Somatoform Disorders and Medically Unexplained Symptoms in Primary Care
Somatoform Disorders and Medically Unexplained Symptoms in Primary Care
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DOI：
10.3238/arztebl.2015.0279
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发表时间：
2015-04-17
影响因子：
7.7
通讯作者：
Dobos, Gustav
中科院分区：
文献类型：
--
作者：
Haller, Heidemarie;Cramer, Holger;Dobos, Gustav
背景：这些文献包含关于初级保健中躯体形式障碍和医学上无法解释的症状的患病率的可变数据。方法：通过系统检索PubMed/MEDLINE、mental Info、Scope us和Cochrane数据库，检索截至2014年7月的相关文献。对检索到的试验进行方法学质量和异质性(I-2)分析。在随机效应模型的帮助下，估计了医学上无法解释的症状、躯体形式障碍及其亚类的患病率，以及相应的95%可信区间(CI)。结果：从总共992篇确定的出版物中，选择了来自24个国家的32项研究，涉及总计70085名患者(年龄范围为15-95岁)，用于进一步分析。所有这些都是在1990年至2012年期间进行的。初步研究总体上更具异质性；严格诊断躯体化障碍的点患病率从0.8%(95%可信区间0.3-1.4%，I-2=86%)到5.9%(95%可信区间2.4-9.4%，I-2=96%)，在应用较少限制性诊断标准的研究中，估计患病率更高。通过DSM-IV和/或ICD-10标准，至少有一种类型的躯体形式障碍可以在一小部分初级保健患者中被诊断，范围从26.2%(95%可信区间19.1-33.3%，I-2=98%)到34.8%(95%可信区间26.6-44.6%；I-2=92%)。患者抱怨至少一种医学上无法解释的症状的比例从40.2%(95%可信区间0.9-79.4%；I-2=98%)到49%(95%可信区间18-79.8%，I-2=98%)。总体而言，这些研究的质量仅为中等。未发现研究质量与患病率估计之间的关系。结论：纳入研究的统计异质性很高。躯体形式障碍和医学上无法解释的症状比通常认为的更常见。已发现的发病率突出了这些疾病在初级保健中的重要性。
Background: The literature contains variable figures on the prevalence of somatoform disorders and medically unexplained symptoms in primary care.Methods: The pertinent literature up to July 2014 was retrieved by a systematic search in the PubMed/MEDLINE, PsychInfo, Scopus, and Cochrane databases. The methodological quality and heterogeneity (I-2) of the retrieved trials were analyzed. The prevalence rates of medically unexplained symptoms, somatoform disorders, and their subcategories were estimated, along with corresponding 95% confidence intervals (CI), with the aid of random-effects modeling.Results: From a total of 992 identified publications, 32 studies from 24 countries involving a total of 70 085 patients (age range, 15-95 years) were selected for further analysis. All had been carried out between 1990 and 2012. The primary studies were more heterogeneous overall; point prevalences for the strict diagnosis of a somatization disorder ranged from 0.8% (95% CI 0.3-1.4%, I-2 = 86%) to 5.9% (95% CI 2.4-9.4%, I-2 = 96%), with higher estimated prevalences in studies that applied less restrictive diagnostic criteria. At least one type of somatoform disorder was diagnosable by DSM-IV and/or ICD-10 criteria in a fraction of primary-care patients that ranged from 26.2% (95% CI 19.1-33.3%, I-2 = 98%) to 34.8% (95% CI 26.6-44.6%; I-2 = 92%). The percentage of patients complaining of at least one medically unexplained symptom ranged from 40.2% (95% CI 0.9-79.4%; I-2 = 98%) to 49% (95% CI 18-79.8%, I-2 = 98%). The quality of the studies, in general, was only moderate. No relationship was found between study quality and prevalence estimates.Conclusion: The statistical heterogeneity of the included studies is very high. Somatoform disorders and medically unexplained symptoms are more common than generally assumed. The found prevalences highlight the importance of these conditions in primary care.