Depression and anxiety in patients repeatedly referred to secondary care with medically unexplained symptoms: a case-control study

C Burton, K McGorm, D Weller, M Sharpe

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background One third of referrals from primary to secondary care are for medically unexplained symptoms (MUS). We aimed to determine the association of depression and anxiety disorders with high use of specialist services by patients with MUS. We did this by comparing their prevalence in patients who had been repeatedly referred with symptoms for which they had received repeated specialist diagnoses of MUS with that in two control groups. We also determined the adequacy of treatment received.
Method A case-control study in five general practices in Edinburgh, UK. Data collection was by case note review and questionnaire. Cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. Controls were: (a) patients referred only once over 5 years (n=152); (b) patients with three or more referrals for symptoms always diagnosed as medically explained (n=162).
Results In total, 93 (48%) of the cases met our criteria for current depression, anxiety or panic disorders. This compared with 38 (25%) and 52 (35.2%) of the control groups; odds ratios (95% confidence intervals) of 2.6 (1.6–4.1) and 1.6 (1.01–2.4), respectively. Almost half (44%) of the cases with current depression or anxiety had not received recent minimum effective therapy.
Conclusions Depression, anxiety and panic disorders are common in patients repeatedly referred to hospital with MUS. Improving the recognition and treatment of these disorders in these patients has the potential to provide better, more appropriate and more cost-effective medical care.
Original languageEnglish
Pages (from-to)555-563
Number of pages9
JournalPsychological Medicine
Volume41
Issue number3
Early online date19 May 2010
DOIs
Publication statusPublished - Mar 2011

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Secondary Care
Case-Control Studies
Anxiety
Depression
Anxiety Disorders
Referral and Consultation
Panic Disorder
Control Groups
General Practice
Health Care Costs
Medically Unexplained Symptoms
Therapeutics
Odds Ratio
Confidence Intervals

Keywords

  • anxiety
  • depression
  • medically unexplained symptoms
  • primary care
  • referral

Cite this

Depression and anxiety in patients repeatedly referred to secondary care with medically unexplained symptoms : a case-control study. / Burton, C; McGorm, K; Weller, D; Sharpe, M.

In: Psychological Medicine, Vol. 41, No. 3, 03.2011, p. 555-563.

Research output: Contribution to journalArticle

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