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Depression and anxiety in patients repeatedly referred to secondary care with medically unexplained symptoms: a case-control study

Published online by Cambridge University Press:  19 May 2010

C. Burton ,
K. McGorm ,
D. Weller  and
M. Sharpe
C. Burton
Affiliation:
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
K. McGorm
Affiliation:
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
D. Weller
Affiliation:
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
M. Sharpe*
Affiliation:
Psychological Medicine Research, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK
*
*Address for correspondence: Professor M. Sharpe, Psychological Medicine Research, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, EdinburghEH10 5HF, UK. (Email: michael.sharpe@ed.ac.uk)
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Abstract

Background

One third of referrals from primary to secondary care are for medically unexplained symptoms (MUS). We aimed to determine the association of depression and anxiety disorders with high use of specialist services by patients with MUS. We did this by comparing their prevalence in patients who had been repeatedly referred with symptoms for which they had received repeated specialist diagnoses of MUS with that in two control groups. We also determined the adequacy of treatment received.

Method

A case-control study in five general practices in Edinburgh, UK. Data collection was by case note review and questionnaire. Cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. Controls were: (a) patients referred only once over 5 years (n=152); (b) patients with three or more referrals for symptoms always diagnosed as medically explained (n=162).

Results

In total, 93 (48%) of the cases met our criteria for current depression, anxiety or panic disorders. This compared with 38 (25%) and 52 (35.2%) of the control groups; odds ratios (95% confidence intervals) of 2.6 (1.6–4.1) and 1.6 (1.01–2.4), respectively. Almost half (44%) of the cases with current depression or anxiety had not received recent minimum effective therapy.

Conclusions

Depression, anxiety and panic disorders are common in patients repeatedly referred to hospital with MUS. Improving the recognition and treatment of these disorders in these patients has the potential to provide better, more appropriate and more cost-effective medical care.

Keywords

Anxietydepressionmedically unexplained symptomsprimary carereferral
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 3 , March 2011 , pp. 555 - 563
Copyright
Copyright © Cambridge University Press 2010

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