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Association between perceived stress, multimorbidity and primary care health services: a Danish population-based cohort study
  1. Anders Prior,
  2. Mogens Vestergaard,
  3. Karen Kjær Larsen,
  4. Morten Fenger-Grøn
  1. Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Anders Prior; anders.prior{at}


Objectives Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental–physical multimorbidity.

Design Population-based cohort study.

Setting Primary healthcare in Denmark.

Participants 118 410 participants from the Danish National Health Survey 2010 followed for 1 year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers.

Outcome measures General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers.

Results Perceived stress levels were associated with primary care activity in a dose–response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95% CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95% CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95% CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95% CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95% CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services.

Conclusion Persons with high stress levels generally had higher use of primary healthcare, 4–6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.

  • stress
  • psychological
  • practice patterns
  • physicians
  • primary health care
  • family practice
  • general practice
  • comorbidity

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  • Contributors AP, MF-G, KKL and MV conceived the study. Data collection and analyses were mainly done by AP and MF-G. AP wrote the first draft. All authors contributed to the interpretation of data, the preparation of the manuscript and approved the final version.

  • Funding This work was supported by an unrestricted grant (grant number: R155-2012-11280) from the Lundbeck Foundation (MEPRICA), by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation and administered by Danish Regions, and by the Central Denmark Region Foundation for Primary Health Care Research. The Danish Health Profile 2010 was funded by the Capital Region of Denmark, Region Zealand, the Region of Southern Denmark, the Central Denmark Region, the North Denmark Region, the Danish Ministry of Interior and Health and the National Institute of Public Health at the University of Southern Denmark.

  • Disclaimer The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval This study was approved by Danish Data Protection Agency (record number 2013-41-1719).

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

  • Data sharing statement No additional data available.

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