title: Shared mental healthcare and somatization: changes in patient symptoms and disability.
abstract: OBJECTIVE
  To describe the symptoms and functional changes in patients with high levels of somatization who were referred to an outpatient, multidisciplinary, shared mental healthcare (SMHC) service that primarily offered cognitive behavioural therapy. Second, we wished to compare the levels of somatization in this outpatient clinical sample with previously published community norms.
  
  
  BACKGROUND
  Somatization is common in primary care, and it can lead to significant impairment, disproportionate resource use, and poses a challenge for management.
  
  
  METHODS
  All the patients (18+ years, n=508) who attended three or more treatment sessions in SMHC primary care over a seven-year period were eligible for inclusion to this pre-post study. Self-report measures included the Patient Health Questionnaire's somatic symptom severity scale (PHQ-15) and the World Health Organization Disability Assessment Schedule (WHODAS II). Normative comparisons were used to assess the degree of symptoms and functional changes.
  
  
  RESULTS
  Clinically significant levels of somatization before treatment were common (n=138, 27.2%) and were associated with a significant reduction in somatic symptom severity (41.3% reduction; P<0.001) and disability (44% reduction; P<0.001) after treatment. Patients' levels of somatic symptom severity and disability approached but did not quite reach the community sample norms following treatment. Multidisciplinary short-term SMHC was associated with significant improvement in patient symptoms and disability, and shows promise as an effective treatment for patients with high levels of somatization. Including a control group would allow more confidence regarding the conclusions about the effectiveness of SMHC for patients impaired by somatization.
authors: 1Medical Director,Mental Health Services,St. Joseph's Health Centre,Thunder Bay,Ontario,Canada.
authors: John M
authors: JM
authors: Haggarty
authors: 5Professor,Department of Psychology,University of British Columbia Okanagan,Kelowna,British Columbia,Canada.
authors: Brian P
authors: BP
authors: O'Connor
authors: 6Family Physician,NorWest Community Health Centre,Thunder Bay,Ontario,Canada.
authors: Jeremy B
authors: JB
authors: Mozzon
authors: 9Researcher,Mental Health Outpatients Services,St. Joseph's Health Centre,Thunder Bay,Ontario,Canada.
authors: S Kathleen
authors: SK
authors: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: PHQ; collaborative care; primary care; somatization