The question of the prevalence of Psychophysiologic Disorders (PPD) is an important one so I looked into it a little more. The original study of this issue was by Kroenke & Mangelsdorf in 1989 and found that 70% of primary care patients had no explanation for their symptoms 12 months after they first went to their primary care physician. However, this study was done on a military base and though it included non-military family may not have been representative of the general public.
The next study I found stated that “at least 33% of all somatic symptoms presented to primary care physicians have been classified as medically unexplained” and this statement referenced another study by Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res 2003: 12:34-43.
Next is a study (Landa A et al. Somatoform Pain: A Developmental Theory and Translational Research Review. Psychosomatic Medicine 74: 717-727. 2012) that says PPD reaches “up to 17% in the general population and accounting for nearly 25% of all visits to primary care clinics” (listing five references for this statement) and costs “an estimated $256 billion annually in the U.S., an amount nearly double the annual $132 billion cost of diabetes” (referencing Barsky AJ et al. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 2005; 62:903-10.)
Finally, the encouraging news quoted in the Landa study above that “establishing the diagnosis and suggesting proper management to primary health care physicians halved the use of somatic inpatient facilities” meaning hospitalization for physical symptoms (Smith GR et al.: Psychiatric consultation in somatization disorder: A randomized controlled study. NEJM 1986; 314:1407-1413).
I confess I have not focused on the literature in this field while trying to achieve greater insight into what my patients were suffering from but it is good to know there is documentation that this problem is hugely prevalent (17% of adults = 40 million in the U.S. alone, diabetics are 10% of the population by comparison) and expensive but has a solution.
Tags: PPD, Prevalence
