Design Patients were surveyed with self-report questionnaires assessing somatization and psychiatric disorder. Medical care utilization was obtained from automated encounter data for the year preceding the index visit. Medical morbidity was indexed with a computerized medical record audit.(from Results)When these findings are extrapolated to the national level, an estimated $256 billion a year in medical care costs are attributable to the incremental effect of somatization alone.
Conclusions Patients with somatization had approximately twice the outpatient and inpatient medical care utilization and twice the annual medical care costs of nonsomatizing patients. Adjusting the findings for the presence of psychiatric and medical comorbidity had relatively little effect on this association.Somatization was assessed with 1 categorical and 1 dimensional instrument: the somatoform disorder module of the Patient Health Questionnaire (PHQ) and the Somatic Symptom Inventory (SSI). The PHQ somatoform disorder module is a self-report instrument composed of 15 somatic symptoms, including 10 of the diagnostic symptoms of DSM-IV somatization disorder.To make a definitive diagnosis of a somatoform disorder, a medical evaluation must be performed to determine whether an adequate medical explanation exists for every symptom the patient endorses. Since we omitted this medical evaluation, we were not able to distinguish definitively between medically explained symptoms and somatoform (medically unexplained) symptoms. However, total self-reported PHQ somatic symptom counts have been shown to be highly associated with physician-rated somatoform disorder symptom counts. Therefore, the PHQ symptom count in this study can only be characterized as indicative of a provisional diagnosis of a somatoform disorder. Thus, in this article, patients referred to as somatizers are those with a high likelihood of being formally diagnosed with a somatoform disorder.I dug up the questionaires:However, like the PHQ, the SSI is a self-report measure and, hence, without an independent medical examination, the possible medical basis of each self-reported symptom cannot be definitively ruled out.
The PHQ is a depression Questionnaire: Not at all (0) - Several days (1) - More than half the days (2) - Nearly every day (3)
(1-4=minimal, 5-9=mild, 10-14=moderate, 15-19=moderately severe, 20-27=severe
Over the last 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way
SSI: (ratings 1-5 indicating severity)
1. Nausea and vomiting
2. Soreness in your abdomen
3. Pains or cramps in your abdomen
4. Feeling faint or dizzy
5. Trouble with your vision
6. Your muscles twitching or jumping
7. Feeling fatigued, weak, or tired all over
8. A fullness in your head or nose
9. Pains in your lower back
11. Trouble catching your breath
12. Hot or cold spells
13. A ringing or buzzing in your ears
14. Pains in your heart or chest
15. Difﬁculty keeping your balance while walking
16. Indigestion, upset stomach, or acid stomach
17. The feeling that you are not in as good physical health as mos
18. Numbness, tingling, or burning in parts of your body
20. A lump in your throat
21. Feeling weak in parts of your body
22. Not feeling well most of the time in the past few years
23. Heavy feelings in your arms or legs
24. Your heart pounding, turning over or missing a beat
25. Your hands and feet not feeling warm enough
26. The sense that your hearing is not as good as it used to be
Translation: If you happen to report as somewhat depressed on a questionnaire, and also happen to be ill at the same time, apparently you are a somatiser and cost the US economy an estimated $256 billion a year in medical care costs. Especially if you are an unmarried woman.
People sometimes (often) get depressed due to unrelated illnesses. And people who are more ill tend to have higher health care costs.
So where do these guys get off calling this science and stating such conclusions?