title: An international study comparing the effect of medically explained and unexplained somatic symptoms on psychosocial outcome.
abstract: OBJECTIVE
  Cross-sectional studies show an association between somatic symptoms and psychiatric morbidity in primary care. However, medically explained and unexplained symptoms have been considered separately as distinct and unrelated. In addition, data on outcome in primary care are equivocal. We compare the effect of both constructs (medically explained and unexplained symptoms) on psychiatric morbidity and disability (social and physical) at 1 year follow-up.
  
  
  METHODS
  Of 5447 patients presenting for primary care in 14 countries, 3201 participants were followed up (72% compliance). We measured physical, psychiatric, and social status using standardised instruments.
  
  
  RESULTS
  Patients with five or more somatic symptoms had increased psychosocial morbidity and physical disability at follow-up, even after controlling for confounders such as sociodemographics and recognition or treatment by general practitioners. There was little difference in outcome between medically explained and unexplained symptoms.
  
  
  CONCLUSIONS
  Somatic symptoms-irrespective of aetiology-are associated with adverse psychosocial and functional outcome in diverse cultures.
authors.affiliation: Department of Psychiatry, Dalhousie University, Halifax, Canada B3H 1V7. stephen.kisely@cdha.nshealth.ca
authors.forename: Stephen
authors.initials: S
authors.lastname: Kisely
authors.forename: Gregory
authors.initials: G
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012803:Sick Role; D012917:Social Adjustment; D013001:Somatoform Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome; D014944:World Health Organization
chemical_list: D011619:Psychotropic Drugs