School of Community-Based Medicine, The University of Manchester, Manchester, UK.
Psychosom Med. 2012 Jul-Aug;74(6):656-64. doi: 10.1097/PSY.0b013e31825cb140. Epub 2012 Jun 28.
To assess whether the number of somatic symptoms and health anxiety are independent predictors of future health care use after adjusting for confounders.
In a random sample of the adult UK population, questionnaires assessed the number of somatic symptoms (Somatic Symptom Inventory), health anxiety (Whiteley Index), anxiety/depression (Hospital Anxiety and Depression Scale), the number of physical illnesses and demographic variables. The number of consultations in primary care was obtained from medical records for 1 year before and after questionnaire assessment, and negative binomial regression analyses identified predictors of consultation rate.
The sample included 961 participants (58.0% response) with complete medical record data for 609 participants. After adjustment for consultation rate in the prior year, the predictors of subsequent consultation rate in primary care were the number of physical illnesses, off work through illness, Whiteley Index (incidence rate ratio [IRR] = 1.22, 95% confidence interval [CI] = 1.09-1.35), and the Whiteley Index-by-Somatic Symptom Inventory interaction term. Reported physical abuse predicted an increased consultation rate in women (IRR = 2.30, 95% CI = 1.08-4.90) but a reduced rate in men (IRR = 0.43, 95% CI = 0.22-0.84), interaction p = 0.003.
These data raise the possibility that both increased health anxiety and number of bothersome somatic symptoms predict frequent medical consultations. A more complex model of predicting future health care use is needed than has been studied previously, which is potentially relevant to the current discussions of the proposed DSM-V and International Classification of Diseases, 11th Revision, diagnostic guidelines regarding complex somatic symptom disorders.
评估在调整混杂因素后，躯体症状数量和健康焦虑是否是未来卫生保健使用的独立预测因素。
在英国成年人的随机样本中，问卷调查评估了躯体症状数量（躯体症状清单）、健康焦虑（Whiteley 指数）、焦虑/抑郁（医院焦虑和抑郁量表）、身体疾病数量和人口统计学变量。在问卷调查前后的 1 年中，从医疗记录中获得初级保健咨询次数，并进行负二项回归分析，以确定咨询率的预测因素。
该样本包括 961 名参与者（58.0%的应答率），其中 609 名参与者有完整的医疗记录数据。在调整前一年的咨询率后，初级保健后续咨询率的预测因素是身体疾病数量、因病缺勤、Whiteley 指数（发病率比 [IRR] = 1.22，95%置信区间 [CI] = 1.09-1.35）和 Whiteley 指数-躯体症状清单交互项。报告的身体虐待预测女性咨询率增加（IRR = 2.30，95%CI = 1.08-4.90），但男性咨询率降低（IRR = 0.43，95%CI = 0.22-0.84），交互作用 p = 0.003。
这些数据表明，健康焦虑增加和躯体症状数量增多均可能预测频繁的医疗咨询。需要建立一个比之前研究更复杂的预测未来卫生保健使用的模型，这与当前关于拟议的 DSM-V 和国际疾病分类，第 11 修订版躯体症状障碍诊断指南的讨论具有潜在相关性。
