Multiple medically unexplained physical symptoms and health care utilization - Outcome of psychological intervention and patient-related predictors of change

被引:40
|
作者
Kolk, AMM [1 ]
Schagen, S [1 ]
Hanewald, GJFP [1 ]
机构
[1] Univ Amsterdam, Dept Clin Psychol, NL-1018 WB Amsterdam, Netherlands
关键词
health care utilization; medically unexplained physical symptoms; psychological intervention; somatization; symptom perception;
D O I
10.1016/j.jpsychores.2004.02.012
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Objectives: To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. Methods: In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N = 98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. Results: ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. Conclusion: Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model. (C) 2004 Elsevier Inc. All rights reserved.
引用
收藏
页码:379 / 389
页数:11
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