Subjective Health Complaints Inventory Research Articles

Is Anatomy Exam Really So Stressful for Dentistry and Medical Students?

Introduction Test-taking situation is a stressful situation in which many students experience negative emotions associated with significant neurohormonal (changes in cortisol level) and physiological changes (psychosomatic symptoms). The aim of this study was to explore the relationship between trait anxiety, test anxiety, cortisol level, psychosomatic symptoms, perception of test difficulty and final grade. Materials and Methods The investigation was conducted with 116 first-year dentistry and medical students while taking a very difficult written examination in anatomy course. Just before the exam they filled in Test Anxiety Inventory, provided saliva samples, assessed the level of difficulty of the exam and the grade they expected. Immediately after the exam they filled in Subjective Health Complaints Inventory and a week after the exam they filled in State-Trait Anxiety Inventory and stated the grade they achieved. Results Exam results had significant effect on the level of trait anxiety and the assessment of exam difficulty, but there was no significant effect of exam difficulty on test anxiety and psychosomatic symptoms. Trait anxiety and test anxiety explained 49% of variance in psychosomatic symptoms. Although there were only five samples of cortisol that were analyzed in the laboratory, the level of salivary cortisol showed significant positive correlation with overall psychosomatic symptoms. Conclusion Although there is no difference in expressing test anxiety and psychosomatic symptoms between successful and unsuccessful students, there is a significant contribution of test anxiety to discomfort caused by psychosomatic symptoms. There is a need for reorganization of teaching classes and exam in anatomy course.

Are 2 Questions Enough to Screen for Depression and Anxiety in Patients With Chronic Low Back Pain?

Cross-sectional study. To examine the sensitivity of 2 single-item questions compared with 2 longer questionnaires for screening depression and anxiety among patients with chronic low back pain (CLBP). Psychosocial factors are frequently identified as risk factors for developing CLBP and as predictors for treatment, and questionnaires are often used to screen for this. Shorter instruments may be easier to use in clinical practice settings. A total of 564 patients with 2 to 10 months of at least 50% sickness absence due to nonspecific low back pain were assessed for depression and anxiety with the Mini-International Neuropsychiatric Interview (MINI). Single-item questions for depression and anxiety from the Subjective Health Complaint Inventory and 2 longer questionnaires, the Hospital Anxiety and Depression Scale and Hopkins Symptom Checklist-25, were compared with MINI results, considered the "gold standard" in this study. Sensitivity and specificity of single-item and longer questionnaires and receiver operating characteristic curves were compared. According to MINI, the prevalence of anxiety disorders was 12% whereas that of depressive disorders was 4%. The screening questions showed 95% sensitivity and 56% specificity for depressive disorders and 68% sensitivity and 85% specificity for anxiety disorders. The longer questionnaire, Hospital Anxiety and Depression Scale, showed 91% sensitivity and 85% specificity for depressive disorders and 58% sensitivity and 83% specificity for anxiety disorders. Hopkins Symptom Checklist-25 showed 86% sensitivity and 74% specificity for depressive disorders and 67% sensitivity and 87% specificity for anxiety disorders. For 3 of the anxiety disorders and 2 of the depressive disorders, a perfect sensitivity was found between the screening questions and MINI. A single-item screening question was sensitive for depression but less sensitive for anxiety. The screening questions further performed equal to 2 widely used questionnaires. Validation of these results in other populations and compared with other short-item screeners is needed.

Chronic fatigue in patients with unexplained self-reported food hypersensitivity and irritable bowel syndrome: validation of a Norwegian translation of the Fatigue Impact Scale.

