Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-26T16:08:44.474Z Has data issue: false hasContentIssue false
  • English
  • Français

Are illness perceptions related to future healthcare expenditure in patients with somatoform disorders?

Published online by Cambridge University Press:  03 March 2014

L. Frostholm ,
K. J. Petrie ,
E. Ørnbøl  and
P. Fink
L. Frostholm*
Affiliation:
Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
K. J. Petrie
Affiliation:
Department of Psychological Medicine, Auckland University, Auckland, New Zealand
E. Ørnbøl
Affiliation:
Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
P. Fink
Affiliation:
Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
*
*Address for correspondence: L. Frostholm, Ph.D., Clinical Associate Professor, Research Clinic for Functional Disorders, Aarhus University Hospital, Barthsgade 5.1, DK-8200 Aarhus N, Denmark. (Email: lisbfros@rm.dk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Somatoform disorders are costly for society in terms of increased healthcare expenditure. Patients' illness perceptions have been found to play a role in somatoform disorders. However, it is unclear whether illness perceptions predict higher health costs in these patients.

Method

A total of 1785 primary care patients presenting a new health complaint completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics after the consultation. In a stratified subsample, physician interviewers established diagnoses of DSM-IV somatization and undifferentiated somatoform disorders (n = 144) using the Schedules for Clinical Assessment in Neuropsychiatry. Healthcare expenditure was obtained from Danish health registers for a 2-year follow-up period.

Results

Patients had more negative perceptions of their well-defined physical health problems when they had a co-morbid somatoform disorder. A strong illness identity [β = 0.120, 95% confidence interval (CI) 0.029–0.212, p = 0.012], perceived negative consequences (β = 0.010, 95% CI 0.001–0.019, p = 0.024), a long timeline perspective (β = 0.013, 95% CI 0.005–0.021, p = 0.001), low personal control (β = − 0.009, 95% CI –0.015 to −0.002, p = 0.011) and negative emotional representations (β = 0.009, 95% CI 0.002–0.017, p = 0.020) predicted healthcare expenditure in somatoform disorders.

Conclusions

The results suggest that illness perceptions play a role in the perpetuation of symptoms in somatoform disorders and predict higher future healthcare expenditure among a subgroup of these patients.

