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Current somatoform disorders in Norway: prevalence, risk factors and comorbidity with anxiety, depression and musculoskeletal disorders

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Abstract

Background

The future existence of somatoform disorders (SDs) has recently been debated. The objectives of this study were to investigate the prevalence of current SDs (defined as the presence of multisomatoform disorder [MSD] or somatoform disorders not otherwise specified [SDnos], without psychosocial impairment) and severe current SDs (MSD or SDnos with psychosocial impairment) in Norway. Differences in markers of severe current SDs, anxiety/depression and self-reported musculoskeletal disorders were explored. In addition, psychological distress and utilization of healthcare in subclasses (defined according to comorbidity with anxiety, depression and musculoskeletal disorders) of severe current SDs were examined.

Methods

We interviewed 1,247 respondents using the Composite International Diagnostic Interview (CIDI) in the Oslo–Lofoten general population survey in 2000–2001. Six-month prevalence rates (%) and 95% confidence intervals (CIs) for current SDs were investigated by gender and age. Risk factors of disorders, psychological distress, healthcare utilization and use of medication were explored using logistic regression analyses.

Results

The overall prevalence rate for severe current SDs was 10.2%. When psychosocial impairment was excluded as a criterion, the rate increased to 24.6%. Anxiety was strongly correlated with severe current SDs. Comorbidity of severe current SDs with anxiety/depression was 45%, and with musculoskeletal disorders, 43%. Analysis of healthcare utilization and use of medication showed that the presence of a comorbid psychiatric condition was more important than the presence of somatoform disorders alone. Conclusion Somatoform symptoms alone (with no psychiatric comorbidity) should not be considered a psychiatric disorder.

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Abbreviations

CIDI:

Composite International Diagnostic Interview

CI:

Confidence interval

DSM-IV:

Diagnostic Statistical Manual of Mental Disorders, fourth edition

HSCL-25:

Hopkins symptoms checklist 25-item scale questionnaire

ES:

Effect size

GP:

General practitioner

MSD:

Multisomatoform disorder ·

MES:

Medically explained symptom

MUS:

Medically unexplained symptom

ICD-10:

International Classi- fication of Diseases, 10th revision

SD:

Somatoform disorder

SDnos:

Somatoform disorder not otherwise specified

SHC:

Subjective health complaints

OR:

Odds ratio

References

  1. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn., Revised. American Psychiatric Association, Washington, DC

  2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  3. American Psychiatric Association (1995) Diagnostic and statistical manual of mental disorders, 4th edn., primary care version. American Psychiatric Association, Washington, DC

  4. Barsky AJ, Orav EJ, Bates DW (2005) Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 62:903–910

    Article  PubMed  Google Scholar 

  5. Barsky AJ, Peekna HM, Borus JF (2001) Somatic symptom reporting in women and men. J Gen Intern Med 16:266–275

    Article  PubMed  CAS  Google Scholar 

  6. Creed F (2006) Can DSM-V facilitate productive research into the somatoform disorders? J Psychosom Res 60:331–334

    Article  PubMed  Google Scholar 

  7. Creed F, Barsky A (2004) A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 56:391–408

    Article  PubMed  Google Scholar 

  8. Duddu V, Isaac MK, Chaturvedi SK (2006) Somatization, somatosensory amplification, attribution styles and illness behaviour: a review. Int Rev Psychiatry 18:25–33

    Article  PubMed  Google Scholar 

  9. Epstein RM, Quill TE, McWhinney IR (1999) Somatization reconsidered: incorporating the patient’s experience of illness. Arch Intern Med 159:215–222

    Article  PubMed  CAS  Google Scholar 

  10. Fink P (1992) The use of hospitalizations by persistent somatizing patients. Psychol Med 22:173–180

    Article  PubMed  CAS  Google Scholar 

  11. Fink P, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P (1999) Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics 40:330–338

    PubMed  CAS  Google Scholar 

  12. Hiller W (2006) Don’t change a winning horse. J Psychosom Res 60:345–347

    Article  PubMed  Google Scholar 

  13. Hiller W, Fichter MM (2004) High utilizers of medical care: a crucial subgroup among somatizing patients. J Psychosom Res 56:437–443

    Article  PubMed  Google Scholar 

  14. Hiller W, Rief W (2005) Why DSM-III was right to introduce the concept of somatoform disorders. Psychosomatics 46:105–108

    Article  PubMed  Google Scholar 

  15. Hiller W, Rief W, Brahler E (2006) Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol 41:704–712

    Article  PubMed  Google Scholar 

  16. Ihlebaek C, Eriksen HR, Ursin H (2002) Prevalence of subjective health complaints (SHC) in Norway. Scand J Public Health 30:20–29

    Article  PubMed  Google Scholar 

  17. Kendell R, Jablenski A (2003) Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry 160:4–12

    Article  PubMed  Google Scholar 

  18. Kringlen E, Torgersen S, Cramer V (2001) A Norwegian psychiatric epidemiological study. Am J Psychiatry 158:1091–1098

    Article  PubMed  CAS  Google Scholar 

  19. Kringlen E, Torgersen S, Cramer V (2006) Mental illness in a rural area: a Norwegian psychiatric epidemiological study. Soc Psychiatry Psychiatr Epidemiol 41:713–719

    Article  PubMed  Google Scholar 

  20. Kroenke K (2006) Physical symptom disorder: a simpler diagnostic category for somatization-spectrum conditions. J Psychosom Res 60:335–339

    Article  PubMed  Google Scholar 

  21. Kroenke K, Spitzer RL, deGruy FV III, Hahn SR, Linzer M, Williams JB, Brody D, Davies M (1997) Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry 54:352–358

    PubMed  CAS  Google Scholar 

  22. Kroenke K, Spitzer RL, deGruy FV III, Swindle R (1998) A symptom checklist to screen for somatoform disorders in primary care. Psychosomatics 39:263–272

    PubMed  CAS  Google Scholar 

  23. Leiknes KA, Finset A, Moum T, Sandanger I (2006) Methodological issues concerning lifetime medically unexplained and medically explained symptoms of the Composite International Diagnostic Interview: a prospective 11-year follow-up study. J Psychosom Res 61:169–179

    Article  PubMed  Google Scholar 

  24. Leiknes KA, Finset A, Moum T, Sandanger I (2006) Overlap, comorbidity and stability of somatoform disorders, and the use of current versus lifetime criteria. Psychosomatics (in press)

  25. Leiknes KA, Finset A, Moum T, Sandanger I (2007) Course and predictors of medically unexplained pain symptoms in the general population. J Psychosom Res 62:119–128

    Article  PubMed  Google Scholar 

  26. Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M (2005) Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry 162:847–855

    Article  PubMed  Google Scholar 

  27. Rief W, Henningsen P, Hiller W (2006) Classification of somatoform disorders. Am J Psychiatry 163:746–747

    Article  PubMed  Google Scholar 

  28. Rief W, Hiller W (1999) Toward empirically based criteria for the classification of somatoform disorders. J Psychosom Res 46:507–518

    Article  PubMed  CAS  Google Scholar 

  29. Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA (1988) The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077

    PubMed  CAS  Google Scholar 

  30. Sandanger I (1993) The Composite International Diagnostic Interview for psychiatric diagnoses as an expounding instrument in the Norwegian Community Diagnosis Project: mental health and physical illness. Int J Methods Psychiatr Res 3:137–141

    Google Scholar 

  31. Sandanger I, Moum T, Ingebrigtsen G, Dalgard OS, Sorensen T, Bruusgaard D (1998) Concordance between symptom screening and diagnostic procedure: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I. Soc Psychiatry Psychiatr Epidemiol 33:345–354

    Article  PubMed  CAS  Google Scholar 

  32. Sandanger I, Moum T, Ingebrigtsen G, Sorensen T, Dalgard OS, Bruusgaard D (1999) The meaning and significance of caseness: the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview. II. Soc Psychiatry Psychiatr Epidemiol 34:53–59

    Article  PubMed  CAS  Google Scholar 

  33. Sandanger I, Nygård JF, Brage S, Tellnes G (2000) Relation between health problems and sickness absence: gender and age differences–a comparison of low-back pain, psychiatric disorders, and injuries. Scand J Public Health 28:244–252

    Article  PubMed  CAS  Google Scholar 

  34. Sandanger I, Nygård JF, Ingebrigtsen G, Sorensen T, Dalgard OS (1999) Prevalence, incidence and age at onset of psychiatric disorders in Norway. Soc Psychiatry Psychiatr Epidemiol 34:570–579

    Article  PubMed  CAS  Google Scholar 

  35. Sandanger I, Nygård JF, Sorensen T, Dalgard OS (2007) Return of depressed men: changes in distribution of depression and symptom cases in Norway between 1990 and 2001. J Affect Disord 100:153–162

