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Prevalence, Impact, and Prognosis of Multisomatoform Disorder in Primary Care: A 5-Year Follow-up Study

From the Department of Medicine (J.L.J.), Uniformed Services University of the Health Sciences, and Department of Medicine (K.K.), Regenstrief Institute for Health Care, Indianapolis University School of Medicine, Indianapolis, Indiana.

Address correspondence and reprint requests to Jeffrey L. Jackson, Medicine-EDP, 4301 Jones Bridge Road, Bethesda, MD 20814. E-mail: jejackson{at}usuhs.mil

Background: To determine the prevalence, impact, and prognosis of multisomatoform disorder (MSD) over a 5-year period in a primary care population. Although somatization is prevalent in primary care, patients rarely meet Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for somatization disorder. MSD, defined as 3 bothersome, medically unexplained somatic symptoms, has been proposed as a more inclusive disorder.

Methods: A total of 500 adults presenting to a primary care clinic with a physical symptom were screened with the Primary Care Evaluation of Mental Disorders. Symptom count was assessed with the Patient Health Questionnaire 15-item somatic symptom scale. Additional baseline measures included functional status and symptom characteristics. Follow-up surveys at 2 weeks, 3 months, and 5 years assessed functioning, symptom outcome, psychiatric diagnoses, and patient satisfaction. Physician surveys assessed encounter difficulty. Utilization was obtained from our health database.

Results: MSD had an 8% prevalence at both baseline (n = 38/500) and at 5 years (n = 33/387). MSD persisted in 21% of those with MSD at baseline, and developed in 7% of those without MSD at baseline. MSD at baseline was a predictor of MSD at 5 years (relative risk (RR) = 2.7, 1.5–5.1). MSD patients were more likely to have comorbid mental disorders (RR = 1.5, 1.1–2.3) and be rated "difficult" by their clinicians (p = .02). They also reported worse functional status at all time points assessed (p < .001 for all), were less likely to experience symptom improvement, and had higher utilization rates (34.1 versus 23.1 visits; p = .006).

Conclusions: MSD identifies a group of patients who are less likely to experience symptom improvement and have significant functional impairment and higher utilization rates.

Key Words: somatization • primary care • multisomatoform disorder • outcomes

Abbreviations: MSD = multisomatoform disorder; DSM = Diagnostic Schedule Manual; DDPRQ = Difficult Doctor Patient Relationship Questionnaire; PRIME-MD = Primary Care Evaluation of Mental Disorders.