This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Prevalence, Classification, and Psychiatric Comorbidity

Kurt Kroenke, MD; Rumi K. Price, PhD

Arch Intern Med. 1993;153(21):2474-2480.

Abstract
Background
While physical symptoms are the leading reason for outpatient visits, a substantial proportion of physical complaints and "minor" illnesses remain poorly understood. The purpose of our study was to determine the prevalence, patient-attributed cause, and psychiatric comorbidity of symptoms in a general population.

Methods
We analyzed data on 13 538 individuals interviewed in the Epidemiologic Catchment Area Program, a multicommunity mental health survey that used the Diagnostic Interview Schedule to determine the prevalence of psychiatric disorders. The Diagnostic Interview Schedule inquires about 38 physical symptoms and includes a probing scheme to classify symptom severity and potential cause. We focused on 26 symptoms most germane to primary care.

Results
Of the 26 symptoms, 24 had been problems for more than 10% of persons at some point in their life, with the most common nonmenstrual symptoms being joint pains (36.7%), back pain (31.5%), headaches (24.9%), chest pain (24.6%), arm or leg pain (24.3%), abdominal pain (23.6%), fatigue (23.6%), and dizziness (23.2%). Most symptoms (84%) were at some point considered major in that they interfered with routine activities or had led individuals to take medications or visit a physician. Nearly one third of symptoms were either psychiatric or unexplained, and most symptoms were associated with at least a twofold increased lifetime risk of a common psychiatric disorder.

Conclusion
Symptoms in the community are prevalent as well as bothersome. Often lacking an apparent physical explanation, such symptoms are associated with an increased likelihood of psychiatric disorders.

(Arch Intern Med. 1993;153:2474-2480)

Author Affiliations
From the Departments of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md, and Walter Reed Army Medical Center, Washington, DC (Dr Kroenke), and the Department of Psychiatry, Washington University School of Medicine, St Louis, Mo (Dr Price).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Intelligence is negatively associated with the number of functional somatic symptoms
Kingma et al.
J. Epidemiol. Community Health 2009;63:900-905.
ABSTRACT | FULL TEXT  

A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping
Dinos et al.
Int J Epidemiol 2009;0:dyp147v1-dyp147.
ABSTRACT | FULL TEXT  

A CBT-based approach to medically unexplained symptoms
Kent and McMillan
Adv. Psychiatr. Treat. 2009;15:146-151.
ABSTRACT | FULL TEXT  

Risk Factors for Unexplained Symptoms After a Disaster: A Five-Year Longitudinal Study in General Practice
van den Berg et al.
Psychosomatics 2009;50:69-77.
ABSTRACT | FULL TEXT  

Burden of Dizziness and Vertigo in the Community
Neuhauser et al.
Arch Intern Med 2008;168:2118-2124.
ABSTRACT | FULL TEXT  

Association of Depression and Anxiety Alone and in Combination With Chronic Musculoskeletal Pain in Primary Care Patients
Bair et al.
Psychosom. Med. 2008;70:890-897.
ABSTRACT | FULL TEXT  

The Conundrum of Medically Unexplained Symptoms: Questions to Consider
McFarlane et al.
Psychosomatics 2008;49:369-377.
ABSTRACT | FULL TEXT  

Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial
Sumathipala et al.
Br. J. Psychiatry 2008;193:51-59.
ABSTRACT | FULL TEXT  

The Association or Otherwise of the Functional Somatic Syndromes
Kanaan et al.
Psychosom. Med. 2007;69:855-859.
ABSTRACT | FULL TEXT  

Stability of Somatoform Symptoms Implications for Classification
Rief and Rojas
Psychosom. Med. 2007;69:864-869.
ABSTRACT | FULL TEXT  

Women in novel occupational roles: mental health trends in the UK Armed Forces
Rona et al.
Int J Epidemiol 2007;36:319-326.
ABSTRACT | FULL TEXT  

Major Depression Symptoms in Primary Care and Psychiatric Care Settings: A Cross-Sectional Analysis
Gaynes et al.
Ann Fam Med 2007;5:126-134.
ABSTRACT | FULL TEXT  

Somatic Complaints in Primary Care: Further Examining the Validity of the Patient Health Questionnaire (PHQ-15)
Interian et al.
Psychosomatics 2006;47:392-398.
ABSTRACT | FULL TEXT  

