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J Eval Clin Pract. 2018 Aug;24(4):892-900. doi: 10.1111/jep.12898. Epub 2018 Mar 2.

Somatoform disorder in primary care: The influence of co-morbidity with anxiety and depression on health care utilization.

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Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Clinic Hamburg-Eilbek, Hamburg, Germany.
Department of Medical Psychology, University Medical School, Greifswald, Germany.



Patients with somatoform disorders are frequent attenders in primary and secondary care. While co-morbid mental disorders, especially depression and anxiety, are frequently present, there is controversy on whether mental co-morbidity leads to higher health care utilization (HCU). The present paper investigates the influence of co-morbid depressive and anxiety disorders on primary, specialized somatic and mental HCU in primary care patients with somatoform disorders. Additionally, we investigated the predictive value of self-rated health and illness perception on HCU.


Patients in 19 primary care practices were screened with the Patient Health Questionnaire, and patients at high risk for somatoform disorders were assessed using the Composite International Diagnostic Interview. N = 71 patients with somatoform disorders were analysed. We analysed whether having one vs two co-morbidities (depression and/or anxiety), self-rated health, and illness perception were predictors for primary, specialized somatic and mental HCU using binominal and hierarchical regression analyses.


Having both co-morbid depressive and anxiety disorder predicted higher primary HCU (IRR = 1.96, 95% CI, 1.30-2.93), and increased the odds of being in mental health care (OR = 5.16, 95% CI, 1.10-24.20), while only one co-morbidity did not. No differences were found for specialized somatic HCU. Illness perception and self-rated health did not predict HCU.


Not a single but only the presence of multiple co-morbidities predicts primary and mental HCU in patients with somatoform disorder. Health care utilization might be essentially influenced by the associated psychological distress, which should be considered in treatment.


anxiety; co-morbidity; depression; health care utilization; primary care; somatoform disorder

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