2006 Volume 7 Issue 1 Pages 9-14
BACKGROUND: Prior research indicates that patients with medically unexplained symptoms and doctorshopping behavior are more likely to have psychological distress. In patients with somatic symptoms, we hypothesized that high scores on COOP/WONCA Functional Assessment Charts, in addition to the presence of medically unexplained symptoms and doctor-shopping behavior, might have an important role in diagnosing psychological distress.
METHODS: Between November 2002 and March 2003, the patients who presented themselves to the hospital for the first time with somatic symptoms were enrolled in this study. In this study, we defined psychological distress as disease conditions, including Mood disorders, Anxiety disorders, Adjustment disorders, and Somatoform disorders, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) . Symptoms that, in the doctor's judgment, could not be medically explained were regarded as medically unexplained symptoms. Doctor shopping was defined as those patients with a complaint of sustained and unsolved symptoms for more than one month who had visited two or more medical facilities prior to visiting our hospital and arrived without any physician's referral.
RESULTS: One hundred and six patients out of 496 were diagnosed as having psychological distress. Among these 106 patients, 49 (46.2%) had doctorshopping behavior, 86 (81.1%) had medically unexplained symptoms, and 95 (89.6%) showed high scores on COOP/WONCA charts. Odds ratios and 95% confidence intervals of medically unexplained symptoms and doctor shopping were 24.12 (11.91-48.84) and 4.18 (2.16-8.07), respectively. High scores on COOP/WONCA charts 2, 3 and 6 were significantly associated with the presence of psychological distress, and the odds ratios (95% confidence intervals) of these three items were 1.41 (1.01-1.98), 1.41 (1.02-1.94), and 2.88 (1.68-4.95), respectively.
Positive and negative likelihood ratios for 4 items (i.e., age of not less than 45 years; duration of symptoms of not less than 6 months, ; doctorshopping behavior; and, medically unexplained symptoms) were 1.16 and 0.85; 1.43 and 0.55; 3.16 and 0.63; and, 3.96 and 0.24, respectively. Positive and negative likelihood ratios for high scores on COOP/WONCA charts were 1.42 and 0.28. Under ROC curves for the diagnosis of psychological distress, the information of COOP/WONCA charts, in addition to that of clinical data, medically unexplained symptoms, and doctor shopping behavior, increased the accuracy in diagnosing psychological distress.
CONCLUSIONS: In patients with somatic symptoms, COOP/WONCA charts increased diagnostic accuracy in predicting psychological distress when patients showed sustained symptoms for more than 6 month, doctor shopping, and medically unexplained symptoms.
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