Physical symptoms that predict psychiatric disorders in rural primary care adults

There is a robust association between physical symptoms and mental distress, but recognition rates of psychiatric disorders by primary care doctors are low. We investigated patient-reported physical symptoms as predictors of concurrent psychiatric disorders in rural primary care adult outpatients.

A convenience sample of 1092 patients were assessed with a two-stage diagnostic system consisting of a brief screening questionnaire and a clinician-administered semi-structured interview that linked common physical symptoms with the concurrent presence of psychiatric disorders.

Somatoform physical symptoms were highly predictive of the concurrent presence of a psychiatric disorder, with odds ratios ranging from 10.4 (fainting spells) to 54.6 (shortness of breath). Aggregate analysis of somatoform and non-somatoform symptoms relative to no physical symptom produced odds ratios of 3.0 or higher for headaches, chest pain, dizziness, sleep problem, shortness of breath, tired or low energy, and fainting spells. As the number of symptoms (especially somatoform) increased, the odds of a psychiatric disorder increased.

Although individual physical symptoms are valid triggers for suspecting a psychiatric disorder, the most powerful correlates are total number of physical complaints and somatoform symptom status.