title: Self-reported symptoms and healthcare seeking in the general population--exploring "The Symptom Iceberg".
abstract: BACKGROUND
  Research has illustrated that the decision-making process regarding healthcare seeking for symptoms is complex and associated with a variety of factors, including gender differences. Enhanced understanding of the frequency of symptoms and the healthcare seeking behaviour in the general population may increase our knowledge of this complex field. The primary objective of this study was to estimate the prevalence of self-reported symptoms and the proportion of individuals reporting GP contact, in a large Danish nationwide cohort. A secondary objective was to explore gender differences in GP contacts in response to experiencing one of the 44 predefined symptoms.
  
  
  METHODS
  A Danish nationwide cohort study including a random sample of 100,000 individuals, representative of the adult Danish population aged 20 years or above. A web-based questionnaire survey formed the basis of this study. A total of 44 different symptoms covering a wide area of alarm symptoms and non-specific frequently occurring symptoms were selected based on extensive literature search. Further, items regarding contact to the GP were included. Data on socioeconomic factors were obtained from Statistics Denmark.
  
  
  RESULTS
  A total of 49,706 subjects completed the questionnaire. Prevalence estimates of symptoms varied from 49.4% (24,537) reporting tiredness to 0.11% (54) reporting blood in vomit. The mean number of reported symptoms was 5.4 (men 4.8; women 6.0). The proportion of contact to the GP with at least one symptom was 37%. The largest proportion of GP contacts was seen for individuals reporting blood in the urine (73.2%), whereas only 11.4% of individuals with increase in waist circumference reported GP contact. For almost 2/3 of the symptoms reported, no gender differences were found concerning the proportion leading to GP contacts.
  
  
  CONCLUSIONS
  Prevalence of symptoms and GP contacts are common in this overview of 44 different self-reported symptoms. For almost 2/3 of the reported symptoms no gender differences were found concerning the proportion leading to GP contacts. An enhanced understanding of healthcare seeking decisions may assist healthcare professionals in identifying patients who are at risk of postponing contact to the GP and may help development of health campaigns targeting these individuals.
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark. selnegaard@health.sdu.dk.
authors.forename: Sandra
authors.initials: S
authors.lastname: Elnegaard
authors.affiliation: The Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care - CaP, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. rsa@feap.dk.
authors.forename: Rikke Sand
authors.initials: RS
authors.lastname: Andersen
authors.affiliation: The Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care - CaP, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. afp@feap.dk.
authors.forename: Anette Fischer
authors.initials: AF
authors.lastname: Pedersen
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark. pia.veldt.larsen@rsyd.dk.
authors.forename: Pia Veldt
authors.initials: PV
authors.lastname: Larsen
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark. jsoendergaard@health.sdu.dk.
authors.forename: Jens
authors.initials: J
authors.lastname: Søndergaard
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark. sphatting@health.sdu.dk.
authors.forename: Sanne
authors.initials: S
authors.lastname: Rasmussen
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark. kiruba@health.sdu.dk.
authors.forename: Kirubakaran
authors.initials: K
authors.lastname: Balasubramaniam
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark. rsvendsen@health.sdu.dk.
authors.forename: Rikke Pilsgaard
authors.initials: RP
authors.lastname: Svendsen
authors.affiliation: The Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care - CaP, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. p.vedsted@feap.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark. djarbol@health.sdu.dk.
authors.forename: Dorte Ejg
authors.initials: DE
authors.lastname: Jarbøl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires