title: Screening for multiple somatic complaints in a population-based survey: does excessive symptom reporting capture the concept of somatic symptom disorders? Findings from the MONICA-KORA Cohort Study.
abstract: OBJECTIVE
  Excessive symptom reporting (ESR) has gained a revived attention in the conceptualization of somatic symptom disorders. We aimed to explore whether ESR captures the concept of somatic symptom disorders regardless of the patient's disease status or the degree of symptom burden.
  
  
  METHODS
  In three independent cross-sectional population-based samples of the MONICA/KORA Study in 1985, 1990, and 1995, somatic symptom reporting and an array of somatic and mental health features were assessed in 11,895 eligible participants. After a mean 12-year follow-up, the vital status was assessed at the end of 2002. All-cause mortality was calculated as hazard risks ratios (HRs).
  
  
  RESULTS
  Among all participants, a total of 1238 men and 1169 women were in the sex-specific upper quintile of the somatic symptom distribution and qualified for ESR subpopulation. ESR participants were older, on a lower educational level, and more often unemployed. They suffered more often from metabolic syndrome and chronic diseases. ESR was associated with psychological distress, negative self-perceived health, and sleeping disorders. ESR was associated with twofold more ambulant and hospital medical utilization. Survival in ESR participants was significantly reduced (HR=1.33; 95% CI=1.18-1.49; P<.001). Frequency of medical ambulatory consultations and days in hospital were higher in ESR participants, even after controlling for potential confounders.
  
  
  CONCLUSIONS
  A simple approach to screen for participants with high symptom reporting in an unselected population-based sample results in the identification of a clinically meaningful target population with high burden of physical and psychological comorbidities.
authors.affiliation: Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, 85764 Neuherberg, Germany. ladwig@helmholtz-muenchen.de
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Ladwig
authors.forename: Birgitt
authors.initials: B
authors.lastname: Marten-Mittag
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Lacruz
authors.forename: Peter
authors.initials: P
authors.lastname: Henningsen
authors.forename: Francis
authors.initials: F
authors.lastname: Creed
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001294:Attitude to Health; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D016016:Proportional Hazards Models; D012737:Sex Factors; D012890:Sleep; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires