Weiss Frauke Dorothee, Rief Winfried, Kleinstäuber Maria
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany.
Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany.
Gen Hosp Psychiatry. 2017 Jan-Feb;44:22-29. doi: 10.1016/j.genhosppsych.2016.10.003. Epub 2016 Oct 15.
Somatoform disorders are characterized by increased health care utilization producing high health costs. The aim of this study was to assess facets of and interdiagnostic differences in health care use in somatoform disorders and to examine health anxiety, symptom-related disability, depression, and phobic anxiety as potential mediating factors of the relationship between somatization and health care use.
An outpatient sample of N=254 patients with somatoform disorders was investigated by analyzing different facets of their health care use over the last 12months. Multiple mediation analyses were applied.
Participants reported a mean of 28.02 doctor visits over the last year. Patients fulfilling criteria of DSM-IV somatization disorder had a significantly higher number of doctor visits than patients with undifferentiated somatoform, and somatoform pain disorder, all p≤.006. In most health care use variables, patients with comorbid mental disorders did not differ from patients without comorbidities. The mediation model on the effect of all mediator variables on the relationship between somatization and health care use reached significance (b=0.32, 95% CI: 0.0576, 0.6435). Surprisingly, specific mediator effects were found for health anxiety (b=0.06, 95% CI: 0.0004, 0.1505) and disability (b=0.18, 95% CI: 0.0389, 0.3530), but not for depression and phobic anxiety.
Health anxiety and symptom-related disability should be further considered when investigating potential etiological factors of increased health care use.
躯体形式障碍的特点是医疗保健利用率增加，导致高昂的医疗成本。本研究的目的是评估躯体形式障碍患者医疗保健使用的各个方面及其诊断间的差异，并检验健康焦虑、症状相关残疾、抑郁和恐惧焦虑作为躯体化与医疗保健使用之间关系的潜在中介因素。
通过分析N = 254例躯体形式障碍门诊患者在过去12个月中医疗保健使用的不同方面进行调查。应用多重中介分析。
参与者报告过去一年平均看医生28.02次。符合DSM-IV躯体化障碍标准的患者看医生的次数显著高于未分化躯体形式障碍和躯体形式疼痛障碍患者，所有p≤0.006。在大多数医疗保健使用变量方面，合并精神障碍的患者与未合并精神障碍的患者没有差异。所有中介变量对躯体化与医疗保健使用之间关系的中介模型具有显著性（b = 0.32，95%CI：0.0576，0.6435）。令人惊讶的是，发现健康焦虑（b = 0.06，95%CI：0.0004，0.1505）和残疾（b = 0.18，95%CI：0.0389，0.3530）有特定的中介效应，但抑郁和恐惧焦虑没有。
在调查医疗保健使用增加的潜在病因时，应进一步考虑健康焦虑和症状相关残疾。