BackgroundPatients with unexplained self-reported food hypersensitivity and irritable bowel syndrome (IBS) suffer from several health complaints, including fatigue. The aim of the present study was to validate a Norwegian translation of the Fatigue Impact Scale (FIS), and to assess the impact of fatigue in patients with self-reported food hypersensitivity and IBS, as compared with healthy controls.MethodsThirty-eight patients with unexplained self-reported food hypersensitivity and IBS, who participated in the validation of the FIS completed the following additional questionnaires: the Short Form of Nepean Dyspepsia Index for assessment of quality of life, the Subjective Health Complaint Inventory, and questionnaires for diagnosis and severity of IBS. Impact of fatigue was studied in 43 patients with unexplained self-reported food hypersensitivity, 70% diagnosed with IBS, and 42 healthy controls.ResultsCronbach’s α for the FIS was 0.98, indicating excellent agreement between individual items. Scores on the FIS correlated with scores on the Short Form of Nepean Dyspepsia Index (r = 0.50, P = 0.001), indicating good convergent validity, and were higher in patients (median 85.0, interquartile range 36.8–105.3) than in controls (median 14.0, interquartile range 3.0–29.0, P ≤ 0.0001).ConclusionThe Norwegian translation of the FIS performed excellently in patients with unexplained self-reported food hypersensitivity and IBS, with patients reporting significantly more impact of chronic fatigue than healthy controls.

Symptom load and functional status: results from the Ullensaker population study

BackgroundThere is evidence to support that the number of self-reported symptoms is a strong predictor of health outcomes. In studies examining the link between symptoms and functional status, focus has traditionally been on individual symptoms or specific groups of symptoms. We aim to identify associations between the number of self-reported symptoms and functional status.MethodsA questionnaire was sent to people in seven age groups (N = 3227) in Ullensaker municipality in Southern Norway. The Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record 10 musculoskeletal symptoms and 13 non-musculoskeletal symptoms, respectively. Four COOP-WONCA charts were used to measure functional status.ResultsWe found a strong linear association between the number of self-reported symptoms and functional status. The number of symptoms explained 39.2% of the variance in functional status after adjusting for the effects of age and sex. Including individual symptoms instead of only the number of symptoms made little difference to the effect of musculoskeletal pain but affected the influence of non-muscular symptoms. Including even minor problems captured substantially more of the variance in functional status than including only serious problems.ConclusionsThe strong association between the number of symptoms and functional status, irrespective of type of symptom, might indicate that the symptoms share some common characteristics. The simple act of counting symptoms may provide an approach to study the relationships between health and function in population studies and might be valuable in research on medically unexplained conditions.

Modern Health Worries, Subjective Health Complaints, Health Care Utilization, and Sick Leave in the Norwegian Working Population

Modern health worries (concerns about aspects of modern life affecting health) heve been associated with subjective health complaints and health care utilization. The aim of this study was to investigate the association between modern health worries (MHW) and subjective health complaints (SHC), health care utilization, and sick leave related to such complaints in the Norwegian working population. A sample of the Norwegian working population (N = 569) answered a questionnaire which included the Subjective Health Complaints Inventory and a Norwegian version of the Modern Health Worries Scale. Ninety-one percent of the participants reported at least one complaint in the past 30 days, and 96 % of the participants reported concerns for at least one of the items in the MHW scale. Women reported significantly more and more severe complaints compared to men and significantly more concern about aspects of modern life affecting health. Participants who reported a high level of MHW showed nearly twice the risk of reporting a high level of SHC (odds ratio (OR) = 1.83; 95 % confidence interval (CI) = 1.30-2.71; p = 0.001), and they showed twice the risk for self-certified sick leave related to SHC (OR = 2.04; 95 % CI = 1.01-3.92; p = 0.048). High levels of MHW showed no significant association with health care utilization or doctor-certified sick leave. Subjective health complaints and concerns about aspects of modern life affecting health are very common, even among healthy workers. Women have more complaints and more concerns compared to men. Within the health care system, it may be advantageous to pay close attention to the association between high levels of MHW and high levels of SHC.

