Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark.
Research Clinic for Functional Disorders, Aarhus University Hospital, Denmark; Research Unit for General Practice, Aarhus, Denmark.
J Psychosom Res. 2022 May;156:110765. doi: 10.1016/j.jpsychores.2022.110765. Epub 2022 Feb 24.
Functional somatic symptoms (FSS) may progress into a functional disorder if poorly managed, which may have serious implications. This cross-sectional study describes the management of youths compared to adults in general practice and estimates the prevalence of FSS in youths in this setting by comparing consultation-related aspects between youths with FSS and 1) youths with a specific diagnosis and 2) adults with FSS.
We used data from a Danish survey (2008-2009), including 3295 face-to-face consultations between GPs and patients aged 15-64 years. Patients were divided into youths (15-24 years) and adults (25-64 years) and then into subgroups according to the GPs' classifications: 1) specific diagnosis, 2) resolving symptom and 3) FSS. Logistic regression analysis was used for all comparisons, and estimates were adjusted for gender, concomitant chronic disorder and GP cluster.
The GPs more frequently ensured continuity of care in adults (AOR:0.75, 95%CI:0.61-0.92, p < 0.01) and perceived youths as less time consuming (AOR:0.58, 95%CI: 0.43-0.77, p < 0.01) and less burdensome (AOR:0.60; 95%CI: 0.45-0.81, p < 0.01) compared to adults. FSS prevalence was 4.4% in youths and 9.0% in adults. However, GPs perceived youths with FSS as more burdensome (AOR:7.77, 95%CI:2.93-20.04, p < 0.01) and more time consuming (AOR:3.98, 95%CI:1.42-11.12, p < 0.01) than youths with a specific diagnosis. No significant differences were found between youths and adults with FSS, respectively, in regards to perceived burden and consultation time.
The results indicate age-related variations in the prevalence and clinical management of FSS in general practice. The GPs perceived both youths and adults with FSS time consuming, which underlines a need for supportive management strategies.
如果功能躯体症状（FSS）得不到妥善管理，可能会发展为功能障碍，这可能会产生严重影响。本横断面研究描述了普通科医生对青少年和成年人的管理，并通过比较 FSS 青少年与 1）有特定诊断的青少年和 2）有 FSS 的成年人之间的就诊相关方面，来估计该环境下青少年中 FSS 的患病率。
我们使用了丹麦一项调查（2008-2009 年）的数据，其中包括 3295 名全科医生与 15-64 岁患者之间的面对面咨询。患者分为青少年（15-24 岁）和成年人（25-64 岁），然后根据全科医生的分类分为亚组：1）特定诊断，2）缓解症状和 3）FSS。所有比较均采用逻辑回归分析，估计值根据性别、同时存在的慢性疾病和全科医生聚类进行调整。
全科医生更频繁地确保成年人的连续护理（优势比[OR]：0.75，95%置信区间[CI]：0.61-0.92，p<0.01），并认为青少年的就诊时间更短（OR：0.58，95%CI：0.43-0.77，p<0.01），负担更轻（OR：0.60；95%CI：0.45-0.81，p<0.01）。FSS 的患病率在青少年中为 4.4%，在成年人中为 9.0%。然而，全科医生认为患有 FSS 的青少年更有负担（OR：7.77，95%CI：2.93-20.04，p<0.01），就诊时间更长（OR：3.98，95%CI：1.42-11.12，p<0.01），而非特定诊断的青少年。在感知负担和就诊时间方面，患有 FSS 的青少年与成年人之间没有发现显著差异。
结果表明，普通科医生对 FSS 的流行程度和临床管理存在与年龄相关的差异。全科医生认为患有 FSS 的青少年和成年人都很费时，这突显了需要支持性管理策略。
