SOMATIZATION IN PRIMARY CARE

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The long-term objectives are to understand the problem of somatization, and particularly somatization disorder, as it occurs in the Primary care setting. The specific aims are: 1) to document the prevalence and profile the characteristics of patients with somatization disorder and patients who are somatizers (6-12 unexplained complaints), and 2) to test an intervention shown in another setting to be effective in reducing the excessive health care expenditures of these patients. A multicenter, prospective, randomized, controlled, single-crossover clinical trial will be undertaken., involving a total of 216 patients distributed equally between three family practices. Subjects will be screened and selected as they appear for care. Three groups will be studied: 24 patients from each practice with somatization disorder, 24 patients who are somatizers, and 24 who are neither. All patients will be evaluated initially for DIS-DSM-III-R diagnoses, demographic and family profile, quality of life, patient satisfaction, functional health status, and health care utilization. The patients with somatization disorder and the somatizers will be randomized after initial evaluation into either a treatment or control group. The physicians of the patients in the treatment group will receive a letter describing the disorder and making management recommendations. All patients will then be followed prospectively with evaluations every six months for changes in functional health status, quality of life, satisfaction, and health care utilization. After one year of followup, the patients in the control groups will be crossed over and receive the intervention. Another year of periodic monitoring of all patients will follow the crossover.