A strong association between non-musculoskeletal symptoms and musculoskeletal pain symptoms: results from a population study

BackgroundThere is a lack of knowledge about the pattern of symptom reporting in the general population as most research focuses on specific diseases or symptoms. The number of musculoskeletal pain sites is a strong predictor for disability pensioning and, hence, is considered to be an important dimension in symptom reporting. The simple method of counting symptoms might also be applicable to non-musculoskeletal symptoms, rendering further dimensions in describing individual and public health. In a general population, we aimed to explore the association between self-reported non-musculoskeletal symptoms and the number of pain sites.MethodsWith a cross-sectional design, the Standardised Nordic Questionnaire and the Subjective Health Complaints Inventory were used to record pain at ten different body sites and 13 non-musculoskeletal symptoms, respectively, among seven age groups in Ullensaker, Norway (n = 3,227).ResultsResults showed a strong, almost linear relationship between the number of non-musculoskeletal symptoms and the number of pain sites (r = 0.55). The number and type of non-musculoskeletal symptoms had an almost equal explanatory power in the number of pain sites reported (27.1% vs. 28.2%).ConclusionThe linear association between the number of non-musculoskeletal and musculoskeletal symptoms might indicate that the symptoms share common characteristics and even common underlying causal factors. The total burden of symptoms as determined by the number of symptoms reported might be an interesting generic indicator of health and well-being, as well as present and future functioning. Research on symptom reporting might also be an alternative pathway to describe and, possibly, understand the medically unexplained multisymptom conditions.

Comorbid subjective health complaints in patients with sciatica: A prospective study including comparison with the general population

Objective Chronic nonspecific low back pain is accompanied by high rates of comorbid mental and physical conditions. The aims of this study were to investigate if patients with specific back pain, that is, sciatica caused by lumbar herniation, report higher rates of subjective health complaints (SHCs) than the general population and if there is an association between change in sciatica symptoms and change in SHCs over a 12-month period. Methods A multicenter cohort study of 466 sciatica patients was conducted with follow-up at 3 months and 1 year. Comorbid SHCs were measured by 27 items of the SHC inventory. Odds ratios (ORs) for each SHC were calculated with comparison to a general population sample ( n=928) by logistic regression. The SHC number was calculated by summing all complaints present. Results At baseline, the ORs for reporting SHCs for the sciatica patients were significantly elevated in 15 of the 27 items with a mean (S.D.) SHC number of 7.5 (4.4), compared to 5.2 (4.4) in the general population ( P<.01). Among those who during the 1-year follow-up period fully recovered from their sciatica, the SHC number was reduced to normal levels. Among those with persisting or worsening sciatica, the number increased to a level almost double that of the general population. Conclusion Compared to the general population, the prevalence of subjective health complaints in sciatica is increased. During follow-up, the number of health complaints increased in patients with persisting or worsening sciatica.

Duodenal administered seal oil for patients with subjective food hypersensitivity: an explorative open pilot study

Short-term duodenal administration of n-3 polyunsaturated fatty acid (PUFA)-rich seal oil may improve gastrointestinal complaints in patients with subjective food hypersensitivity, as well as joint pain in patients with inflammatory bowel disease (IBD). The aim of the present explorative pilot study was to investigate whether 10-day open treatment with seal oil, 10 mL self-administrated via a nasoduodenal tube 3 times daily, could also benefit nongastrointestinal complaints and quality of life (QoL) in patients with subjective food hypersensitivity. Twenty-six patients with subjective food hypersensitivity, of whom 25 had irritable bowel syndrome (IBS), were included in the present study. Before and after treatment and 1 month posttreatment, patients filled in the Ulcer Esophagitis Subjective Symptoms Scale (UESS) and the Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal symptoms and subjective health complaints (SHC) inventory for nongastrointestinal symptoms in addition to short form of the Nepean dyspepsia index (SF-NDI) for evaluation of QoL. Compared with baseline, gastrointestinal, as well as nongastrointestinal, complaints and QoL improved significantly, both at end of treatment and 1 month posttreatment. The consistent improvements following seal oil administration warrant further placebo-controlled trials for confirmation of effect.

