Long-term outcome of Bodily Distress Syndrome (BDS) on sick leave, healthcare costs and work disability in primary care patients. A ten-year follow-up study

Abstract

Background: To assess the ten-year outcome as to sick leave and work disability in primary care patients with BDS compared with patients with a well-defined physical disease and to study the persistence of BDS over time. Method: 1785 consecutive patients consulting their family physician (FP) were screened by questionnaires for symptoms and mental illness. FPs rated patients’ main reason for consultation. A stratified subsample was examined with a standardized diagnostic interview. Patients with BDS single-organ type (n=124) and BDS multi-organ type (n=35) and a reference group having a medical condition according to their FP (n=880) were included. Patients completed questionnaires at three, 12and 24-month follow-up. Register data on health care costs and work were obtained for 2and 10-year follow-up. Results: Patient with BDS displayed poorer self-rated health and higher illness worry at index and throughout follow-up compared to the medical condition group (p≤0.001). Annual total health care costs were higher in the BDS groups compared with the medical condition group (2,270 USD and 4,066 USD vs 1,392 USD, ASL≤0.001). Both BDS groups had higher risk of sick leave during the first two years of follow-up (RRBDS single-organ =3.0, 95%CI: 1.8;5.0, RRBDS multi-organ =3.4, 95%CI:1.5;7.5), and they had substantially higher ten-year risk of new disability pension awards compared with the reference group (HRBDS single-organ=4.9, 95%CI: 2.8;8.4, HRBDS multi-organ=8.7, 95%CI:3.7;20.7). Conclusions This long-term follow-up study of primary care patients with BDS showed that the disorder has severe long-term consequences for the patients including poor physical and mental health, high health care costs and high risk of permanent work disability. This stresses the need for adequate recognition and management of BDS.