Keywords

Healthcare useillness perceptionsprimary caresomatization disorderundifferentiated somatoform disorder
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 13 , October 2014 , pp. 2903 - 2911
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cameron, L, Leventhal, EA, Leventhal, H (1993). Symptom representations and affect as determinants of care seeking in a community-dwelling, adult sample population. Health Psychology 12, 171–179.Google Scholar
Cheng, C (2000). Seeking medical consultation: perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia. Psychosomatic Medicine 62, 844–852.CrossRefGoogle ScholarPubMed
Creed, F, Barsky, A (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research 56, 391–408.Google Scholar
Derogatis, LR, Cleary, PA (1977). Confirmation of the dimensional structure of the SCL-90: a study in construct validation. Journal of Clinical Psychology 33, 981–989.3.0.CO;2-0>CrossRefGoogle Scholar
Dickson, A, Toft, A, O'Carroll, RE (2009). Neuropsychological functioning, illness perception, mood and quality of life in chronic fatigue syndrome, autoimmune thyroid disease and healthy participants. Psychological Medicine 39, 1567–1576.Google Scholar
Efron, B, Tibshirani, R (2003). An Introduction to the Bootstrap. Chapman & Hall/CRC: New York.Google Scholar
Ewing, J (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association 252, 1905–1907.Google Scholar
Fink, P, Ewald, H, Jensen, J, Sorensen, L, Engberg, M, Holm, M, Munk-Jorgensen, P (1999). Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. Journal of Psychosomatic Research 46, 261–273.Google Scholar
Fink, P, Ørnbøl, E, Huyse, FJ, de Jonge, P, Lobo, A, Herzog, T, Slaets, J, Arolt, V, Cardoso, G, Rigatelli, M, Hansen, MS (2004). A brief diagnostic screening instrument for mental disturbances in general medical wards. Journal of Psychosomatic Research 57, 17–24.Google Scholar
Frostholm, L, Fink, P, Christensen, KS, Toft, T, Oernboel, E, Olesen, F, Weinman, J (2005 a). The patients’ illness perceptions and the use of primary health care. Psychosomatic Medicine 67, 997–1005.Google Scholar
Frostholm, L, Fink, P, Oernboel, E, Christensen, KS, Toft, T, Olesen, F, Weinman, J (2005 b). The uncertain consultation and patient satisfaction: the impact of patients’ illness perceptions and a randomized controlled trial on the training of physicians’ communication skills. Psychosomatic Medicine 67, 897–905.Google Scholar
Hansen, MS, Fink, P, Frydenberg, M, Oxhoj, ML (2002). Use of health services, mental illness, and self-rated disability and health in medical inpatients. Psychosomatic Medicine 64, 668–675.Google Scholar
Hansen, HS, Rosendal, M, Oernboel, E, Fink, P (2011). Are medically unexplained symptoms and functional disorders predictive for the illness course? A two-year follow-up on patients’ health and health care utilisation. Journal of Psychosomatic Research 71, 38–44.Google Scholar
Hiller, W, Fichter, MM (2004). High utilizers of medical care: a crucial subgroup among somatizing patients. Journal of Psychosomatic Research 56, 437–443.CrossRefGoogle ScholarPubMed
Kettell, J, Jones, R, Lydeard, S (1992). Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. British Journal of General Practice 42, 459–461.Google ScholarPubMed
Leventhal, H, Brissette, I, Leventhal, EA (2003). The common-sense model of self-regulation of health and illness. In The Self-Regulation of Health and Illness Behaviour (ed. Cameron, L. D. and Leventhal, H.), pp. 42–65. Routledge: London.Google Scholar
Martin, A, Rauh, E, Fichter, M, Rief, W (2007). A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics 48, 294–303.Google Scholar
Martin, A, Rief, W (2011). Relevance of cognitive and behavioral factors in medically unexplained syndromes and somatoform disorders. Psychiatric Clinics of North America 34, 565–578.Google Scholar
Morriss, R, Gask, L, Ronalds, C, Downes-Grainger, E, Thompson, H, Leese, B, Goldberg, D (1998). Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs. Family Practice 15, 119–125.Google Scholar
Moss-Morris, R, Chalder, T (2003). Illness perceptions and levels of disability in patients with chronic fatigue syndrome and rheumatoid arthritis. Journal of Psychosomatic Research 55, 305–308.Google Scholar
Moss-Morris, R, Weinman, J, Petrie, KJ, Horne, R, Cameron, LD, Buick, D (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health 17, 1–16.Google Scholar
Petrie, KJ, Weinman, J (2012). Patients’ perceptions of their illness: the dynamo of volition in health care. Current Directions in Psychological Science 21, 60–65.Google Scholar
Reid, S, Wessely, S, Crayford, T, Hotopf, M (2002). Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. British Journal of Psychiatry 180, 248–253.Google Scholar
Rief, W, Broadbent, E (2007). Explaining medically unexplained symptoms – models and mechanisms. Clinical Psychology Review 27, 821–841.Google Scholar
Rosendal, M, Bro, F, Fink, P, Christensen, KS, Olesen, F (2003). Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial. British Journal of General Practice 53, 917–922.Google Scholar
Schroder, A, Fink, P (2011). Functional somatic syndromes and somatoform disorders in special psychosomatic units: organizational aspects and evidence-based treatment. Psychiatric Clinics of North America 34, 673–687.Google Scholar
Severeijns, R, Vlaeyen, JW, van den Hout, MA, Picavet, HS (2004). Pain catastrophizing is associated with health indices in musculoskeletal pain: a cross-sectional study in the Dutch community. Health Psychology 23, 49–57.Google Scholar
Toft, T, Fink, P, Oernboel, E, Christensen, K, Frostholm, L, Olesen, F (2005). Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary Care (FIP) study. Psychological Medicine 35, 1175–1184.Google Scholar
Toft, T, Rosendal, M, Ornbol, E, Olesen, F, Frostholm, L, Fink, P (2010). Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study). Psychotherapy and Psychosomatics 79, 227–237.Google Scholar
World Health Organization (1998). SCAN: Schedules for Clinical Assessment in Neuropsychiatry, version 2.1. WHO Division of Mental Health: Geneva.Google Scholar