title: Health care utilization in outpatients with somatoform disorders: Descriptives, interdiagnostic differences, and potential mediating factors.
abstract: Somatoform disorders are characterized by increased health care utilization producing high health costs. The aim of this study was to assess facets of and interdiagnostic differences in health care use in somatoform disorders and to examine health anxiety, symptom-related disability, depression, and phobic anxiety as potential mediating factors of the relationship between somatization and health care use.
  
  
  
  An outpatient sample of N=254 patients with somatoform disorders was investigated by analyzing different facets of their health care use over the last 12months. Multiple mediation analyses were applied.
  
  
  
  Participants reported a mean of 28.02 doctor visits over the last year. Patients fulfilling criteria of DSM-IV somatization disorder had a significantly higher number of doctor visits than patients with undifferentiated somatoform, and somatoform pain disorder, all p≤.006. In most health care use variables, patients with comorbid mental disorders did not differ from patients without comorbidities. The mediation model on the effect of all mediator variables on the relationship between somatization and health care use reached significance (b=0.32, 95% CI: 0.0576, 0.6435). Surprisingly, specific mediator effects were found for health anxiety (b=0.06, 95% CI: 0.0004, 0.1505) and disability (b=0.18, 95% CI: 0.0389, 0.3530), but not for depression and phobic anxiety.
  
  
  
  Health anxiety and symptom-related disability should be further considered when investigating potential etiological factors of increased health care use.
authors.affiliation: Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany.
authors.forename: Frauke Dorothee
authors.initials: FD
authors.lastname: Weiss
authors.affiliation: Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Rief
authors.affiliation: Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University, Marburg, Germany. Electronic address: maria.kleinstaeuber@staff.uni-marburg.de.
authors.forename: Maria
authors.initials: M
authors.lastname: Kleinstäuber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000145:classification / Q000523:psychology* / Q000628:therapy*; D055815:Young Adult
keywords: Health anxiety; Health care utilization; Somatoform disorders; Symptom-related disability