Psychosomatics 40:330-338, August 1999
© 1999 The Academy of Psychosomatic Medine
Somatization in Primary Care
Prevalence, Health Care Utilization, and General Practitioner Recognition
Per Fink, M.D., Ph.D., Dr. Med. Sc.,
Lisbeth Sørensen, M.D., MSc. Econ.,
Marianne Engberg, M.D., Ph.D.,
Martin Holm, M.D., and
Paul Munk-Jørgensen, M.D., Dr. Med. Sc.
Received April 22, 1998; revised November 4, 1998; accepted December 4, 1998. From the Department of Psychiatric Demography, Institute for Basic Psychiatric Research, Psychiatric Hospital in Aarhus, Aarhus University Hospital , DK–8240 Risskov, Denmark. Address correspondence and reprint requests to Dr. Fink at the same address; e-mail: perfink{at}aaa.dk
To study the prevalence of somatoform disorders (SDs) in primary care, a questionnaire including the modified 25-item version of the Symptom Checklist-90 was administered to 191 patients consecutively consulting their family physician. A stratified sample of the patients was interviewed with the Schedules for Clinical Assessment in Neuropsychiatry. The study showed that 22.3% (confidence interval [CI]: 95%: 16.4–28.1) of the patients fulfilled the diagnostic criteria for an International Classification of Diseases-10th Revision (ICD-10) SD, excluding SD, unspecified, and 57.5% (CI: 95%: 50.5–64.5) for DSM-IV SD. But 30.3% met the criteria (CI: 95%: 23.8–36.9) when the DSM-IV Not Otherwise Specified (NOS) diagnostic group is excluded. The most frequent ICD-10 diagnosis was autonomous dysfunction, for which 14.1% of the patients fulfilled the criteria, whereas the prevalence of the other somatoform diagnosis was between 3.0% and 8.1%. The most frequent DSM-IV diagnoses were SD NOS and undifferentiated SD, which 29.93% and 27.3% of the interviewed patients, respectively, received, whereas the prevalence of the other diagnoses was between 1.0% and 8.1%. A high comorbidity between SDs and other mental disorders was found. The general practitioners identified between 50% and 71% of the patients with an ICD-10 SD and between 36% and 48%, according to DSM-IV criteria. Patients with SDs used more nonpsychiatric health care facilities than other patients (P=0.01).
Key Words: Somatization • Primary Care • Health Services
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