Jyväsjärvi S, Joukamaa M, Väisänen E, Larivaara P, Kivelä S L, Keinänen-Kiukaanniemi S
Department of Public Health Science and General Practice, University of Oulu, Oulu University Hospital, Finland.
Compr Psychiatry. 1999 Jul-Aug;40(4):292-8. doi: 10.1016/s0010-440x(99)90130-x.
Frequent use of health services has been associated with such concepts as alexithymia, hypochondriasis, and psychological distress. The aim of this case-control study was firstly to assess whether alexithymia, hypochondriasis, and psychological distress are associated with frequent attendance and secondly to assess the gender differences of these associations in a primary health care setting. A sample of 304 frequent attenders (eight or more visits during 1 year), including all of the frequent attenders during 1994, and 304 randomly selected age- and sex-matched controls were selected. Half of the sample (every second individual selected in date-of-birth order) was invited for an interview, 113 frequent attenders and 107 controls completed a questionnaire during the interview. Alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20), hypochondriasis was screened with the Whiteley Index (WI), and Symptom Checklist-36 (SCL-36) was used to determine psychological distress. We found a distinct gender difference in the associations of these characteristics with frequent attending. Significant associations of alexithymia, hypochondriasis, and psychological distress with frequent attending were found among men, but not among women. Alexithymia, hypochondriasis, and psychological distress should be considered when treating frequent attenders, especially males.
频繁使用医疗服务与述情障碍、疑病症和心理困扰等概念相关。本病例对照研究的目的，一是评估述情障碍、疑病症和心理困扰是否与频繁就诊有关，二是在初级卫生保健环境中评估这些关联的性别差异。选取了304名频繁就诊者（1年内就诊8次或更多次，包括1994年所有的频繁就诊者）以及304名随机选取的年龄和性别匹配的对照。样本的一半（按出生日期顺序每隔一人选取）被邀请参加访谈，113名频繁就诊者和107名对照在访谈期间完成了一份问卷。用多伦多述情障碍量表-20（TAS-20）测量述情障碍，用惠特利指数（WI）筛查疑病症，并用症状自评量表-36（SCL-36）确定心理困扰。我们发现这些特征与频繁就诊之间的关联存在明显的性别差异。在男性中发现述情障碍、疑病症和心理困扰与频繁就诊有显著关联，但在女性中未发现。在治疗频繁就诊者，尤其是男性时，应考虑述情障碍、疑病症和心理困扰。
