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Diagnostic barriers for somatic symptom disorders in primary care: study protocol for a mixed methods study in Germany
  1. Christina Heinbokel1,
  2. Marco Lehmann1,
  3. Nadine Janis Pohontsch2,
  4. Thomas Zimmermann2,
  5. Astrid Althaus2,3,
  6. Martin Scherer2,
  7. Bernd Löwe1
  1. 1 Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Hamburg, Germany
  2. 2 General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  3. 3 Department of General Medicine Cologne, University Hospital of Cologne, Cologne, Germany
  1. Correspondence to Dr Christina Heinbokel; c.heinbokel{at}


Introduction Somatoform or somatic symptom disorders ((S)SD) are common and have a negative impact on the patients’ health-related quality of life, healthcare use and costs. In primary care, which is central to the management of (S)SD, diagnosis and treatment tend to be delayed. There is a significant lack of evidence regarding the barriers in the diagnostic process of (S)SD in primary care and how interventions should be tailored to address them. The aim of this study is to analyse the diagnostic process in primary care that results in the diagnosis or non-diagnosis of a (S)SD.

Methods and analysis This mixed methods study will investigate the topic with qualitative methods, subsequently proceeding to a quantitative phase where the initial results will be validated and/or generalised. First, focus groups will explore meanings and patterns, inconsistencies and conflicts in general practitioners’ (GPs) thoughts and behaviours when diagnosing (S)SD. Second, the results of these focus groups will be used to develop interview guidelines for subsequent face-to-face interviews. Patients and their treating GPs will be interviewed separately on how they experience the history of illness, the diagnostic process and treatment. Third, based on the results of the first two study parts, a questionnaire will be derived and a nationwide survey among German GPs will be conducted, quantifying the barriers and difficulties identified before.

Ethics and dissemination Ethics approval was obtained from the Ethics Committee of the Hamburg Medical Association, Germany (approval number PV4763). The results of this study will be disseminated through conference presentation and publications in peer-reviewed journals.

Trial registration number The study is registered in the German Clinical Trial Register (DRKS), DRKS-ID DRKS00009736.

  • Somatic Symptom Disorder
  • Somatoform Disorders
  • Diagnostic Process
  • Mental Disorders
  • Primary Care

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  • Contributors CH drafted this manuscript. The study’s principal investigators BL and MS designed the study with AA and obtained the funding and ethics’ approval. NJP, TZ and ML and CH advanced the concept, prepared the study, conduct the study and analyse the data. All authors read and approved the final manuscript.

  • Funding This study is supported by the Deutsche Forschungsgemeinschaft (DFG); principal investigators are Martin Scherer (SCHE 1689/5-1), Astrid Althaus (AL 1459/5-1) and Bernd Löwe (LO 766/13-1). The project will be conducted, analysed, interpreted and published independently from the funding source.

  • Competing interests None declared.

  • Ethics approval Ethics Committee of the Hamburg Medical Association, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.