86: 262-266. 10.1016/0002-9343(89)90293-3.CrossRefPubMed Kroenke K: Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy, and Outcome. The American Journal of Medicine. 1989, 86: 262-266. 10.1016/0002-9343(89)90293-3.CrossRefPubMed
5.
go back to reference Kroenke K: Symptoms in Medical Patients: An Untended Field. The American Journal of Medicine. 1992, 92 (supp. 1A): 3S-6S.CrossRefPubMed Kroenke K: Symptoms in Medical Patients: An Untended Field. The American Journal of Medicine. 1992, 92 (supp. 1A): 3S-6S.CrossRefPubMed
6.
go back to reference Kroenke K, Spitzer RL, Williams JB: Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Archives of Family Medicine. 1994, 3: 774-9. 10.1001/archfami.3.9.774.CrossRefPubMed Kroenke K, Spitzer RL, Williams JB: Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Archives of Family Medicine. 1994, 3: 774-9. 10.1001/archfami.3.9.774.CrossRefPubMed
7.
go back to reference Servan-Schreiber D, Tabas G: Somatizing Patients: Part 2. Practical Management. American Family Physician. 2000, 61: 1423-8.PubMed Servan-Schreiber D, Tabas G: Somatizing Patients: Part 2. Practical Management. American Family Physician. 2000, 61: 1423-8.PubMed
8.
go back to reference Duddu V, Husain N, Dickens C: Medically unexplained presentations and quality of life: a study of a predominantly South Asian primary care population in England. J Psychosom Res. 2008, 65 (4): 311-7. 10.1016/j.jpsychores.2008.05.002.CrossRefPubMed Duddu V, Husain N, Dickens C: Medically unexplained presentations and quality of life: a study of a predominantly South Asian primary care population in England. J Psychosom Res. 2008, 65 (4): 311-7. 10.1016/j.jpsychores.2008.05.002.CrossRefPubMed
9.
go back to reference Kroenke K, Wood DR, Manggelsdorff : Chronic Fatigue in primary care: prevalence, patient characteristics, and outcome. JAMA. 1988, 260: 929-940. 10.1001/jama.260.7.929.CrossRefPubMed Kroenke K, Wood DR, Manggelsdorff : Chronic Fatigue in primary care: prevalence, patient characteristics, and outcome. JAMA. 1988, 260: 929-940. 10.1001/jama.260.7.929.CrossRefPubMed
10.
go back to reference Barsky AJ, Borus JF: Somatization and medicalization in the era of managed care. JAMA. 1995, 72: 127-135. Barsky AJ, Borus JF: Somatization and medicalization in the era of managed care. JAMA. 1995, 72: 127-135.
11.
go back to reference Holloway KL, Zerbe KJ: Simplified approach to somatization disorder. Postgraduate Medical Journal. 2000, 108 (6): 89-95.CrossRef Holloway KL, Zerbe KJ: Simplified approach to somatization disorder. Postgraduate Medical Journal. 2000, 108 (6): 89-95.CrossRef
12.
go back to reference Jackson JL, Kroenke K: Difficult Patient Encounters in Ambulatory Care. Archives of Internal Medicine. 1999, 159: 1069-75. 10.1001/archinte.159.10.1069.CrossRefPubMed Jackson JL, Kroenke K: Difficult Patient Encounters in Ambulatory Care. Archives of Internal Medicine. 1999, 159: 1069-75. 10.1001/archinte.159.10.1069.CrossRefPubMed
13.
go back to reference Smith GR, Monson R: Patients with Multiple Unexplained Symptoms. Archives of Internal Medicine. 1986, 146: 69-72. 10.1001/archinte.146.1.69.CrossRefPubMed Smith GR, Monson R: Patients with Multiple Unexplained Symptoms. Archives of Internal Medicine. 1986, 146: 69-72. 10.1001/archinte.146.1.69.CrossRefPubMed
14.
go back to reference Servan-Schreiber D, Tabas G: Somatizing Patients: Part 1. Practical Diagnosis. American Family Physician. 2000, 61: 1073-8.PubMed Servan-Schreiber D, Tabas G: Somatizing Patients: Part 1. Practical Diagnosis. American Family Physician. 2000, 61: 1073-8.PubMed
15.
go back to reference Katon W, Sullivan M, Walker E: Medical symptoms without identified pathology: Relationship to psychiatric disorders, Childhood and adult trauma, and personality traits. Annals of Internal Medicine. 2001, 134: 917-925.CrossRefPubMed Katon W, Sullivan M, Walker E: Medical symptoms without identified pathology: Relationship to psychiatric disorders, Childhood and adult trauma, and personality traits. Annals of Internal Medicine. 2001, 134: 917-925.CrossRefPubMed
16.
go back to reference Kroenke K, Jackson JL, Chamberlin J: Depressive and Anxiety Disorders in Patients Presenting with Physical Complaints: Clinical Predictors and Outcome. The American Journal of Medicine. 1997, 103: 339-347. 10.1016/S0002-9343(97)00241-6.CrossRefPubMed Kroenke K, Jackson JL, Chamberlin J: Depressive and Anxiety Disorders in Patients Presenting with Physical Complaints: Clinical Predictors and Outcome. The American Journal of Medicine. 1997, 103: 339-347. 10.1016/S0002-9343(97)00241-6.CrossRefPubMed
17.
go back to reference Hilderink PH, Benraad CE, van Driel D, Buitelaar JK, Speckens AE, Olde Rikkert MG, Voshaar RC: Medically unexplained physical symptoms in elderly people: a pilot study of psychiatric geriatric characteristics. Am J Geriatr Psychiatry. 2009, 17 (12): 1085-8. 10.1097/JGP.0b013e3181b975a1.CrossRefPubMed Hilderink PH, Benraad CE, van Driel D, Buitelaar JK, Speckens AE, Olde Rikkert MG, Voshaar RC: Medically unexplained physical symptoms in elderly people: a pilot study of psychiatric geriatric characteristics. Am J Geriatr Psychiatry. 2009, 17 (12): 1085-8. 10.1097/JGP.0b013e3181b975a1.CrossRefPubMed
18.
go back to reference Kressler D, Lloyd K, Lewis G, Gray D: Cross sectional study of symptoms attribution and recognition of depression and anxiety in primary care. BMJ. 1999, 318: 436-440.CrossRef Kressler D, Lloyd K, Lewis G, Gray D: Cross sectional study of symptoms attribution and recognition of depression and anxiety in primary care. BMJ. 1999, 318: 436-440.CrossRef
19.
go back to reference Schullberg HC, Burns BJ: Mental disorders in primary care: epidemiologic, diagnostic, and treatment research directions. General Hospital Psychiatry. 1988, 10: 79-87. 10.1016/0163-8343(88)90092-8.CrossRef Schullberg HC, Burns BJ: Mental disorders in primary care: epidemiologic, diagnostic, and treatment research directions. General Hospital Psychiatry. 1988, 10: 79-87. 10.1016/0163-8343(88)90092-8.CrossRef
20.
go back to reference Kessler LG, Clearly PD, Burke JD: Psychiatric disorders in primary care: results of a follow up study. Archives of General Psychiatry. 1988, 45: 1100-1106.CrossRef Kessler LG, Clearly PD, Burke JD: Psychiatric disorders in primary care: results of a follow up study. Archives of General Psychiatry. 1988, 45: 1100-1106.CrossRef
21.
go back to reference Katon W, Kleinman A, Rosan G: Depression and Somatization: a review. The American Journal of Medicine. 1982, 72: 127-135. 10.1016/0002-9343(82)90599-X.CrossRefPubMed Katon W, Kleinman A, Rosan G: Depression and Somatization: a review. The American Journal of Medicine. 1982, 72: 127-135. 10.1016/0002-9343(82)90599-X.CrossRefPubMed
22.
go back to reference Teng EJ, Chaison AD, Bailey SD, Hamilton JD, Dunn NJ: When anxiety symptoms masquerade as medical symptoms: what medical specialists know about panic disorder and available psychological treatments. J Clin Psychol Med Settings. 2008, 15 (4): 314-21. 10.1007/s10880-008-9129-4.CrossRefPubMed Teng EJ, Chaison AD, Bailey SD, Hamilton JD, Dunn NJ: When anxiety symptoms masquerade as medical symptoms: what medical specialists know about panic disorder and available psychological treatments. J Clin Psychol Med Settings. 2008, 15 (4): 314-21. 10.1007/s10880-008-9129-4.CrossRefPubMed
23.
go back to reference Brazier JE, Harper R: Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992, 305: 160-4. 10.1136/bmj.305.6846.160.CrossRefPubMedPubMedCentral Brazier JE, Harper R: Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992, 305: 160-4. 10.1136/bmj.305.6846.160.CrossRefPubMedPubMedCentral
24.
go back to reference Mc Horney CA, Ware JE, Rogers W: The validity and Relative Precision of MOS Short and Long Form Health Status Scales and Dartmouth COOP charts. Medical Care. 1992, 30: 253-265. Mc Horney CA, Ware JE, Rogers W: The validity and Relative Precision of MOS Short and Long Form Health Status Scales and Dartmouth COOP charts. Medical Care. 1992, 30: 253-265.
25.
go back to reference Hays RD, Sherbourne CD, Mazel RM: The Rand 36-Item Health Survey 1.0 Rand Health Sciences Program. Health Economics. 1993, 2: 217-227. 10.1002/hec.4730020305.CrossRefPubMed Hays RD, Sherbourne CD, Mazel RM: The Rand 36-Item Health Survey 1.0 Rand Health Sciences Program. Health Economics. 1993, 2: 217-227. 10.1002/hec.4730020305.CrossRefPubMed
26.
go back to reference Lewin-Epstein N, Sagiv-Schifter T, Shabtai EL: Validation of the 36-item short-form Health Survey (Hebrew version) in the adult population of Israel. Medical Care. 1988, 36: 1361-70.CrossRef Lewin-Epstein N, Sagiv-Schifter T, Shabtai EL: Validation of the 36-item short-form Health Survey (Hebrew version) in the adult population of Israel. Medical Care. 1988, 36: 1361-70.CrossRef
27.
go back to reference Whooley MA, Simon GE: Managing depression in medical outpatients. New England Journal of Medicine. 2000, 343 (26): 1942-50. 10.1056/NEJM200012283432607.CrossRefPubMed Whooley MA, Simon GE: Managing depression in medical outpatients. New England Journal of Medicine. 2000, 343 (26): 1942-50. 10.1056/NEJM200012283432607.CrossRefPubMed
28.
go back to reference El-Mallakh RS, Wright JC: Clues to depression in primary care practice. Postgraduate Medical Journal. 1996, 100: 91-8. El-Mallakh RS, Wright JC: Clues to depression in primary care practice. Postgraduate Medical Journal. 1996, 100: 91-8.
29.
go back to reference Nakao M, Yano E: Somatic symptoms for predicting depression: one-year follow-up study in annual health examinations. Psychiatry Clin Neurosci. 2006, 60 (2): 219-25. 10.1111/j.1440-1819.2006.01489.x.CrossRefPubMed Nakao M, Yano E: Somatic symptoms for predicting depression: one-year follow-up study in annual health examinations. Psychiatry Clin Neurosci. 2006, 60 (2): 219-25. 10.1111/j.1440-1819.2006.01489.x.CrossRefPubMed
30.
go back to reference Wu LR, Parkerson GR: Health Perception, Pain, and Disability as Correlates of Anxiety and Depression symptoms in Primary Care Patients. The Journal of the American Board of Family Practice. 2002, 15 (5): 183-190.PubMed Wu LR, Parkerson GR: Health Perception, Pain, and Disability as Correlates of Anxiety and Depression symptoms in Primary Care Patients. The Journal of the American Board of Family Practice. 2002, 15 (5): 183-190.PubMed
31.
go back to reference Bridges KW, Goldberg DP: Somatic presentation of DSM III psychiatric disorders in primary care. Journal of Psychosomatic Research. 1985, 29: 563-569. 10.1016/0022-3999(85)90064-9.CrossRefPubMed Bridges KW, Goldberg DP: Somatic presentation of DSM III psychiatric disorders in primary care. Journal of Psychosomatic Research. 1985, 29: 563-569. 10.1016/0022-3999(85)90064-9.CrossRefPubMed
32.
go back to reference Kirmayer LJ, Robbins JM, Dworkind M: Somatization and the recognition of depression and anxiety in primary care. The American Journal of Psychiatry. 1993, 150: 734-41.CrossRefPubMed Kirmayer LJ, Robbins JM, Dworkind M: Somatization and the recognition of depression and anxiety in primary care. The American Journal of Psychiatry. 1993, 150: 734-41.CrossRefPubMed
33.