Somatic Symptoms in Outpatients With Major Depressive Disorder Treated With Fluoxetine
Denninger et al.
Psychosomatics 2006;47:348-352.
ABSTRACT | FULL TEXT  

The burden of psychological symptoms in UK Armed Forces
Jones et al.
Occup Med (Lond) 2006;56:322-328.
ABSTRACT | FULL TEXT  

Why Do Primary Care Physicians Propose Medical Care to Patients With Medically Unexplained Symptoms? A New Method of Sequence Analysis to Test Theories of Patient Pressure
Salmon et al.
Psychosom. Med. 2006;68:570-577.
ABSTRACT | FULL TEXT  

Multi-symptom illnesses, unexplained illness and Gulf War Syndrome
Ismail and Lewis
Phil Trans R Soc B 2006;361:543-551.
ABSTRACT | FULL TEXT  

Managing future Gulf War Syndromes: international lessons and new models of care
Engel et al.
Phil Trans R Soc B 2006;361:707-720.
ABSTRACT | FULL TEXT  

Physicians' responses to patients' medically unexplained symptoms.
Epstein et al.
Psychosom. Med. 2006;68:269-276.
ABSTRACT | FULL TEXT  

Medication-Attributed Adverse Effects in Placebo Groups: Implications for Assessment of Adverse Effects
Rief et al.
Arch Intern Med 2006;166:155-160.
ABSTRACT | FULL TEXT  

A genome-wide linkage scan of familial benign recurrent vertigo: linkage to 22q12 with evidence of heterogeneity
Lee et al.
Hum Mol Genet 2006;15:251-258.
ABSTRACT | FULL TEXT  

Epidemiology of vestibular vertigo: A neurotologic survey of the general population
Neuhauser et al.
Neurology 2005;65:898-904.
ABSTRACT | FULL TEXT  

Assessing the potential health impact of the 1991 Gulf War on Saudi Arabian National Guard Soldiers
Gackstetter et al.
Int J Epidemiol 2005;34:801-808.
ABSTRACT | FULL TEXT  

Medically Unexplained Physical Symptoms in the Aftermath of Disasters
van den Berg et al.
Epidemiol Rev 2005;27:92-106.
FULL TEXT  

Effects of Duloxetine on Painful Physical Symptoms Associated With Depression
Goldstein et al.
Psychosomatics 2004;45:17-28.
ABSTRACT | FULL TEXT  

The Value of Pseudoneurological Symptoms for Assessing Psychopathology in Primary Care
Interian et al.
Psychosom. Med. 2004;66:141-146.
ABSTRACT | FULL TEXT  

Somatic Symptoms in Primary Care: Etiology and Outcome
Khan et al.
Psychosomatics 2003;44:471-478.
ABSTRACT | FULL TEXT  

Depression and Pain Comorbidity: A Literature Review
Bair et al.
Arch Intern Med 2003;163:2433-2445.
ABSTRACT | FULL TEXT  

Predictors of Psychiatric Comorbidity in Medical Outpatients
Lowe et al.
Psychosom. Med. 2003;65:764-770.
ABSTRACT | FULL TEXT  

What Do Doctors Find Meaningful about Their Work?
Horowitz et al.
ANN INTERN MED 2003;138:772-775.
FULL TEXT  

Managing patients with inexplicable health problems
Fischhoff and Wessely
BMJ 2003;326:595-597.
FULL TEXT  

Prevalence of Symptoms and Symptom-based Conditions among Gulf War Veterans: Current Status of Research Findings
Barrett et al.
Epidemiol Rev 2002;24:218-227.
FULL TEXT  

Psychological Disorders and Distress in Older Primary Care Patients: A Comparison of Older and Younger Samples
Klapow et al.
Psychosom. Med. 2002;64:635-643.
ABSTRACT | FULL TEXT  

Response to Symptoms among a U.S. National Probability Sample of Adults Infected with Human Immunodeficiency Virus
Kilbourne et al.
Med Care Res Rev 2002;59:36-58.
ABSTRACT  

The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke et al.
Psychosom. Med. 2002;64:258-266.
ABSTRACT | FULL TEXT  

Somatization: A Critical Review of Conceptual and Methodological Issues
De Gucht and Fischler
Psychosomatics 2002;43:1-9.
ABSTRACT | FULL TEXT  

Somatization Symptoms and Hypochondriacal Features in the General Population
Rief et al.
Psychosom. Med. 2001;63:595-602.
ABSTRACT | FULL TEXT  

Result-Based Compensation in Health Care: A Good, But Limited, Idea
Morreim
J Law Med Ethics 2001;29:174-181.
 

