Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, UK.
BMC Fam Pract. 2011 Oct 2;12:107. doi: 10.1186/1471-2296-12-107.
Around 1% of adults are repeatedly referred from primary to secondary care with medically unexplained symptoms (MUS); many of these patients have depression and anxiety disorders which are unrecognized or inadequately treated. We aimed to investigate the ways patients with MUS and their General Practitioners (GPs) interpret low mood and worry, whether they regard them as depressive or anxiety disorders and how they relate them causally to symptoms.
We carried out semi-structured interviews with 27 patients who had been repeatedly referred to specialists for MUS and their GPs and analysed transcripts by qualitative comparison. The analysis examined themes relating to low mood and worry, and their influence on symptoms. It drew on the concept of "otherness", whereby mental phenomena can be located either within the self or as separate entities.
Both patients and GPs acknowledged the presence of low mood and worry. They viewed low mood as either an individual's personal response to circumstances (including their physical symptoms) or as the illness called "depression"; only the latter was amenable to medical intervention. Worry was seen as a trait rather than as a symptom of an anxiety disorder. While low mood and worry were acknowledged to influence physical symptoms, they were considered insufficient to be the main cause by either the patients or their doctors.
Patients with MUS who are high users of secondary care services interpret low mood and worry in ways which allow them to be discussed with professionals, but not as the cause of their physical symptoms.
约有 1%的成年人因无法用医学解释的症状（MUS）而反复从初级医疗保健转诊到二级医疗保健；这些患者中有许多患有抑郁症和焦虑症，但未被识别或治疗不当。我们旨在调查 MUS 患者及其全科医生（GP）如何解释情绪低落和担忧，他们是否将其视为抑郁或焦虑障碍，以及他们如何将其因果关系与症状联系起来。
我们对 27 名因 MUS 而反复转诊给专科医生的患者及其 GP 进行了半结构化访谈，并通过定性比较分析转录本。该分析检查了与情绪低落和担忧相关的主题，以及它们对症状的影响。它借鉴了“他者性”的概念，即心理现象可以位于自我内部或作为独立实体。
患者和 GP 都承认存在情绪低落和担忧。他们认为情绪低落要么是个人对环境（包括身体症状）的反应，要么是称为“抑郁症”的疾病；只有后者可以通过医学干预来治疗。担忧被视为一种特征，而不是焦虑障碍的症状。尽管情绪低落和担忧被认为会影响身体症状，但无论是患者还是他们的医生都认为这不足以成为主要原因。
高频率使用二级医疗保健服务的 MUS 患者以允许他们与专业人员讨论的方式解释情绪低落和担忧，但不会将其作为身体症状的原因。
