Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study

Psychosom Med. 2008 May;70(4):430-4. doi: 10.1097/PSY.0b013e31816aa0ee. Epub 2008 Apr 23.


Background: To determine the prevalence, impact, and prognosis of multisomatoform disorder (MSD) over a 5-year period in a primary care population. Although somatization is prevalent in primary care, patients rarely meet Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for somatization disorder. MSD, defined as > or = 3 bothersome, medically unexplained somatic symptoms, has been proposed as a more inclusive disorder.

Methods: A total of 500 adults presenting to a primary care clinic with a physical symptom were screened with the Primary Care Evaluation of Mental Disorders. Symptom count was assessed with the Patient Health Questionnaire 15-item somatic symptom scale. Additional baseline measures included functional status and symptom characteristics. Follow-up surveys at 2 weeks, 3 months, and 5 years assessed functioning, symptom outcome, psychiatric diagnoses, and patient satisfaction. Physician surveys assessed encounter difficulty. Utilization was obtained from our health database.

Results: MSD had an 8% prevalence at both baseline (n = 38/500) and at 5 years (n = 33/387). MSD persisted in 21% of those with MSD at baseline, and developed in 7% of those without MSD at baseline. MSD at baseline was a predictor of MSD at 5 years (relative risk (RR) = 2.7, 1.5-5.1). MSD patients were more likely to have comorbid mental disorders (RR = 1.5, 1.1-2.3) and be rated "difficult" by their clinicians (p = .02). They also reported worse functional status at all time points assessed (p < .001 for all), were less likely to experience symptom improvement, and had higher utilization rates (34.1 versus 23.1 visits; p = .006).

Conclusions: MSD identifies a group of patients who are less likely to experience symptom improvement and have significant functional impairment and higher utilization rates.

MeSH terms

  • Activities of Daily Living / psychology
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology
  • Cohort Studies
  • Comorbidity
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Panic Disorder / diagnosis
  • Panic Disorder / epidemiology
  • Panic Disorder / psychology
  • Patient Satisfaction / statistics & numerical data
  • Personality Inventory / statistics & numerical data
  • Primary Health Care / statistics & numerical data
  • Prognosis
  • Psychometrics
  • Sick Role
  • Somatoform Disorders / diagnosis
  • Somatoform Disorders / epidemiology*
  • Somatoform Disorders / psychology
  • Utilization Review