Screening for multiple somatic complaints in a population-based survey: Does excessive symptom reporting capture the concept of somatic symptom disorders? Findings from the MONICA-KORA Cohort Study

Ladwig, Karl Heinz; Marten-Mittag, Birgitt; Lacruz, Maria Elena; Henningsen, Peter; Creed, Francis; for the MONICA KORA Investigators,

doi:10.1016/j.jpsychores.2010.01.009

« Previous Next »Journal of Psychosomatic Research
Volume 68, Issue 5 , Pages 427-437, May 2010

Screening for multiple somatic complaints in a population-based survey: Does excessive symptom reporting capture the concept of somatic symptom disorders?☆

Findings from the MONICA-KORA Cohort Study

Karl Heinz Ladwig
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- Corresponding author. Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany. Tel.: +49 89 3187 3623; fax: +49 89 3187 3667.
Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
Maria Elena Lacruz
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
Francis Creed
- Psychiatry Research Group, School of Medicine, University of Manchester, Manchester, United Kingdom
for the MONICA KORA Investigators

Received 2 November 2009; received in revised form 5 January 2010; accepted 14 January 2010. published online 02 March 2010.

Abstract

Objective

Excessive symptom reporting (ESR) has gained a revived attention in the conceptualization of somatic symptom disorders. We aimed to explore whether ESR captures the concept of somatic symptom disorders regardless of the patient's disease status or the degree of symptom burden.

Methods

In three independent cross-sectional population-based samples of the MONICA/KORA Study in 1985, 1990, and 1995, somatic symptom reporting and an array of somatic and mental health features were assessed in 11,895 eligible participants. After a mean 12-year follow-up, the vital status was assessed at the end of 2002. All-cause mortality was calculated as hazard risks ratios (HRs).

Results

Among all participants, a total of 1238 men and 1169 women were in the sex-specific upper quintile of the somatic symptom distribution and qualified for ESR subpopulation. ESR participants were older, on a lower educational level, and more often unemployed. They suffered more often from metabolic syndrome and chronic diseases. ESR was associated with psychological distress, negative self-perceived health, and sleeping disorders. ESR was associated with twofold more ambulant and hospital medical utilization. Survival in ESR participants was significantly reduced (HR=1.33; 95% CI=1.18–1.49; P<.001). Frequency of medical ambulatory consultations and days in hospital were higher in ESR participants, even after controlling for potential confounders.

Conclusion

A simple approach to screen for participants with high symptom reporting in an unselected population-based sample results in the identification of a clinically meaningful target population with high burden of physical and psychological comorbidities.

Keywords: Somatic symptom disorders, Excessive symptom reporting, Medical utilization, Mortality