Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care

Margot WM de Waal,Just AH Eekhof,Willem JJ Assendelft,Albert M van Hemert,Ingrid A Arnold

doi:10.1186/1471-2296-9-5

Margot WM de Waal, Just AH Eekhof + Show 3 more

Open Access

https://doi.org/10.1186/1471-2296-9-5

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Abstract

BackgroundBetter management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively.MethodsIn eight family practices 1046 consulting patients (25–79 yrs) were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV) using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP).ResultsIn the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7)). Anxiety disorders had no independent effect.ConclusionHealth care planning should focus on the recognition and treatment of somatoform as well as affective disorders.

Highlights

Better management of affective and somatoform disorders may reduce consultation rates in primary care
We prospectively studied the use of primary health care by patients with DSM-IV diagnoses of undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders
If a referral is indicated for a somatoform or an affective disorder, the Dutch family physicians (FP) has the option of a primary care mental health psychologist or a mental health service

Summary

Introduction

Better management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively. With an estimated prevalence rate between 13% and 27%, undifferentiated somatoform disorder is the most prevalent somatoform disorder in primary care [8,3]. In DSM-IV the diagnosis of undifferentiated somatoform disorder (USD) can be made when at least one medically unexplained physical symptom leads to substantial impairment for a minimum of 6 months [10]. Health-seeking behaviour is not an explicit part of the definition

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