title: Depression and anxiety in multisomatoform disorder: prevalence and clinical predictors in primary care.
abstract: OBJECTIVE
  Multisomatoform disorder (MSD) is characterised by > or = 3 medically inexplicable, troublesome physical symptoms, together with a > or = 2-year history of somatisation. The aim of this study was to evaluate the prevalence of depressive and anxiety disorders in a South African sample MSD, and to compare demographic and clinical outcomes in those patients with and without co-morbidity.
  
  
  METHODS
  Fifty-one adult outpatients with MSD were recruited from primary care clinics in the Cape Town metropolitan area. Participants were assessed for the presence of co-morbid depressive and anxiety disorders using the Mini Neuropsychiatric Interview-Plus (MINI-Plus). Outcomes included somatic symptom severity, disability, reported sick days and health care visits, pain experience, patient satisfaction with health services, and clinician-experienced difficulty.
  
  
  RESULTS
  A current co-morbid depressive disorder was present in 29.4% (N = 15) of patients, and a current co-morbid anxiety disorder in 52.9% (N = 27). MSD patients with a co-morbid depressive disorder (current or lifetime) had significantly higher physical symptom counts, greater functional impairment, higher unemployment rates, more clinician-reported difficulties, and more dissatisfaction with health care services than those without the disorder. A larger number of co-morbid disorders was associated with greater overall disability.
  
  
  CONCLUSIONS
  High rates of co-morbid depressive and anxiety disorders were present in a South African sample of primary care patients with MSD. Not all patients had co-morbidity, which is consistent with the view that MSD should be viewed as an independent disorder. However, co-morbid depressive disorders were associated with increased symptom severity and functional impairment, consistent with previous reports from developing countries, emphasising the importance of comorbidity in MSD.
authors.affiliation: Medical Research Council Unit on Anxiety Disorders, Department of Psychiatry, Stellenbosch University, Tygerberg, W Cape. jmuller@boardwalkmanor.co.za
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Muller
authors.forename: Ignatius
authors.initials: I
authors.lastname: Wentzel
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Nel
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009484:Neuropsychology; D010147:Pain Measurement; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011581:Psychological Tests; D011594:Psychometrics; D012307:Risk Factors; D013001:Somatoform Disorders / Q000150:complications* / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires