Randomised controlled trial of disclosure of emotionally important events in somatisation in primary care.
OBJECTIVE
To test whether a disclosure intervention improves subjective health and reduces medical consumption and sick leave in somatising patients in general practice.


METHODS
Non-blind randomised controlled trial.


METHODS
10 general practices in the Netherlands.


METHODS
161 patients who frequently attended general practice with somatising symptoms.


METHODS
Patients in the intervention group were visited two to three times and invited to disclose emotionally important events in their life. Control patients received normal care from their general practitioners.


METHODS
Use of medical services (drugs and healthcare visits), subjective health, and sick leave assessed by self completion questionnaires after 6, 12, and 24 months.


RESULTS
Of the 161 patients, 137 completed the trial (85%). Both groups were comparable at baseline. The intervention had no effect on the main outcome measures at any point. Intervention patients made one more visit to health care (95% confidence interval -4 to 6); the use of medicines did not change in both groups (-1 to 1); subjective health improved 3.6 points more in the control group (-11.2 to 4.3); and disclosure patients were on sick leave one more week (-1 to 3). Patients often had a depression or anxiety disorder for which they were not receiving adequate care.


CONCLUSIONS
Although the intervention was well received by patients and doctors, disclosure had no effect on the health of somatising patients in general practice.
Schilte
A F
AF
Department of General Practice, University of Maastricht, PO Box 616, 6200 MD Maastricht, Netherlands. Bert.Schilte@hag.unimaas.nl
Portegijs
P J
PJ
Blankenstein
A H
AH
van Der Horst
H E
HE
Latour
M B
MB
van Eijk
J T
JT
Knottnerus
J A
JA
D000328:Adult; D005194:Family Practice / Q000379:methods; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012650:Self Disclosure; D018582:Sick Leave; D013001:Somatoform Disorders / Q000209:etiology / Q000628:therapy*; D013315:Stress, Psychological / Q000523:psychology*; D016896:Treatment Outcome