title: Impact of physical symptoms on perceived health in the community.
abstract: OBJECTIVE
  Physical symptoms, such as musculoskeletal pain, dizziness, or headache, are common. People with more symptoms are reported to use more healthcare and have higher sickness absenteeism. We studied the impact of the number of symptoms on perceived health in a community sample.
  
  
  METHODS
  Between June 2005 and March 2006, a random sample of 4741 adults was selected from the records of five general practices in The Netherlands. They were sent a questionnaire regarding the frequency and impact of physical symptoms, and other factors that may influence health (potential confounders or modifiers), including lifestyle factors, childhood illness experiences, and psychological factors. We studied the association between increasing number of physical symptoms and perceived health using the SF-36 as the outcome measure.
  
  
  RESULTS
  Response rate was 53.5% (n=2447). Fatigue was the most commonly reported symptom with a prevalence of 57%, followed by headache (40%) and back pain (39%). More than half of responders reported three symptoms or more. Responders with multiple symptoms were more often female, had lower educational level, less often paid work, higher body mass index, more negative childhood health experiences, and higher scores for anxiety and depression. Multiple symptoms were strongly associated with perceived health, especially among responders with negative illness perceptions, more anxiety, or those reporting family members with a chronic illness during childhood.
  
  
  CONCLUSIONS
  Physical symptoms are common and often seem to be mild. However, increasing number of symptoms is strongly associated with poorer physical, emotional, and social functioning. Different somatization processes may explain our findings.
authors.affiliation: Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, United Kingdom. d.van.der.windt@cphc.keele.ac.uk
authors.forename: Daniëlle A W M
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Kate M
authors.initials: KM
authors.lastname: Dunn
authors.forename: Marinda N
authors.initials: MN
authors.lastname: Spies-Dorgelo
authors.forename: Christian D
authors.initials: CD
authors.lastname: Mallen
authors.forename: Antoinette H
authors.initials: AH
authors.lastname: Blankenstein
authors.forename: Wim A B
authors.initials: WA
authors.lastname: Stalman
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology*; D001294:Attitude to Health; D002391:Catchment Area, Health; D003153:Community Health Services; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology*