Original article
Impact of physical symptoms on perceived health in the community,☆☆

https://doi.org/10.1016/j.jpsychores.2007.10.003Get rights and content

Abstract

Objective

Physical symptoms, such as musculoskeletal pain, dizziness, or headache, are common. People with more symptoms are reported to use more healthcare and have higher sickness absenteeism. We studied the impact of the number of symptoms on perceived health in a community sample.

Methods

Between June 2005 and March 2006, a random sample of 4741 adults was selected from the records of five general practices in The Netherlands. They were sent a questionnaire regarding the frequency and impact of physical symptoms, and other factors that may influence health (potential confounders or modifiers), including lifestyle factors, childhood illness experiences, and psychological factors. We studied the association between increasing number of physical symptoms and perceived health using the SF-36 as the outcome measure.

Results

Response rate was 53.5% (n=2447). Fatigue was the most commonly reported symptom with a prevalence of 57%, followed by headache (40%) and back pain (39%). More than half of responders reported three symptoms or more. Responders with multiple symptoms were more often female, had lower educational level, less often paid work, higher body mass index, more negative childhood health experiences, and higher scores for anxiety and depression. Multiple symptoms were strongly associated with perceived health, especially among responders with negative illness perceptions, more anxiety, or those reporting family members with a chronic illness during childhood.

Conclusion

Physical symptoms are common and often seem to be mild. However, increasing number of symptoms is strongly associated with poorer physical, emotional, and social functioning. Different somatization processes may explain our findings.

Introduction

Physical symptoms, such as fatigue, musculoskeletal pain, dizziness, or abdominal pain, are common and are among the top 10 reasons for consultation in primary care [1], [2], [3], [4], [5], [6], [7]. In many consulters there is no identifiable pathology to explain the symptoms. It has been estimated that unexplained physical symptoms are responsible for 30% to 50% of all physician visits [8], [9]. Research among primary care consulters has shown that when the number of physical symptoms increases, the number of psychological distress symptoms and functional impairment increases [10], [11]. People with more symptoms are reported to use more healthcare and have higher sickness absenteeism [12], [13], [14].

Many studies on unexplained physical symptoms have been performed among patients with diagnosed chronic functional syndromes such as fibromyalgia, irritable bowel syndrome, or chronic fatigue syndrome [15], [16], [17]. However, these syndromes represent the far end of the spectrum of unexplained symptoms. The results from these populations may not be generalisable to the large number of people who report multiple physical symptoms but do not necessarily meet the criteria for a chronic functional syndrome. We therefore set out to study such symptoms in a community sample of adults in order to estimate their impact on perceived health, and on physical, emotional, and social functioning.

Several explanations have been offered for the occurrence and impact of unexplained physical symptoms. Although physiological processes, especially neurohormonal dysfunction, may be involved in the development of chronic fatigue and pain syndromes [18], [19], [20], there is evidence to suggest that increased attention to bodily sensations, poor illness perceptions, anxiety, and depressive disorders may play important roles in illness behavior and presence of unexplained physical symptoms [21], [22], [23], [24]. Furthermore, adverse childhood experiences and parental modelling of illness behavior have been shown to be associated with increased adult vulnerability to somatization and the development of chronic pain or other functional syndromes [25], [26], [27]. We therefore investigated in a community sample whether the association between increasing number of physical symptoms and poor perceived health was explained or modified by other indicators of health, including body mass index, sleeping problems, anxiety and depression, illness perceptions, and childhood health experiences.

Section snippets

Design

This study is part of a population-based cohort study on the course and impact of physical symptoms. For this study, a general questionnaire about health was distributed among a random sample of adults registered with five general practices in The Netherlands. Approval for the study was obtained from the Medical Ethics Committee of the VU University Medical Centre in Amsterdam.

Study population

As nearly all residents in the Netherlands are registered with a general practitioner (GP) [28], practice registers

Study population

A total of 4741 questionnaires were distributed, of which 171 were returned because people had died, or addresses were incorrect. A total of 2447 responders completed the questionnaire, resulting in an adjusted response rate of 53.5%. Of the responders, 62.5% returned the questionnaire after the first mailing, 18.6% after the reminder, and 18.9% after the last mailing. Responders more often were female (58.4% compared to 53.8% in the total sample) and older (mean age 49.9 compared to 46.8

Discussion

The results of this community survey show that many people regularly experience physical symptoms. In most responders, symptoms were mild in terms of impact on daily activities, and only a minority had consulted the GP for their symptoms. However, an increasing number of symptoms was strongly associated with decreasing levels of perceived health. The association between physical symptoms and health was particularly strong in responders with negative illness perceptions, in those who reported

Acknowledgments

We gratefully acknowledge Prof. Peter R. Croft, PhD, for his critical review of our manuscript and his useful suggestions.

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    Funding: The study was made possible by a grant from the Netherlands Organisation for Health Research and Development (ZonMw no. 4200.0007).

    ☆☆

    The work was conducted at the EMGO Institute and Department of General Practice, VU University Medical Centre in Amsterdam

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