go back to reference Robbins PR, Meyersburg HA, Tanck RH: Interpersonal stress and physical complaints. Journal of Personality Assessment. 1974, 38: 578-85. 10.1080/00223891.1974.10120020.CrossRefPubMed Robbins PR, Meyersburg HA, Tanck RH: Interpersonal stress and physical complaints. Journal of Personality Assessment. 1974, 38: 578-85. 10.1080/00223891.1974.10120020.CrossRefPubMed
34.
go back to reference Mechanic D: Effects of psychological distress on perceptions of physical health and use of medical and psychiatric facilities. Journal of Human Stress. 1978, 4: 26-32.CrossRefPubMed Mechanic D: Effects of psychological distress on perceptions of physical health and use of medical and psychiatric facilities. Journal of Human Stress. 1978, 4: 26-32.CrossRefPubMed
35.
go back to reference Dirkzwager AJE, Verhaak PFM: Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Family Practice. 2007, 8: 33-42. 10.1186/1471-2296-8-33.CrossRefPubMedPubMedCentral Dirkzwager AJE, Verhaak PFM: Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Family Practice. 2007, 8: 33-42. 10.1186/1471-2296-8-33.CrossRefPubMedPubMedCentral
36.
go back to reference Sloane PD, Coeytaux RR: Dizziness. State of the Science. Annals of Internal Medicine. 2001, 134: 823-832.CrossRefPubMed Sloane PD, Coeytaux RR: Dizziness. State of the Science. Annals of Internal Medicine. 2001, 134: 823-832.CrossRefPubMed
37.
go back to reference Haug TH, Mykletun A, Dahl AA: The association between anxiety, depression and somatic symptoms in a large population: the HUNT-II study. Psychosomatic Medicine. 2004, 66: 845-851. 10.1097/01.psy.0000145823.85658.0c.CrossRefPubMed Haug TH, Mykletun A, Dahl AA: The association between anxiety, depression and somatic symptoms in a large population: the HUNT-II study. Psychosomatic Medicine. 2004, 66: 845-851. 10.1097/01.psy.0000145823.85658.0c.CrossRefPubMed
38.
go back to reference Spitzer RL, Williams JB, Kroenke K: Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care- The Prime MD 1000 Study. JAMA. 1994, 272 (22): 1749-1756. 10.1001/jama.272.22.1749.CrossRefPubMed Spitzer RL, Williams JB, Kroenke K: Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care- The Prime MD 1000 Study. JAMA. 1994, 272 (22): 1749-1756. 10.1001/jama.272.22.1749.CrossRefPubMed
39.
go back to reference Wilhelm KA, Finch AW, Davenport TA, Hickie IB: What can alert the general practitioner to people whose common mental health problems are unrecognized?. MJA. 2008, 188 (12): S114-8.PubMed Wilhelm KA, Finch AW, Davenport TA, Hickie IB: What can alert the general practitioner to people whose common mental health problems are unrecognized?. MJA. 2008, 188 (12): S114-8.PubMed
40.
go back to reference Cummings SM, Savitz LA, Konrad TR: Reported response rates to mailed physician questionnaires. Health Services Research. 2001, 35 (6): 1347-55.PubMedPubMedCentral Cummings SM, Savitz LA, Konrad TR: Reported response rates to mailed physician questionnaires. Health Services Research. 2001, 35 (6): 1347-55.PubMedPubMedCentral
41.
go back to reference Burton C, Weller D, Sharpe M: Functional somatic symptoms and psychological states: an electronic diary study. Psychosom Med. 2009, 71 (1): 77-83. 10.1097/PSY.0b013e31818f2acb.CrossRefPubMed Burton C, Weller D, Sharpe M: Functional somatic symptoms and psychological states: an electronic diary study. Psychosom Med. 2009, 71 (1): 77-83. 10.1097/PSY.0b013e31818f2acb.CrossRefPubMed
Metadata
Title
Non-specific symptoms as clues to changes in emotional well-being
Authors
Andre Matalon
Andy Kotliroff
Gari Blumberg
John Yaphe
Eliezer Kitai
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2011
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-12-77

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