The effect of psychomotor physical therapy on subjective health complaints and psychological symptoms

The objective of this study was to examine the effect of Norwegian psychomotor physical therapy on subjective health complaints and psychological symptoms. A non-randomized waiting list controlled design was used. Physiotherapists in Norway recruited patients for a treatment group (n = 40) and waiting list control group (n = 22). Patients on the waiting list could only be included for 6 months, as they then started treatment. Symptoms registration was obtained from both groups at baseline and 6 months, and only for the treatment group also at 12 months. The following self-report forms were used; Subjective Health Complaints Inventory (SCH); Beck Depression Inventory-II (BDI-II); Spielberger State-Trait Anxiety Inventory-Trait (STAI-T); Bergen Insomnia Scale (BIS); Fatigue Questionnaire (FQ); Quality of Life Inventory (QOLI); The Client Satisfaction Questionnaire (CSQ). The patients had had widespread and clinically significant health problems for an average of 9 years upon entrance to the study. After 6 months in psychomotor physical therapy, all the measured symptoms in the treatment group were significantly reduced, but only quality of life was significantly reduced when compared to the waiting list control group. After 12 months in therapy, the patients in the treatment group had continued to improve on all measured variables. The symptoms of anxiety and depression, as well as quality of life, were improved from clinical to non-clinical level. Norwegian psychomotor physical therapy seems to have potential for reducing symptoms of subjective health complaints, depression, anxiety, insomnia, fatigue and improving quality of life, although the process takes time. Further research is needed to gain more rigorous data, and randomized controlled studies are highly welcomed.

Subjective health complaints in individuals with Ehlers–Danlos syndrome: A questionnaire study

Background Ehlers–Danlos syndrome (EDS) is an inherited connective tissue disorder where symptoms such as hyper mobile joints, fragile tissues, a bleeding tendency and chronic pain are frequent. Consequently, functional disability is common. Objective In the present study we investigated the prevalence of subjective health complaints in a Swedish EDS group. Design, participants and method Members of the Swedish EDS Association were invited to respond to the questionnaire Subjective Health Complaints Inventory (SHCI). Of the 365 individuals receiving questionnaires, 250 diagnosed individuals >18 years (mean age 46.15; SD 12) responded. The overall response rate was 68% (females 89.2%; n = 223). Results The total number of persons reporting any health complaint was 247 (99%). The mean number of complaints was 16.1 (SD 5.7) in the whole group. The complaints reported were musculoskeletal by 246 (98%), pseudoneurological by 241 (96%), gastrointestinal by 236 (94%), allergic by 182 (73%) and influenza-like by 144 (58%) persons. Substantial complaints were reported by 240 (96%) persons. Women reported a significantly higher number of complaints, mean total SHC, and severity per complaint compared to men and the reference group; the Norwegian general population. Conclusion Swedish females with EDS have higher number of and more substantial health complaints like tiredness and different localisations of pain than the compared Norwegian general population. Musculoskeletal, pseudoneurological and gastrointestinal complaints are most frequent in individuals with the hyper mobile EDS type.

Is one question enough to screen for depression?

The aim of this study was to determine if chronic pain patients with symptoms of depression could be identified by one single question. Data from 595 patients, 55% women, and 45% men, from three different patient populations; low back pain patients (n = 387), whiplash patients (n = 119), and disability pensioners (n = 89), were analysed. We evaluated the test characteristics of one question on depression from the Subjective Health Complaints (SHC) Inventory. The respondents report if, and to what extent, they have been affected by sadness/depression in the last 30 days. The Hopkins Symptom Checklist-25 (HSCL-25) was used as the criterion standard. HSCL-25 is a self-report symptom rating scale with two dimensions: depression and anxiety. ''Depressed'' was defined as having a score above 1.75 on the depression subscale. Thirty-three per cent of the patients were depressed according to HSCL-25. The sensitivity of the single SHC depression-question was 79%, and the specificity was 81%. Positive predictive value was 67% while negative predictive value was 89%. Kappa value for all groups combined was 0.58 (p < 0.001). The receiver operating characteristic (ROC) curve showed an area under the curve of 0.83. The depression-question from SHC identified most of the depressed patients measured by HSCL-25 in low back pain patients, whiplash patients, and disability pensioners, and can therefore be considered an indicator of depression. Satisfactory sensitivity and specificity were detected, as well as similar responsiveness as determined by the ROC analyses. The results indicate that one simple question could replace a whole questionnaire (HSCL-25) in identifying depressive patients.

Do psychological factors predict symptom severity in patients with subjective food hypersensitivity?

Objective. We examined whether psychological factors such as general and gastrointestinal symptom-specific anxiety and depression could predict symptom severity in patients with unexplained, self-reported (subjective) food hypersensitivity. For the purpose, we translated and validated the Visceral Sensitivity Index (VSI). Material and methods. Seventy consecutive patients completed questionnaires for Hospital Anxiety and Depression Scale, VSI, Irritable Bowel Syndrome Symptom Questionnaire, and Subjective Health Complaints Inventory. Relationship between scores on psychological factors and scores on somatic symptoms were studied by multiple regression analyses. Results. Most patients reported non-gastrointestinal symptoms in addition to their irritable bowel syndrome complaints, but general and symptom-specific anxiety, and depression could not explain a significant amount of the variance in somatic complaints. Gastrointestinal symptom-specific anxiety was a significant predictor of gastrointestinal complaints (p = 0.02), and age was the sole significant predictor of non-gastrointestinal complaints (p = 0.01). Approximately 90% of the total variance in symptom severity remained unexplained by the psychological factors. The Norwegian version of the VSI had satisfactory validity (Cronbach alfa = 0.93). Symptom-specific and general anxiety were significantly correlated (r = 0.48, p ≤ 0.0001). Conclusions. Psychological factors were not major predictors of symptom severity in patients with subjective food hypersensitivity. The Norwegian version of VSI had satisfactory validity.

Subjective Health Complaints of Teachers From Primary and Secondary Schools in Hong Kong

This study aimed to investigate the subjective health complaints (SHC) in the teaching profession of Hong Kong. On the basis of the SHC inventory, a questionnaire was prepared for data collection through a mail survey. A total of 1 710 usable questionnaires were returned by the primary or secondary school teachers. The results showed that 99.5% (n =1702) of respondents suffered at least one type of the 39 single health problems on the total SHC scale during the preceding 30 days. The 10 most frequently reported health complaints among the teachers were tiredness, eyestrain, anxiety, sleep problems, voice disorder, shoulder pain, neck pain, headache, cold/flu, and lower-back pain. With the exception of the category of pseudoneurological complaints, primary school teachers showed a statistically higher prevalence in reporting problems in 6 of 7 subscales. The 5 most severe complaints were tiredness, eyestrain, sleep problems, shoulder pain, and voice disorder.

The Subjective Health Complaints Inventory: A useful instrument to identify various aspects of health and ability to cope in older people?

The aims were to investigate the factor structure of the Subjective Health Complaints Inventory (SHC) in a population of 75 years and above and to identify whether somatic, psychosocial, and coping factors were associated with the SHC factors. Data from 242 elderly persons were analyzed. The measures were: the SHC Inventory, Sense of Coherence, Social Provision Scale, Self-Rated Health, General Health Questionnaire, Clinical Dementia Rating, Reported Illness, Barthel ADL Index, sex, age, and education. The factor analysis resulted in four subgroups: musculoskeletal pain (15% of variance), gastrointestinal problems (12% of variance), respiratory/allergy complaints (11% of variance), and pseudoneurology (11% of variance). The occurrence of complaints was 76% for musculoskeletal complaints, 51% for gastrointestinal complaints, 30% for flu, 43% for allergy, and 93% for pseudoneurology. Self-rated health and reported illness were significantly associated with musculoskeletal complaints (15% of variance), impairment in activities of daily living (ADL) with gastrointestinal complaints (3% of variance), and finally sense of coherence, self-rated health, and psychological distress were associated with pseudoneurology (32% of variance). No variables were associated with respiratory/allergy complaints. This study supports the stability of the SHC's factor structure. The low occurrence of health complaints could possibly be due to survival effects, or that old people to a greater extent than younger people compare themselves with aged peers. The subscales focusing on somatic symptoms were explained by reported illnesses and functional impairments to a limited degree only. The pseudoneurology subscale score was associated with psychological measures, particularly ability to cope.

