title: Medically unexplained and explained physical symptoms in the general population: association with prevalent and incident mental disorders.
abstract: BACKGROUND
  Clinical studies have shown that Medically Unexplained Symptoms (MUS) are related to common mental disorders. It is unknown how often common mental disorders occur in subjects who have explained physical symptoms (PHY), MUS or both, in the general population, what the incidence rates are, and whether there is a difference between PHY and MUS in this respect.
  
  
  OBJECTIVE
  To study the prevalence and incidence rates of mood, anxiety and substance use disorders in groups with PHY, MUS and combined MUS and PHY compared to a no-symptoms reference group in the general population.
  
  
  METHODS
  Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a nationally representative face-to-face survey of the general population aged 18-64 years. We selected subjects with explained physical symptoms only (n=1952), with MUS only (n=177), with both MUS and PHY (n=209), and a reference group with no physical symptoms (n=4168). The assessment of common mental disorders was through the Composite International Diagnostic Interview 3.0. Multivariate logistic regression analyses were used to examine the association between group membership and the prevalence and first-incidence rates of comorbid mental disorders, adjusted for socio-demographic characteristics.
  
  
  RESULTS
  MUS were associated with the highest prevalence rates of mood and anxiety disorders, and combined MUS and PHY with the highest prevalence rates of substance disorder. Combined MUS and PHY were associated with a higher incidence rate of mood disorder only (OR 2.9 (95%CI:1.27,6.74)).
  
  
  CONCLUSIONS
  In the general population, PHY, MUS and the combination of both are related to mood and anxiety disorder, but odds are highest for combined MUS and PHY in relation to substance use disorder. Combined MUS and PHY are related to a greater incidence of mood disorder. These findings warrant further research into possibilities to improve recognition and early intervention in subjects with combined MUS and PHY.
authors: Topclinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo department, Tilburg University, Tilburg, the Netherlands.
authors: Jonna
authors: J
authors: van Eck van der Sluijs
authors: Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors: Margreet
authors: M
authors: Ten Have
authors: Department of Residency training, GGz Breburg, Tilburg, The Netherlands.
authors: Cees
authors: C
authors: Rijnders
authors: Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Department of General Practice & Elderly Care Medicine and the EMGO+-Institute for Health and Care Research of VU University medical centre (VUmc), Amsterdam, The Netherlands.
authors: Harm
authors: H
authors: van Marwijk
authors: Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors: Ron
authors: R
authors: de Graaf
authors: Topclinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo department, Tilburg University, Tilburg, the Netherlands; Department of Residency training, GGz Breburg, Tilburg, The Netherlands.
authors: Christina
authors: C
authors: van der Feltz-Cornelis
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D001007:Anxiety / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult