Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population

Gen Hosp Psychiatry. 2008 Jul-Aug;30(4):349-55. doi: 10.1016/j.genhosppsych.2008.04.007.


Objective: Somatization is related to elevated health care utilization (HCU) and high health care costs. However, it is unclear whether HCU in somatizers and nonsomatizers in the general population is determined by existing symptoms or by lower thresholds for doctor visits.

Method: A representative sample of the German general population (N=2510) was screened for psychopathology and HCU in the prior 12 months. The sample was subdivided into somatizers (n=712) and controls (n=1796), using the Patient Health Questionnaire (PHQ-15). A general tendency to visit doctors even for minor reasons was assessed. Demographic and psychopathological variables were additionally entered into regression analyses to predict HCU for the whole investigated sample and the two subsamples.

Results: Higher somatization, unemployment or retirement, a lower decision threshold for doctor visits and higher posttraumatic symptomatology were consistent and unique positive predictors of HCU in the prior 12 months.

Conclusion: Not only symptoms per se but also a lower decision threshold for doctor visits contribute to increased HCU. Psychopathological and demographic variables can further predict HCU in somatizing persons and controls. Although somatization and reduced thresholds for doctor visits are associated, they have to be distinguished from each other and contribute independently to increased costs.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Appointments and Schedules
  • Decision Making*
  • Female
  • Germany / epidemiology
  • Health Care Costs
  • Health Services / economics
  • Health Services / statistics & numerical data*
  • Health Services Research / statistics & numerical data
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Physicians / statistics & numerical data*
  • Probability
  • Regression Analysis
  • Retirement / psychology
  • Retirement / statistics & numerical data
  • Somatoform Disorders / diagnosis*
  • Somatoform Disorders / epidemiology
  • Somatoform Disorders / therapy*
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / psychology
  • Unemployment / psychology
  • Unemployment / statistics & numerical data