title: Patients presenting with somatic complaints in general practice: depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors.
abstract: BACKGROUND
  Mental disorders in primary care patients are frequently associated with physical complaints that can mask the disorder. There is insufficient knowledge concerning the role of anxiety, depression, and somatoform disorders in patients presenting with physical symptoms. Our primary objective was to determine the prevalence of depression, anxiety, and somatoform disorders among primary care patients with a physical complaint. We also investigated the relationship between cumulated psychosocial stressors and mental disorders.
  
  
  METHODS
  We conducted a multicentre cross-sectional study in twenty-one private practices and in one academic primary care centre in Western Switzerland. Randomly selected patients presenting with a spontaneous physical complaint were asked to complete the self-administered Patient Health Questionnaire (PHQ) between November 2004 and July 2005. The validated French version of the PHQ allowed the diagnosis of mental disorders (DSM-IV criteria) and the analyses of exposure to psychosocial stressors.
  
  
  RESULTS
  There were 917 patients exhibiting at least one physical symptom included. The rate of depression, anxiety, and somatoform disorders was 20.0% (95% confidence interval [CI] = 17.4% to 22.7%), 15.5% (95% CI = 13.2% to 18.0%), and 15.1% (95% CI = 12.8% to 17.5%), respectively. Psychosocial stressors were significantly associated with mental disorders. Patients with an accumulation of psychosocial stressors were more likely to present anxiety, depression, or somatoform disorders, with an increase of 2.2 fold (95% CI = 2.0 to 2.5) for each additional stressor.
  
  
  CONCLUSIONS
  The investigation of mental disorders and psychosocial stressors among patients with physical complaints is relevant in primary care. Psychosocial stressors should be explored as potential epidemiological causes of mental disorders.
authors.affiliation: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: Nader
authors.initials: N
authors.lastname: Haftgoli
authors.forename: Bernard
authors.initials: B
authors.lastname: Favrat
authors.forename: François
authors.initials: F
authors.lastname: Verdon
authors.forename: Paul
authors.initials: P
authors.lastname: Vaucher
authors.forename: Thomas
authors.initials: T
authors.lastname: Bischoff
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: Lilli
authors.initials: L
authors.lastname: Herzig
mesh_terms: D001007:Anxiety / Q000150:complications* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D013001:Somatoform Disorders / Q000453:epidemiology*; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology