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BMC Public Health
Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

Severe MUPS in a sick-listed population: a cross-sectional study on prevalence, recognition, psychiatric co-morbidity and impairment

Authors: Rob Hoedeman, Boudien Krol, Nettie Blankenstein, Petra C Koopmans, Johan W Groothoff

Published in: BMC Public Health | Issue 1/2009

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Abstract

Background

Medically unexplained physical symptoms (MUPS) have a high prevalence in the general population and are associated with psychiatric morbidity. There are indications that MUPS are an important determinant of frequent and long-term disability.
The primary objective was to assess the prevalence of MUPS in sick-listed-employees and its associations with depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. Secondary objectives were to investigate the classification of the occupational health physicians (OHPs), their opinions about the causes as well as the attributions of the employee.

Methods

In a cross-sectional study of 489 sick-listed employees from 5 OHP group practices, MUPS, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment were assessed with the Patient Health Questionnaire (PHQ), the Whitely Index (WI), the Four- Dimensional Symptom Questionnaire (4DSQ) and the Short-Form 36 Health Survey (SF-36).
We used a cut off score of 15 on the PHQ for the categorisation of severe MUPS.
The opinions of the OHPs were evaluated by means of a separate questionnaire with regard to the presence of employees physical symptoms, and the symptoms attributions, and the diagnoses of the OHPs.

Results

Severe MUPS had a prevalence of 15.1% in this population of sick-listed employees. These employees had 4-6 times more depressive and anxiety disorders, and were more impaired. Female gender and PHQ-9 scores were determinants of severe MUPS.
Most of the time the OHPs diagnosed employees with severe MUPS as having a mental disorder. The employees attributed their physical symptoms in 66% to mental or to both mental and physical causes.

Conclusion

The prevalence of severe MUPS is higher in long-term sick-listed employees than in the non-sick- listed working population and at least equals the prevalence in the general practice population.
Severe MUPS are associated with psychiatric morbidity and functional impairment and must therefore be specifically recognised as such. Validated questionnaires, such as the PHQ-15, are useful instruments in order to help OHPs to recognise severe MUPS.
Appendix
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Literature
1.
Escobar JI, Burnam A, Karno M, Forsythe A, Goldinig JM: Somatisation in the community. Arch Gen Psych. 1987, 44: 713-718.CrossRef
2.
De Waal MWM, Arnold IA, Eekhof JAH, van Hemert AM: Somatoform disorders in general practice. Br J Psych. 2004, 184: 470-476. 10.1192/bjp.184.6.470.CrossRef
3.
Escobar JI, Rubio-Stipec M, Canino G, Karno M: Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples. J Nerv Ment Dis. 1989, 177: 140-146. 10.1097/00005053-198903000-00003.CrossRefPubMed
4.
Escobar JI, Gara M, Silver RC: Waitkin H, Holman A, Compton W: Somatisation disorder in primary care. Br J Psych. 1998, 173: 262-266. 10.1192/bjp.173.3.262.CrossRef
5.
Kroenke K, Spitzer RL, Williams JB: The PHQ-15: Validity of a new measure for evaluation of the severity of somatic symptoms. Psychosom Med. 2002, 64: 258-266.CrossRefPubMed
6.
Kroenke K, Spitzer RL, Williams JB: A symptom checklist to screen for somatoform disorders in primary care. Psychosomatics. 1998, 39: 263-272.CrossRefPubMed
7.
Escobar JI, Golding JM, Hough RL, Karno M, Burnam MA, Wells KB: Somatization in the community: relationship to disability and use of services. Am J Public Health. 1987, 77: 837-840. 10.2105/AJPH.77.7.837.CrossRefPubMedPubMedCentral
8.
Godin I, Kittel F, Coppieters Y, Siegrist J: A prospective study of cumulative job stress in relation to mental health. BMC Public Health. 2005, 5: 67-10.1186/1471-2458-5-67.CrossRefPubMedPubMedCentral
9.
Fagring AJ, Kjellgren K, Rosengren A, Lissner L, Manhem K, Welin C: Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain. BMC Public Health. 2008, 8: 165-10.1186/1471-2458-8-165.CrossRefPubMedPubMedCentral
10.
Pilowsky I: Dimensions of hypochondriasis. Br J Psychiatry. 1967, 113: 39-43. 10.1192/bjp.113.494.89.CrossRef
11.
Löwe B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K: Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psych. 2008, 30: 191-199. 10.1016/j.genhosppsych.2008.01.001.CrossRef
12.
Van Ravestijn H, Wittkampf K, Lucassen P, Lisdonk van de E, Hoogen van den H, van Weert H, Huijser J, Schene A, van Weel C, Speckens A: Detecting somatoform diorders in primary care with the PHQ-15. Ann Fam Med. 2009, 7: 232-238. 10.1370/afm.985.CrossRef
13.
Derogatis L, Cleary P: Confirmation of the dimensional structure of the SCL-90: a study in construct validation. J Clin Psychol. 1977, 33: 981-989. 10.1002/1097-4679(197710)33:4<981::AID-JCLP2270330412>3.0.CO;2-0.CrossRef
14.
Terluin B, Van Rhenen W, Schaufeli WB, De Haan M: The Four-Dimensional Symptom Questionnaire (4DSQ): measuring distress and other mental health problems in a working population. Work Stress. 2004, 18: 187-207. 10.1080/0267837042000297535.CrossRef
15.
Barsky AJ, Orav J, Bates DW: Somatization increases medical utilization and costs independent of psychiatric and medical co-morbidity. Arch Gen Psych. 2005, 62: 903-910. 10.1001/archpsyc.62.8.903.CrossRef
16.
Norrmén G, Svärdsudd K, Andersson DKG: How primary health care physicians make sick listing decisions: The impact of medical factors and functioning. BMC Fam Pract. 2008, 9: 3-10.1186/1471-2296-9-3.CrossRefPubMedPubMedCentral
17.
Eriksen HR, Ihlebaek C, Jansen JP, Burdorf : The relations between psychological factors at work and health status among workers in home care organizations. Int J Beh Med. 2006, 13: 183-192. 10.1207/s15327558ijbm1303_1.CrossRef
18.
Al Windi A: Determinants of complaints symptoms in a Swedish health care practice- - results of a questionnaire survey. J Psychosom Res. 2004, 57: 307-316. 10.1016/S0022-3999(03)00612-3.CrossRefPubMed
19.
Hansen A, Edlund C, Bränholm I-B: Significant resources needed for return to work after sick leave. Work. 2005, 25: 231-240.PubMed
20.
Roelen CAM, Pol Van der TR, Koopmans PC, Groothoff JW: Identifying workers at risk of sickness absence by questionnaire. Occup Med. 2006, 56: 442-446. 10.1093/occmed/kql087.CrossRef
21.
Marmot M, Feeney A, Shipley M, North F, Syme SL: Sickness absence as a measure of health status and functioning: from the Whitehall II Study. J Epidemiol Community Health. 1995, 49: 124-130. 10.1136/jech.49.2.124.CrossRefPubMedPubMedCentral
22.
Fink P, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P: Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosom. 1999, 40: 330-338.CrossRef
23.
Kessler D, Lloyd K, Lewis G, Gray DP: Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ. 1999, 318: 436-440.CrossRefPubMedPubMedCentral
24.
Clarke DM, Piterman L, Byrne CJ, Austin DW: Somatic symptoms, hypochondriasis and psychological distress: a study of somatisation in Australian general practice. Med J Austr. 2008, 189: 560-564.
25.
Terluin B, Van Marwijk HWJ, Ader HJ, De Vet HCW, Penninx BWJH, Hermens MLM, Van Boeijen CA, Van Balkom AJLM, Klink Van der JJL, Stalman WAB: The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry. 2006, 6: 34-10.1186/1471-244X-6-34.CrossRefPubMedPubMedCentral
26.
NVAB: Guideline for mental health problems. 2007, NVAB (Dutch Association of Occupational Health Physicians). Eindhoven, Second
27.
Spitzler RL, Kroenke K, Williams JB: Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999, 282: 1737-1744. 10.1001/jama.282.18.1737.CrossRef
28.
Interian A, Allen LA, Gara MA, Escobar JI, Diaz-Martinez AM: Somatic complaints in primary care: Further examining the validity of the Patient Health Questionnaire (PHQ-15). Psychosomatics. 2006, 47: 392-398. 10.1176/appi.psy.47.5.392.CrossRefPubMed
29.
Kroenke K, Spitzer RL, Williams JB: The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med. 2001, 16: 606-613. 10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentral
30.
Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, Bucholz C, Witte S, Herzog W: Comperative validity of three screening questionnaires for DSM-IV depressive disorders and physicians diagnoses. J Affect Disord. 2004, 78: 131-140. 10.1016/S0165-0327(02)00237-9.CrossRefPubMed
31.
Martin A, Rief W, Klaiberg A, Braehler E: Validity of the brief Patient Health Questionnaire Mood Scale (PHQ-9. in the general population. Gen Hosp Psych. 2006, 28: 71-77. 10.1016/j.genhosppsych.2005.07.003.CrossRef
32.
Cameron IM, Crawford JR, Lawton K, Reid IC: Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract. 2008, 58: 32-36. 10.3399/bjgp08X263794.CrossRefPubMedPubMedCentral
33.
Löwe B, Gräfe K, Zipfel S, Spitzer RL, Herrmann-Lingen C, Witte S, Herzog W: Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians diagnosis. J Psychosom Res. 2003, 55: 515-519. 10.1016/S0022-3999(03)00072-2.CrossRefPubMed
34.
Speckens AEM, Spinhoven P, Sloekers PPA, Bolk JH, Van Hemert AM: A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. J Psychosom Res. 1996, 40 (1): 95-104. 10.1016/0022-3999(95)00561-7.CrossRefPubMed
35.
Zee Van der KI, Sanderman R: Het meten van de algemene gezondheidstoestand met de RAND-36. Een handleiding. [Measuring general health status with the RAND-36. Manual] Groningen. Noordelijk Centrum voor Gezondheidsvraagstukken. 1993
36.
Ware JE, Sherbourne CD: The MOS 36-item short form health survey (SF-36). Conceptual framework and item selection. Med Care. 1992, 30 (6): 473-483. 10.1097/00005650-199206000-00002.CrossRefPubMed
37.
Windt Van der DA, Dunn KM, Spies-Dorgelo MN, Mallen CD, Blankenstein AH, Stalman WA: Impact of physical symptoms on perceived health in the community. J Psychosom Res. 2008, 64: 265-274. 10.1016/j.jpsychores.2007.10.003.CrossRefPubMed
38.
Ring A, Dowrick CF, Humphris G, Salmon P: What do general practice patients want when they present their medically unexplained symptoms, and why do their general practitioners feel pressurized?. J Psychosom Res. 2005, 59: 255-260. 10.1016/j.jpsychores.2005.03.004.CrossRefPubMed
39.
Goldberg DP, Bridges K: Somatic presentations of psychiatric illness in the primary care setting. J Psychosom Res. 1988, 32: 137-144. 10.1016/0022-3999(88)90048-7.CrossRefPubMed
40.
Airzaguena JM, Grandes G, Gaminde I, Salazar A, Sanchez A, Arino J: A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychol Med. 2007, 37: 283-294. 10.1017/S0033291706009536.CrossRef
41.
Post M, Krol B, Groothoff JW: Self-rated health as a predictor of return to work among employees on long-term sickness absence. Disability and Rehabilitation. 2006, 28: 289-297. 10.1080/09638280500160303.CrossRefPubMed
42.
Eriksen HR, Ihlebaek C, Jansen JP, Burdorf A: The relations between psychosocial factors at work and health status among workers in home care organizations. Int J Behav Med. 2006, 13: 183-192. 10.1207/s15327558ijbm1303_1.CrossRefPubMed
43.
Dirkzwager AAJE, Verhaak PPFM: Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Fam Pract. 2007, 8: 33-10.1186/1471-2296-8-33.CrossRefPubMedPubMedCentral
44.
Smith GR, Rost K, Kashner TM: A trial on the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Arch Gen Psych. 1995, 52: 238-243.CrossRef
45.
Dickinson WP, Dickinson LW, De Gruy FV, Main DS, Candib LM, Rost K: A randomized clinical trial of a care recommendation letter intervention for somatization in primary care. Ann Fam Med. 2003, 4: 228-235. 10.1370/afm.5.CrossRef
46.
Feltz-Cornelis Van der CM, Van Oppen P, Ader H, Van Dyck R: Randomised controlled trial of a collaborative care model with psychiatric consultation for persistent medically unexplained symptoms in general practice. Psychother Psychosom. 2006, 75: 282-289. 10.1159/000093949.CrossRefPubMed
47.
Henningsen P, Zipfel S, Herzog W: Management of functional somatic syndromes. Lancet. 2007, 369: 946-955. 10.1016/S0140-6736(07)60159-7.CrossRefPubMed
48.
Sumathipala A: What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med. 2007, 69: 889-900. 10.1097/PSY.0b013e31815b5cf6.CrossRefPubMed
49.
Thomson A, Page L: Psychotherapies for hypochondriasis. Cochrane Database Syst Rev. 2007, 4: CD006520-PubMed
50.
Epstein RM, Hadee T, Caroll J, Meldrum SC, Lardner J, Shields CG: "Could this be something serious?" Reassurance, uncertainty, and empathy in response to patients' expression of worry. J Gen Med. 2007, 22: 1731-1739.
Metadata
Title
Severe MUPS in a sick-listed population: a cross-sectional study on prevalence, recognition, psychiatric co-morbidity and impairment
Authors
Rob Hoedeman
Boudien Krol
Nettie Blankenstein
Petra C Koopmans
Johan W Groothoff
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-440

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