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Multiple somatic symptoms in primary care: A field study for ICD-11 PHC, WHO's revised classification of mental disorders in primary care settings
David P. Goldberg, D.M.a, , (Professor), Geoffrey M. Reed, Ph.D.b, c, Rebeca Robles, Ph.D.d, JulioBobes, M.D.e, Celso Iglesias, M.D.e, Sandra Fortes, M.D.f, Jair de Jesus Mari, M.D.g, Tai-ongLam, M.D.h, Fareed Minhas, M.D.i, Bushra Razzaque, M.D.i, José Ángel Garcia, M.Sc.c, d, Marianne Rosendal, M.D.j, C. Anthony Dowell, M.D.k, Linda Gask, M.D.l, Joseph K. Mbatia, M.D.m, Shekhar Saxena, M.D.b
a Institute of Psychiatry, London, United Kingdom
b World Health Organization, Geneva, Switzerland
c National Autonomous University of Mexico, Mexico, DF, Mexico
d National Institute of Psychiatry ‘Ramón de la Fuente Muñiz’, Mexico, DF, Mexico
e University of Oviedo, CIBERSAM, Oviedo, Asturias, Spain
f Rio de Janeiro State University, Rio de Janeiro, Brazil
g Federal University of São Paulo, São Paulo, Brazil
h University of Hong Kong, Hong Kong, People's Republic of China
i Institute of Psychiatry, Rawalpindi, Pakistan
j Research Unit for General Practice, University of Southern Denmark, Denmark
k University of Otago, Wellington, New Zealand
l University of Manchester, Manchester, United Kingdom
m Sebastian Kolowa Memorial University, Lushoto, Tanzania
Received 11 April 2016, Revised 30 September 2016, Accepted 3 October 2016, Available online 4 October 2016
Highlights
• Of those with bodily stress disorder or health anxiety, 70% had both disorders, and 79% had anxious depression, current anxiety or non-anxious depression
• Those with somatic symptoms in multiple bodily systems are more disabled than those with symptoms in only one system
• Anxious depression is the most common additional disorder, and is associated with the greatest disability
Abstract
Objective
A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11.
BSS requires multiple somatic symptoms not caused by known physical pathology and associated with distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations.
This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability.
Method
PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability.
Results
Of 587 patients with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability.
Conclusion
Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care.
Keywords
Primary care; Classification; Mental disorders; ICD; Bodily stress syndrome; Health anxiety
http://www.sciencedirect.com/science/article/pii/S0022399916304196
David P. Goldberg, D.M.a, , (Professor), Geoffrey M. Reed, Ph.D.b, c, Rebeca Robles, Ph.D.d, JulioBobes, M.D.e, Celso Iglesias, M.D.e, Sandra Fortes, M.D.f, Jair de Jesus Mari, M.D.g, Tai-ongLam, M.D.h, Fareed Minhas, M.D.i, Bushra Razzaque, M.D.i, José Ángel Garcia, M.Sc.c, d, Marianne Rosendal, M.D.j, C. Anthony Dowell, M.D.k, Linda Gask, M.D.l, Joseph K. Mbatia, M.D.m, Shekhar Saxena, M.D.b
a Institute of Psychiatry, London, United Kingdom
b World Health Organization, Geneva, Switzerland
c National Autonomous University of Mexico, Mexico, DF, Mexico
d National Institute of Psychiatry ‘Ramón de la Fuente Muñiz’, Mexico, DF, Mexico
e University of Oviedo, CIBERSAM, Oviedo, Asturias, Spain
f Rio de Janeiro State University, Rio de Janeiro, Brazil
g Federal University of São Paulo, São Paulo, Brazil
h University of Hong Kong, Hong Kong, People's Republic of China
i Institute of Psychiatry, Rawalpindi, Pakistan
j Research Unit for General Practice, University of Southern Denmark, Denmark
k University of Otago, Wellington, New Zealand
l University of Manchester, Manchester, United Kingdom
m Sebastian Kolowa Memorial University, Lushoto, Tanzania
Received 11 April 2016, Revised 30 September 2016, Accepted 3 October 2016, Available online 4 October 2016
Highlights
• Of those with bodily stress disorder or health anxiety, 70% had both disorders, and 79% had anxious depression, current anxiety or non-anxious depression
• Those with somatic symptoms in multiple bodily systems are more disabled than those with symptoms in only one system
• Anxious depression is the most common additional disorder, and is associated with the greatest disability
Abstract
Objective
A World Health Organization (WHO) field study conducted in five countries assessed proposals for Bodily Stress Syndrome (BSS) and Health Anxiety (HA) for the Primary Health Care Version of ICD-11.
BSS requires multiple somatic symptoms not caused by known physical pathology and associated with distress or dysfunction. HA involves persistent, intrusive fears of having an illness or intense preoccupation with and misinterpretation of bodily sensations.
This study examined how the proposed descriptions for BSS and HA corresponded to what was observed by working primary care physicians (PCPs) in participating countries, and the relationship of BSS and HA to depressive and anxiety disorders and to disability.
Method
PCPs referred patients judged to have BSS or HA, who were then interviewed using a standardized psychiatric interview and a standardized measure of disability.
Results
Of 587 patients with BSS or HA, 70.4% were identified as having both conditions. Participants had an average of 10.9 somatic symptoms. Patients who presented somatic symptoms across multiple body systems were more disabled than patients with symptoms in a single system. Most referred patients (78.9%) had co-occurring diagnoses of depression, anxiety, or both. Anxious depression was the most common co-occurring psychological disorder, associated with the greatest disability.
Conclusion
Study results indicate the importance of assessing for mood and anxiety disorders among patients who present multiple somatic symptoms without identifiable physical pathology. Although highly co-occurring with each other and with mood and anxiety disorders, BSS and HA represent distinct constructs that correspond to important presentations in primary care.
Keywords
Primary care; Classification; Mental disorders; ICD; Bodily stress syndrome; Health anxiety
http://www.sciencedirect.com/science/article/pii/S0022399916304196