Hessel Aike, Geyer Michael, Hinz Andreas, Brahler Elmar
University of Leipzig, Department of Psychotherapy and Psychosomatic Medicine, K.-Tauchnitz-Strasse 25, D-04107 Leipzig, Germany.
Z Psychosom Med Psychother. 2005;51(1):38-56. doi: 10.13109/zptm.2005.51.1.38.
Utilization of the health care system is not determined by the presence of an organic illness, but by a multitude of interacting factors. This applies particularly to somatoform complaints and disorders, in the context of which the health care system is used very intensively and inadequately in relation to the disorder. The present paper summarizes the frequency of somatoform complaints in the general population and health care utilization due to these complaints.
On the basis of a survey carried out in 2002 for a representative population of 2089 persons (aged 14 to 92 years), the prevalence of somatoform complaints during a period of 2 years was determined. In this survey, physical complaints were defined as being somatoform when they seriously affected the person's well-being but exhibited a disparity between objective diagnostic findings and subjective experience. The psychosocial aspects were also determined. When somatoform complaints were identified, the specific utilization of the healthcare system for them was investigated.
Somatoform complaints are very frequent in Germany: 8.3% of the population claim to suffer from clinically relevant somatoform disorders that fully meet the criteria mentioned above. The health care system is used heavily for these complaints. Within the last two years, each test person suffering from somatoform disorders consulted a physician a mean 18 times and was incapable of working for a mean of 20 days. 16% of these persons were hospitalized, 9 % received treatment at a health resort, 9 % retired, etc.
The considerable utilization of health care services is an essential element of somatoform pathology and has immense medico-political relevance. The most important prerequisite for handling the 'commitment to health care system' symptom is thorough training of all physicians in the basics of somato-psycho-social medicine. This will be an important measure for cost reduction in the health care system.
医疗保健系统的使用并非由器质性疾病的存在所决定，而是由众多相互作用的因素所决定。这尤其适用于躯体形式障碍和主诉，在这种情况下，医疗保健系统针对该疾病的使用非常频繁但并不充分。本文总结了普通人群中躯体形式障碍主诉的发生率以及因这些主诉而进行的医疗保健利用情况。
基于2002年对2089名（年龄在14至92岁之间）具有代表性人群进行的一项调查，确定了两年期间躯体形式障碍主诉的患病率。在这项调查中，当身体主诉严重影响个人幸福感但客观诊断结果与主观体验之间存在差异时，这些主诉被定义为躯体形式的。同时也对心理社会方面进行了测定。当识别出躯体形式障碍主诉时，对针对这些主诉的医疗保健系统的具体使用情况进行了调查。
躯体形式障碍主诉在德国非常常见：8.3%的人口声称患有完全符合上述标准的具有临床相关性的躯体形式障碍。针对这些主诉，医疗保健系统的使用频率很高。在过去两年中，每一位患有躯体形式障碍的受测者平均咨询医生18次，平均有20天无法工作。其中16%的人住院治疗，9%的人在疗养胜地接受治疗，9%的人退休等。
医疗保健服务的大量使用是躯体形式障碍病理学的一个基本要素，并且具有重大的医学政治意义。处理“对医疗保健系统的依赖”症状的最重要前提是对所有医生进行身心社会医学基础知识的全面培训。这将是医疗保健系统降低成本的一项重要措施。
