South African Medical Journal

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Depression and anxiety in multisomatoform disorder: Prevalence and clinical predictors in primary care

JE Muller, I Wentzel, DG Nel


Objective. Multisomatoform disorder (MSD) is characterised by ≥3 medically inexplicable, troublesome physical symptoms, together with a ≥2-year history of somatisation. The aim of this study was to evaluate the prevalence of depressive and anxiety disorders in a South African sample MSD, and to compare demographic and clinical outcomes in those patients with and without co-morbidity.
Methods. Fifty-one adult outpatients with MSD were recruited from primary care clinics in the Cape Town metropole. Participants were assessed for the presence of co-morbid depressive and anxiety disorders using the Mini Neuropsychiatric Interview-Plus (MINI-Plus). Outcomes included somatic symptom severity, disability, reported sick days and health care visits, pain experience, patient satisfaction with health services, and clinician-experienced
Results. A current co-morbid depressive disorder was present in 29.4% (N=15) of patients, and a current co-morbid anxiety disorder in 52.9% (N=27). MSD patients with a co-morbid
depressive disorder (current or lifetime) had significantly higher physical symptom counts, greater functional impairment, higher unemployment rates, more clinicianreported
difficulties, and more dissatisfaction with health care services than those without the disorder. A larger number of co-morbid disorders was associated with greater overall
Conclusion. High rates of co-morbid depressive and anxiety disorders were present in a South African sample of primary care patients with MSD. Not all patients had co-morbidity,
which is consistent with the view that MSD should be viewed as an independent disorder. However, co-morbid depressive disorders were associated with increased symptom severity
and functional impairment, consistent with previous reports from developing countries, emphasising the importance of comorbidity in MSD.

South African Medical Journal Vol. 98 (6) 2008 pp. 473-476

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