Are physical symptoms among survivors of a disaster presented to the general practitioner? A comparison between self-reports and GP data.
BACKGROUND
Most studies examining medically unexplained symptoms (MUS) have been performed in primary or secondary care and have examined symptoms for which patients sought medical attention. Disasters are often described as precipitating factors for MUS. However, health consequences of disasters are typically measured by means of questionnaires, and it is not known whether these self-reported physical symptoms are presented to the GP. It is also not known if the self-reported symptoms are related to a medical disorder or if they remain medically unexplained. In the present study, three research questions were addressed. Firstly, were self-reported symptoms among survivors presented to the GP? Secondly, were the symptoms presented to the GP associated with a high level of functional impairment and distress? Thirdly, what was the GP's clinical judgment of the presented symptoms, i.e. were the symptoms related to a medical diagnosis or could they be labeled MUS?


METHODS
Survivors of a man-made disaster (N = 887) completed a questionnaire 3 weeks (T1) and 18 months (T2) post-disaster. This longitudinal health survey was combined with an ongoing surveillance program of health problems registered by GPs.


RESULTS
The majority of self-reported symptoms was not presented to the GP and survivors were most likely to present persistent symptoms to the GP. For example, survivors with stomachache at both T1 and T2 were more likely to report stomachache to their GP (28%) than survivors with stomachache at only T1 (6%) or only T2 (13%). Presentation of individual symptoms to the GP was not consistently associated with functional impairment and distress. 56 - 91% of symptoms were labeled as MUS after clinical examination.


CONCLUSIONS
These results indicate that the majority of self-reported symptoms among survivors of a disaster are not presented to the GP and that the decision to consult with a GP for an individual symptom is not dependent on the level of impairment and distress. Also, self-reported physical symptoms such as headache, back pain and shortness of breath are likely to remain medically unexplained after the clinical judgment of a GP.
van den Berg
Bellis
B
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. bellis.van.den.berg@regioplan.nl
Yzermans
C Joris
CJ
van der Velden
Peter G
PG
Stellato
Rebecca K
RK
Lebret
Erik
E
Grievink
Linda
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D005194:Family Practice; D005260:Female; D005390:Fires; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009426:Netherlands; D012650:Self Disclosure; D011795:Surveys and Questionnaires; D017741:Survivors