Send to

Choose Destination
Psychol Med. 2019 Jan;49(1):121-131. doi: 10.1017/S0033291718000582. Epub 2018 Mar 20.

The association of psychological factors and healthcare use with the discrepancy between subjective and objective respiratory-health complaints in the general population.

Author information

Finnish Institute of Occupational Health,Helsinki,Finland.
Finnish Lung Health Association,Helsinki,Finland.
Department of Psychology and Logopedics,Faculty of Medicine,University of Helsinki,Helsinki,Finland.
Independent Science Researcher Ylöjärvi,Finland.
Health Sciences, andUniversity Hospital Psychiatric Department,University of Tampere,Tampere,Finland.
Department of Health,National Institute for Health and Welfare,Helsinki,Finland.



We examined the prevalence of self-perceived respiratory symptoms (SRS) in the absence of any objective findings of respiratory pathology, and the association of such prevalence with psychological factors and healthcare use in the general population.


The study was conducted among a nationally representative sample of Finnish adults (BRIF8901). Respiratory functioning was measured by a spirometry test. Structured questionnaires were used to measure SRS, physician visits and psychological factors of alexithymia, sense of coherence, illness worry and common mental disorders. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder, determined in a diagnostic interview, were excluded, giving a sample comprising 4544 participants.


Twenty-six per cent of the general population and 36% of those with no diagnosed severe psychiatric disorder or respiratory disease experienced SRS despite a normal spirometry result. Psychological factors were associated with SRS (0.0001 < p < 0.032), and on the number of physician visit explaining 42.7% of the difference in visits between individuals with and without SRS, respectively. Illness worry was associated most strongly with SRS [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.19-1.41, p < 0.0001] and higher numbers of physician visits (OR 1.35, CI 1.32-1.38, p < 0.00001), even after several adjustments.


Respiratory symptoms without objective findings are common in the general population. The study results underline the role of psychological factors in the reporting of respiratory symptoms and the associated medical burden, thereby indicating the functional nature of the symptomatology.


Alexithymia; health anxiety; healthcare use; illness perception; population-based study; respiratory symptoms; sense of coherence; subjective health complaints


Supplemental Content

Full text links

Icon for Cambridge University Press
Loading ...
Support Center