Faculty Collaboration Database

The outcomes among patients presenting in primary care with a physical symptom at 5 years. J Gen Intern Med 2005 Nov;20(11):1032-7

Date

11/26/2005

Pubmed ID

16307629

Pubmed Central ID

PMC1490256

DOI

10.1111/j.1525-1497.2005.0241.x

Scopus ID

2-s2.0-28444497077 (requires institutional sign-in at Scopus site)   100 Citations

Abstract

BACKGROUND: Symptoms are common and often remain medically unexplained.

OBJECTIVE: To assess 5-year symptom outcomes, determine how often symptoms remain unexplained and assess their relationship with mental disorders.

DESIGN: Prospective cohort study.

PARTICIPANTS: Five hundred consecutive patients presenting to a medicine clinic with physical symptoms. MEASUREMENTS PREVISIT: Mental disorders, symptom characteristics, stress, expectations, illness worry, and functional status. Postvisit (immediately, 2 weeks, 3 months, 5 years): unmet expectations, satisfaction, symptom outcome, functional status, and stress.

RESULTS: While most subjects (81%) experienced symptom improvement by 5 years, resolution rates were lower (56%), with 35% of symptoms remained medically unexplained. Most patients with medically unexplained symptoms (MUS) did not have a mental disorder. Mood or anxiety disorders were not associated with MUS (relative risks [RR]: 0.94, 95% confidence interval [CI]: 0.79 to 1.13), or with lower rates of symptom improvement (RR: 1.14, 95% CI: 0.60 to 2.2). In contrast, most patients with somatoform disorders had MUS and were unlikely to improve. Worse functioning (RR: 0.95, 95% CI: 0.91 to 0.99), longer duration of symptom at presentation (RR: 0.5, 95% CI: 0.28 to 0.87), illness worry at presentation (RR: 0.56, 95% CI: 0.35 to 0.89), or lack of resolution by 3 months (RR: 0.47, 95% CI: 0.26 to 0.86) reduced the likelihood of symptom improvement at 5 years.

CONCLUSIONS: More than half of patients presenting with a physical symptom resolve by 5 years, while a third remain medically unexplained. Most patients whose symptom remained unexplained had no mental disorder. While mood and anxiety disorders were not associated with MUS or worse outcomes, most patients with somatoform disorders had MUS and were unlikely to improve.

Author List

Jackson JL, Passamonti M

Author

Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anxiety
Cohort Studies
Female
Follow-Up Studies
Health Status
Hospitals, Military
Humans
Male
Mental Disorders
Middle Aged
Office Visits
Patient Satisfaction
Prospective Studies
Somatoform Disorders
Surveys and Questionnaires
Treatment Outcome