Shift Work Disorder Among Oil Rig Workers in the North Sea

Shift work disorder (SWD) is a circadian rhythm sleep disorder caused by work hours during the usual sleep period. The main symptoms are excessive sleepiness and insomnia temporally associated with the working schedule. The aim of the present study was to examine SWD among shift workers in the North Sea. A total of 103 shift workers (2 weeks on 7 nights/7days, 12-h shifts, 4 weeks off), mean age 39.8 years, working at an oil rig in the North Sea responded to a questionnaire about SWD. They also completed the Pittsburgh Sleep Quality Index, Bergen Insomnia Scale, Epworth Sleepiness Scale, Composite Morningness Questionnaire, Subjective Health Complaint Inventory, Demand/Control, and Instrumental Mastery Oriented Coping (based on the Utrecht Coping list). Most of these instruments were administered during the first day of the 2-week working period, thus reflecting symptoms and complaints during the 4-week non-work period. The shift workers were also compared to day workers at the oil rig. Twenty-four individuals were classified as suffering from SWD, yielding a prevalence for SWD of 23.3%. During the 4-week non-work period, individuals with SWD reported significantly poorer sleep quality, as measured by the Pittsburgh Sleep Quality Index, and more subjective health complaints than individuals not having SWD. There were no differences between the 2 groups in sleepiness, insomnia, circadian preference, psychological demands, or control. Individuals with SWD reported significantly lower scores on coping. The reports of shift workers without SWD were similar to those of day workers regarding sleep, sleepiness, subjective health complaints, and coping. The prevalence of SWD was relatively high among these shift workers. Individuals with SWD reported poorer sleep quality and more subjective health complaints in the non-work period than shift workers not having SWD.

P02-60 Subjective health complaints in a sample with morbid obesity and the complaints' relation with work ability

Background and aims:Obesity is associated with psychological, social and physical problems. The aim of this study was to examine the prevalence of subjective health complaints and their impact on work ability in a sample with morbid obesity.Method:Fortysix patients, 31 women and 15 men, aged 23 to 65 years (mean 43.7, s.d. 10.7), with BMI from 37 to 60 kg/m2 (mean 45 kg/m2, s.d. 5.02), on a waiting list for bariatric surgery participated. Subjective health complaints were measured by the 29-items Subjective Health Complaint Inventory. Five subscales were computed; Allergy, Flu, Musculoskeletal pain, Gastrointestinal problems and Pseudoneurology.Results:All participants reported subjective health complaints the last month, in particular they suffered from musculoskeletal (mean 8.2, s.d. 5.46), pseudoneurological (mean 4.7, s.d. 4.31) and gastrointestinal (mean 3.2, s.d. 5.46) complaints. Mean sickness absence the last year was 185 days (s.d. 163.32). Days of sickness absence were significant correlated with the Musculoskeletal (r = .35, p= .023) and Pseudoneurological (r= .40, p= .009) subscales.Conclusion:All patients reported subjective health complaints, with mean levels of symptoms considerably higher than in the general population. In particular, levels of musculoskeletal and pseudoneurological complaints were high, and these complaints were significantly related to work absence. It thus seems like subjective health complaints influence work ability to a significant degree in patients with morbid obesity.

Subjective health complaints are more prevalent in Maasais than in Norwegians

The aim of this observational, population-based study was to compare subjective health complaints (SHC) in Norwegians, living in a Western welfare society, and Maasai people, living in rural Kenya under primitive conditions. An interview-based version of SHC inventory was used. Data from 320 Maasais were compared to data from 1243 Norwegians. The Maasais had significantly higher score than the Norwegians on 23 of 28 items, involving musculoskeletal, “pseudo-neurological” and gastrointestinal complaints. The Maasais, living under primitive conditions, close to nature, seems to have more SHC than Norwegians, living in a modern, highly developed and industrialized country.

The two-factor model of social desirability: Relation to coping and defense, and implications for health

Recent research has questioned whether two components of social desirability, impression management (IM) and self-deception (SDE) are reflective of conscious and unconscious processes. This paper examines if IM and SDE, as measured by the Balanced Inventory of Desirable Responding (BIDR-6), are differentially related to measures of coping strategies, defensive mechanisms, and self-efficacy. In addition this paper will analyse associations between these constructs and health complaints as measured by the Subjective Health Complaints Inventory. A student sample ( N = 237) completed the BIDR-6, the General Self-efficacy Scale, the Marlowe–Crowne Social Desirability Scale, CODE, and the SHC. A factor-analysis of these scales revealed five dimensions. The factor structure did not support the hypothesis that SDE would cluster with defense scales, and that IM would cluster with active mastery-oriented coping strategies. SDE loaded on an active coping factor as did self-efficacy and three coping strategies; active problem-solving, depressive reactions and comforting cognitions. IM and MC loaded on a separate factor other-deception. Both active coping and other-deception were negatively related to subjective health complaints. The results question the widespread practice of applying social desirability measures as indicators of psychological defense and the interchangeable use of these constructs in the literature.

Subjective Health Complaints and Modern Health Worries in Patients with Subjective Food Hypersensitivity

Perceived food hypersensitivity is much more common than food allergy as medically verified. Unexplained symptoms and wrong attribution are typical in subjective health complaints. We hypothesize that subjective health complaints and worries are abnormally prevalent among patients with subjective food hypersensitivity. Forty-six patients with subjective food hypersensitivity and two control groups, one formed by 50 health care workers and one by 70 sex- and age-matched volunteers from the general population, were included in our study. All filled in two questionnaires: Subjective Health Complaints Inventory and Modern Health Worries Scale. None of the patients had IgE-mediated food allergy. The patients scored significantly higher than the controls on sum scores for four domains of subjective health complaints, including gastrointestinal complaints (P < 0.001), musculoskeletal complaints (P < 0.01), "pseudoneurology" (P < 0.001), and allergy (P < 0.001). Sum scores on modern health worries did not differ significantly between groups. The results support our hypothesis of an association between subjective food hypersensitivity and subjective health complaints, corroborating the view that, in the absence of food allergy, the conditions are sharing pathogenetic mechanisms.

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

Somatic comorbid symptoms might identify irritable bowel syndrome patients with different aetiologies and needs of treatment. To measure comorbid symptoms in patients with irritable bowel syndrome in general practice, and to explore characteristics of patients with low, intermediate and high somatic comorbidity. Prospective study of 208 of 278 consecutive patients with irritable bowel syndrome (Rome II) in nine general practices. Questionnaires assessed 22 comorbid symptoms (subjective health complaint inventory), psychosocial factors including psychological distress (Symptom Check list-10) and quality of life (Short form-12). Subjective health complaint data from 1240 adults (controls) constituted a reference material. Patients with low, intermediate and high somatic comorbidity were identified by a somatic comorbidity score (17 subjective health complaint items). Health care seeking was assessed after 6-9 months. Patients with irritable bowel syndrome (67% females, mean age 50, s.d. 16) reported 20 of 22 comorbid symptoms significantly more frequent than controls (odds ratios = 2-7, P < 0.001). The somatic comorbidity score correlated with psychological distress (R = 0.46, P < 0.001). Patients with high somatic comorbidity reported higher levels of mood disorder, health anxiety, neuroticism, adverse life events and reduced quality of life and increased health care seeking when compared to those with low and intermediate somatic comorbidity (P-values < 0.05). Our findings support the hypothesis that structured assessment of comorbid somatic symptoms might identify subgroups with different aetiology and needs of treatment.