Prevalence and detection of medically unexplained symptoms among out-patients in a Primary Health Care setting in South-west Nigeria

  • OO Ogunsemi
  • TO Afe
  • BS Osalusi
  • OO Adeleye
  • AO Ale
Keywords: Nigeria, Patient Health Questionnaire, Primary Health Care, Somatisation, Symptoms

Abstract

Background: Medically unexplained symptoms are frequently encountered by physicians at the primary care level. The complexity lies in the ill-defined nature of the multiple physical symptoms and the similarity to several organic disorders.

Objective: To determine the prevalence of medically unexplained symptoms and relate this to physicians detection rate in a primary care setting in South-west, Nigeria.

Methods: The study was a cross-sectional, descriptive study of consecutive patients of the General Out-patient Department of Olabisi Onabanjo University Teaching  Hospital, Sagamu, Ogun State. Interviews were conducted on 472 participants using a purposely designed socio-demographic questionnaire and the self-administered Patient Health Questionnaire -15 to screen for somatic symptoms.

Results: The ages of the participants ranged from 18 years to 90 years with the mean of 52.7±20.9 years. Out of the 472 participants, 225 (47.7%) met the criteria for medically unexplained symptoms using the Patient Health Questionnaire (PHQ). Across ages, medically unexplained symptoms were more often diagnosed among younger age groups especially those close to the age of 35 years (59.2%) [χ2 = 12.34, p = 0.02]. There were significant differences in the prevalence of somatisation across different levels of education [χ2= 9.78, p = 0.03]. Physicians were able to diagnose psychological disorders in 12.4% of participants (n = 28) with somatisation disorders.

Conclusion: There was a moderately high prevalence of medically unexplained symptoms in primary health care settings and physicians’ detection rate of somatisation was also low. Physicians in primary health care should have a high index of suspicion for somatisation.

References

Löwe B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. General Hospital Psychiatry 2008; 30: 191-199.

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders DSM- (American Psychiatric Press) 2013.

Cloninger CR, Dokucu M. Somatizing and Dissociative Disorders. InThe Medical Basis of Psychiatry. Springer, New York, NY. 2016: 195-209.

Gureje O, Simon GE, Ustun TB, Goldberg DP. Somatization in cross-cultural perspective: a World Health Organization study in primary care. Am J Psychiatr 1997; 154: 989-995.

Chua D, Johnson T. Frequent Attenders in Primary Care. Population 2019; 2: 1-19.

Haller H, Cramer H, Lauche R, Dobos G. Somatoform disorders and medically unexplained symptoms in primary care: a systematic review and meta-analysis of prevalence. Deutsches Ärzteblatt International 2015; 112: 279-287.

Gureje O, Obikoya B. Somatization in primary care: pattern and correlates in a clinic in Nigeria. Acta Psychiatr Scand 1992; 86:223-227.

Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002; 64: 258–266.

Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999, 282: 1737–1744.

Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res 2003; 12: 34–43.

Kroenke K, Spitzer RL, Williams JB, Lowe B. The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatr 2010; 32: 345–359.

Okulate GT, Olayinka MO, Jones OB. Somatic symptoms in depression: evaluation of their diagnostic weight in an African setting. Brit J Psychiatr 2004; 184: 422-427.

van Ravesteijn H, Wittkampf K, Lucassen P, van de Lisdonk E, van den Hoogen H, van Weert H, Huijser J, Schene A, Van Weel C, Speckens A. Detecting somatoform disorders in primary care with the PHQ-15. Ann Fam Med 2009; 7: 232-238.

Jyväsjärvi S, Joukamaa M, Väisänen E, Larivaara P, Kivelä SL, Keinänen-Kiukaanniemi S. Somatizing frequent attenders in primary health care. J Psychosom Res. 2001; 50: 185-192.

Fink P. The use of hospitalizations by persistent somatizing patients. Psychol Med 1992; 22: 173–180.

Ohaeri JU, Adeyemi JD. The pattern of somatization symptoms at the Ibadan Teaching Hospital Psychiatric Clinic. West Afr J Med 1990; 9: 26-34.

Sartorius N, Ustun TB, Lecrubier Y, Wittchen HU. Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. Br J Psychiatr 1996; Suppl: 38–43.

Afana AH, Dalgard OS, Bjertness E, Grunfeld B. The ability of general practitioners to detect mental disorders among primary care patients in a stressful environment: Gaza Strip. J Public Health 2002; 24: 326-331.

Abiodun OA. A study of mental morbidity among primary care patients in Nigeria., Comprehensive Psychiatr 1993; 34:10-13.

Rosendal M, Hartman TC, Aamland A, Van der Horst H, Lucassen P, Budtz-Lilly A, Burton C. “Medically unexplained” symptoms and symptom disorders in primary care: prognosis-based recognition and classification. BMC Fam Pract 2017; 18:18.

Published
2020-05-17
Section
Original Research