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Article |

Symptoms in the Community Prevalence, Classification, and Psychiatric Comorbidity

Kurt Kroenke, MD; Rumi K. Price, PhD
Arch Intern Med. 1993;153(21):2474-2480. doi:10.1001/archinte.1993.00410210102011.
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Background:  While physical symptoms are the leading reason for outpatient visits, a substantial proportion of physical complaints and "minor" illnesses remain poorly understood. The purpose of our study was to determine the prevalence, patient-attributed cause, and psychiatric comorbidity of symptoms in a general population.

Methods:  We analyzed data on 13 538 individuals interviewed in the Epidemiologic Catchment Area Program, a multicommunity mental health survey that used the Diagnostic Interview Schedule to determine the prevalence of psychiatric disorders. The Diagnostic Interview Schedule inquires about 38 physical symptoms and includes a probing scheme to classify symptom severity and potential cause. We focused on 26 symptoms most germane to primary care.

Results:  Of the 26 symptoms, 24 had been problems for more than 10% of persons at some point in their life, with the most common nonmenstrual symptoms being joint pains (36.7%), back pain (31.5%), headaches (24.9%), chest pain (24.6%), arm or leg pain (24.3%), abdominal pain (23.6%), fatigue (23.6%), and dizziness (23.2%). Most symptoms (84%) were at some point considered major in that they interfered with routine activities or had led individuals to take medications or visit a physician. Nearly one third of symptoms were either psychiatric or unexplained, and most symptoms were associated with at least a twofold increased lifetime risk of a common psychiatric disorder.

Conclusion:  Symptoms in the community are prevalent as well as bothersome. Often lacking an apparent physical explanation, such symptoms are associated with an increased likelihood of psychiatric disorders.(Arch Intern Med. 1993;153:2474-2480)


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