    Google Scholar 

  36. Sandanger I, Nygård JF, Sorensen T, Moum T (2004) Is women’s mental health more susceptible than men’s to the influence of surrounding stress? Soc Psychiatry Psychiatr Epidemiol 39:177–184

    Article  PubMed  Google Scholar 

  37. Sharpe M, Bass C (1992) Pathophysiological mechanisms in somatization. Int Rev Psychiatry 4:81–97

    Google Scholar 

  38. Sharpe M, Mayou R, Walker J (2006) Bodily symptoms: new approaches to classification. J Psychosom Res 60:353–356

    Article  PubMed  Google Scholar 

  39. Simon GE, Gureje O (1999) Stability of somatization disorder and somatization symptoms among primary care patients. Arch Gen Psychiatry 56:90–95

    Article  PubMed  CAS  Google Scholar 

  40. Smith RC, Gardiner JC (2006) Administrative database screening to identify somatizing patients. Med Care 44:799–802

    Article  PubMed  Google Scholar 

  41. Smith RC, Gardiner JC, Armatti S, Johnson M, Lyles JS, Given CW, Lein C, Given B, Goddeeris J, Korban E, Haddad R, Kanj M (2001) Screening for high utilizing somatizing patients using a prediction rule derived from the management information system of an HMO: a preliminary study. Med Care 39:968–978

    Article  PubMed  CAS  Google Scholar 

  42. Starcevic V (2006) Somatoform disorders and DSM-V: conceptual and political issues in the debate. Psychosomatics 47:277–281

    Article  PubMed  Google Scholar 

  43. Sykes R (2006) Somatoform disorders in DSM-IV: mental or physical disorders? J Psychosom Res 60:341–344

    Article  PubMed  Google Scholar 

  44. Wessely S, Nimnuan C, Sharpe M (1999) Functional somatic syndromes: one or many? Lancet 354:936–939

    Article  PubMed  CAS  Google Scholar 

  45. Wise TN, Birket-Smith M (2002) The somatoform disorders for DSM-V: the need for changes in process and content. Psychosomatics 43:437–440

    Article  PubMed  Google Scholar 

  46. Wittchen HU, Jacobi F (2005) Size and burden of mental disorders in Europe–a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15:357–376

    Article  PubMed  CAS  Google Scholar 

  47. Wittchen HU, Lachner G, Wunderlich U, Pfister H (1998) Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Soc Psychiatry Psychiatr Epidemiol 33:568–578

    Article  PubMed  CAS  Google Scholar 

  48. World Health Organization (1978) Mental disorders: glossary and guide to their classification in accordance with the ninth revision of the international classification of diseases. WHO, Geneva, New York

    Google Scholar 

  49. World Health Organization (1993) The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. WHO, Geneva

    Google Scholar 

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Acknowledgments

This study has been possible because of research grant funding from the Research Council of Norway and from Henrik Homans Minde Legacy. The Oslo–Lofoten study was supported by grants from the Norwegian Council for Mental Health, the Norwegian Women’s Public Health Association, Anders Jahres Foundation, Dr. Trygve Gythfeldt and Wife’s Foundation, Josef and Haldis Andresen Legacy, Maja and Jonn Nilsen Legacy, Per Risteigen Legacy, Nathalia and Knut Juul Christiansen’s Legacy, Solveig and Johan P. Sommer’s Legacy. We would also like to thank the lay interviewers, and the researchers, T. Sørensen, J. Nygård, W. Platou, and O. Klungsøyr, who collaborated on the Oslo–Lofoten study from 1990 to 2001.

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Correspondence to Kari Ann Leiknes MD, MHA.

Additional information

Work conducted at: Institute of Basic Medical Sciences, Department of Behavioural Sciences in Medicine.

Appendices

Appendix A

Table 6 List of specific clinically significant MESs and MUSs examined by the CIDI somatoform section in 2001

Appendix B

Table 7 Diagnostic criteria, physical disease lists, HSCL-25 score and subscores, self-assessed health, general well-being and working ability scores

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Leiknes, K.A., Finset, A., Moum, T. et al. Current somatoform disorders in Norway: prevalence, risk factors and comorbidity with anxiety, depression and musculoskeletal disorders. Soc Psychiat Epidemiol 42, 698–710 (2007). https://doi.org/10.1007/s00127-007-0218-8

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