Somatic and Psychological Complaints and Their Correlates With Insomnia in the Japanese General Population
Kim et al.
Psychosom. Med. 2001;63:441-446.
ABSTRACT | FULL TEXT  

Studying Symptoms: Sampling and Measurement Issues
Kroenke
ANN INTERN MED 2001;134:844-853.
ABSTRACT | FULL TEXT  

Symptom Management in Older Primary Care Patients: Feasibility of an Experimental, Written Self-Disclosure Protocol
Klapow et al.
ANN INTERN MED 2001;134:905-911.
ABSTRACT | FULL TEXT  

Medical Symptoms without Identified Pathology: Relationship to Psychiatric Disorders, Childhood and Adult Trauma, and Personality Traits
Katon et al.
ANN INTERN MED 2001;134:917-925.
ABSTRACT | FULL TEXT  

Result-Based Compensation in Health Care: A Good, But Limited, Idea
Morreim
J Law Med Ethics 2001;29:174-181.
 

The interrelations of migraine, vertigo, and migrainous vertigo
Neuhauser et al.
Neurology 2001;56:436-441.
ABSTRACT | FULL TEXT  

Prevalence and Patterns of Gulf War Illness in Kansas Veterans: Association of Symptoms with Characteristics of Person, Place, and Time of Military Service
Steele
Am J Epidemiol 2000;152:992-1002.
ABSTRACT | FULL TEXT  

Traumatic Life Events in Primary Care Patients: A Study in an Ethnically Diverse Sample
Holman et al.
Arch Fam Med 2000;9:802-810.
ABSTRACT | FULL TEXT  

Psychosomatics and Psychodynamics: An Introductory Review
Ikkos
Group Analysis 2000;33:235-250.
ABSTRACT  

Somatoform Symptoms in a Japanese Community Population: Prevalence and Association with Personality Characteristics
Ono et al.
Transcultural Psychiatry 2000;37:219-228.
ABSTRACT  

Relationship of Psychiatric Status to Gulf War Veterans' Health Problems
Wolfe et al.
Psychosom. Med. 1999;61:532-540.
ABSTRACT | FULL TEXT  

Effects of Physician Awareness of Symptom-Related Expectations and Mental Disorders: A Controlled Trial
Jackson et al.
Arch Fam Med 1999;8:135-142.
ABSTRACT | FULL TEXT  

Somatization Reconsidered: Incorporating the Patient's Experience of Illness
Epstein et al.
Arch Intern Med 1999;159:215-222.
ABSTRACT | FULL TEXT  

The Value of Screening for Psychiatric Disorders in Rheumatology Referrals
O'Malley et al.
Arch Intern Med 1998;158:2357-2362.
ABSTRACT | FULL TEXT  

Clinical Predictors of Mental Disorders Among Medical Outpatients: Validation of the "S4" Model
Jackson et al.
Psychosomatics 1998;39:431-436.
ABSTRACT | FULL TEXT  

Rheumatic Findings in Gulf War Veterans
Grady et al.
Arch Intern Med 1998;158:367-371.
ABSTRACT | FULL TEXT  

Concerns and Expectations in Patients Presenting With Physical Complaints: Frequency, Physician Perceptions and Actions, and 2-Week Outcome
Marple et al.
Arch Intern Med 1997;157:1482-1488.
ABSTRACT  

Multisomatoform Disorder: An Alternative to Undifferentiated Somatoform Disorder for the Somatizing Patient in Primary Care
Kroenke et al.
Arch Gen Psychiatry 1997;54:352-358.
ABSTRACT  

Disease and Suspicion after the Persian Gulf War
Campion
NEJM 1996;335:1525-1527.
FULL TEXT  

Side Effects Associated With Influenza Vaccination in Healthy Working Adults: A Randomized, Placebo-Controlled Trial
Nichol et al.
Arch Intern Med 1996;156:1546-1550.
ABSTRACT