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Somatizing frequent attenders in primary health care
S Jyväsjärvi1, M Joukamaa, E Väisänen
1Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland. simo.jyvasjarvi@oulu.fi
Objective:
The aim of this case-control study was to investigate the association of somatization with frequent attendance in primary health care.
Methods:
Frequent attenders in a health center (FAs) (N=112) and age- and sex-matched controls (COs) (N=105) constituted the study series. Data were collected from annual statistics, medical records, postal questionnaires and personal interviews. Psychological distress was assessed using Symptom Checklist-36 (SCL-36), alexithymia was measured with Toronto Alexithymia Scale-20 (TAS-20) and hypochondriasis was screened with Whiteley Index (WI).
Results:
About one-third of FAs were somatizers when a cut-off point of eight symptoms on the SCL-36 somatization subscale was used as a criterion. The significant association of somatization with frequent attendance disappeared in multivariate analyses when adjusted for age, sex and chronic somatic illnesses. Hypochondriacal beliefs and psychiatric comorbidity were connected with FAs' somatization. Hypochondriacal beliefs explained somatizers' frequent attendance. A significant interaction effect between somatization and hypochondriacal beliefs was found when explaining frequent attendance.
Conclusion:
The results emphasize the need to use a comprehensive approach of somatization, including hypochondriacal beliefs, when treating somatizing FA patients in primary health care.