Long-Term Outcome of Bodily Distress Syndrome in Primary Care: A Follow-Up Study on Health Care Costs, Work Disability, and Self-Rated Health

Psychosom Med. 2017 Apr;79(3):345-357. doi: 10.1097/PSY.0000000000000405.


Objective: The upcoming International Classification of Diseases, 11th Revision for primary care use suggests inclusion of a new diagnostic construct, bodily (di)stress syndrome (BDS), for individuals with medically unexplained symptoms. We aimed to explore the long-term outcome of BDS in health care costs, work disability, and self-rated health.

Methods: Consecutive patients consulting their family physician for a new health problem were screened for physical and mental symptoms by questionnaires (n = 1785). A stratified subsample was examined with a standardized diagnostic interview (n = 701). Patients with single-organ BDS (n = 124) and multiorgan BDS (n = 35), and a reference group with a family physician-verified medical condition (n = 880) were included. All included patients completed a questionnaire at 3, 12, and 24 months of follow-up. Register data on health care costs and work disability were obtained after 2 and 10 years of follow-up, respectively.

Results: Patients with BDS displayed poorer self-rated health and higher illness worry at index consultation and throughout follow-up than the reference group (p ≤ .001). The annual health care costs were higher in the BDS groups (2270 USD and 4066 USD) than in the reference group (1392 USD) (achieved significance level (ASL) ≤ 0.001). Both BDS groups had higher risk of sick leave during the first 2 years of follow-up (RRsingle-organ BDS = 3.0; 95% confidence interval [CI] = 1.8-5.0; RRmultiorgan BDS = 3.4; 95% CI = 1.5-7.5) and substantially higher risk of newly awarded disability pension than the reference group (HRsingle-organ BDS = 4.9; 95% CI = 2.8-8.4; HRmultiorgan BDS = 8.7; 95% CI = 3.7-20.7).

Conclusions: Patients with BDS have poor long-term outcome of health care costs, work disability, and subjective suffering. These findings stress the need for adequate recognition and management of BDS.

MeSH terms

  • Adult
  • Denmark
  • Disabled Persons / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Medically Unexplained Symptoms*
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Pensions / statistics & numerical data*
  • Primary Health Care / economics
  • Primary Health Care / statistics & numerical data*
  • Registries / statistics & numerical data*
  • Sick Leave / economics
  • Sick Leave / statistics & numerical data*
  • Somatoform Disorders* / diagnosis
  • Somatoform Disorders* / economics
  • Somatoform Disorders* / psychology
  • Young Adult