Patients with medically unexplained symptoms and their significant others: Illness attributions and behaviors as predictors of patient functioning over time

Hilbert, Anja; Martin, Alexandra; Zech, Thomas; Rauh, Elisabeth; Rief, Winfried

doi:10.1016/j.jpsychores.2009.09.012

« Previous Next »Journal of Psychosomatic Research
Volume 68, Issue 3 , Pages 253-262, March 2010

Patients with medically unexplained symptoms and their significant others: Illness attributions and behaviors as predictors of patient functioning over time

Anja Hilbert
- Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
- Corresponding author. Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Gutenbergstrasse 18, D-35032 Marburg, Germany. Tel.: +49 6421 2823787; fax: +49 6421 2828904.
Alexandra Martin
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Erlangen, Germany
Thomas Zech
- Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
Elisabeth Rauh
- Psychosomatic Clinic, Klinikum Staffelstein, Bad Staffelstein, Germany
Winfried Rief
- Division of Clinical Psychology and Psychological Therapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany

Received 20 February 2009; received in revised form 18 August 2009; accepted 14 September 2009. published online 10 December 2009.

Abstract

Objective

Previous research suggests that medically unexplained symptoms (MUS) are maintained in an interpersonal context. The current study examined MUS concurrently and prospectively by measuring specific interpersonal predictors of symptom severity and health care use.

Methods

A total of 127 patients with MUS and their significant others were recruited through primary care offices and assessed with self-report questionnaires and structured interviews about illness attributions, illness behavior and responses, relationship quality, symptom severity, and health care use at baseline and 6-month follow-up.

Results

Illness attributions and interpersonal illness behaviors of patients with MUS were cross-sectionally associated with illness attributions and responses of the patients' significant others. Relationship quality was related to specific illness behaviors and responses. Symptom severity at baseline was predicted by patients' somatic illness attributions. Symptom severity at 6-month follow-up was predicted by somatic illness attributions of patients and withdrawal of patients' significant others at baseline, but these predictors became insignificant when correcting for baseline symptomatology. Health care use at baseline was predicted by a greater amount of coping behavior and higher anxiety scores of patients, and health care use at 6-month follow-up was predicted by more attention-seeking behaviors and health care use of patients at baseline.

Conclusion

The results document the interpersonal influences on the maintenance of MUS. The perspective of significant others should be considered for enhancement of psychological approaches to the treatment of patients with MUS.

Keywords: Illness behavior, Illness beliefs, Interpersonal, Marital, Pain, Somatoform