Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-27T21:07:36.522Z Has data issue: false hasContentIssue false
  • English
  • Français

The contribution of epidemiology to psychosomatic medicine

Published online by Cambridge University Press:  11 October 2011

Antonio Lobo  and
Ricardo Campos
Antonio Lobo*
Affiliation:
Departamento de Medicina y Psiquiatría, Facultad de Medicina de la Universidad de Zaragoza and Servicio de Psicosomática, Hospital Clínico Universitario, Zaragoza, Spain
Ricardo Campos
Affiliation:
Departamento de Medicina y Psiquiatría, Facultad de Medicina de la Universidad de Zaragoza and Servicio de Psicosomática, Hospital Clínico Universitario, Zaragoza, Spain
*
Indirizzo per la corrispondenza: Professor A. Lobo, Servicio de Psicosomática, Hospital Clinico Universitario, planta 11, Zaragoza 50009 (Spain).
Get access Rights & Permissions [Opens in a new window]

Summary

Objective — To discuss the contribution of epidemiology and epidemiological methods to psychosomatic medicine. Method — Critical review of the literature, including both philosophical concepts and empirical data. Results — The adjective «psychosomatic» has been used in two different ways: in the so called «psychosomatic» or holistic approach to medicine; and in a narrower approach, referring to particular disorders in which psychological factors were considered to have a fundamental aetiological role. While the ideal of the holistic, «humanistic» or «anthropological» approach should probably be never abandoned, the practical limitations of encompassing models, including Engel's bio-psycho-social model are also obvious: they may be heuristically sterile. On the other side, in relation to the narrow psychosomatic approach, psychogenetic views in the so called «psychosomatic illnesses» have been strongly criticized on empirical grounds. The potential of epidemiological methods to study these illnesses, but also «somatopsychic» disorders is shown in a number of papers in the empirical literature. We have grouped such contributions, including our own experience, in the five categories suggested by M. Shepherd for epidemiological methods in general: 1) the completion of the spectrum of disease; 2) the establishment of outcome; 3) the actuarial assessment of morbid risk; 4) the evaluation of the efficacy of treatment; and 5) the conceptual construction of diagnosis and classification. Conclusions — The contribution of epidemiological data to areas of interest in psychosomatic medicine has been relevant in recent years. The potential of epidemiological methods in this area is very important both to increase knowledge and to improve the quality of clinical practice.

Riassunto

Scopo — Discutere il contribute dell'epidemiologia e dei metodi epidemiologici alla medicina psicosomatica. Metodo — Revisione critica della letteratura, comprendente sia concetti filosofici che dati empirici. Risultati — Il termine «psicosomatico» è stato usato in due differenti accezioni: nel cosiddetto approccio «psicosomatico» o olistico alia medicina e in un approccio più ristretto riferito a particolari disturbi nei quali si pensa che i fattori psicologici abbiano un fondamentale ruolo etiologico. Mentre l'ideale di un approccio olistico, «umanistico» o antropologico non dovrebbe mai essere abbandonato, in limiti pratici dei modelli che utilizziamo, incluso il modello bio-psicosociale di Engel, sono evidenti: essi possono essere sterili dal punto di vista euristico. D'altra parte, in relazione all'approccio psicosomatico più ristretto, i punti di vista psicogenetici nei cosiddetti «disturbi psicosomatici» sono stati fortemente criticati su basi empiriche. La potenzialità dei metodi epidemiologici per lo studio di queste malattie, ma anche per quello dei disturbi «somatopsichici», è illustrata in numerosi articoli pubblicati nella letteratura. Abbiamo raggruppato tali contributi, compresi i nostri, nelle 5 categorie suggerite da M. Shepherd per i metodi epidemiologici in generale: 1) la completezza dello spettro del disturbo; 2) l'accertamento dell'esito; 3) la realistica valutazione del rischio di morbidità; 4) la valutazione dell'efficacia del trattamento e 5) la definizione concettuale della diagnosi e della classificazione. Conclusioni — Il contribute dei dati epidemiologici ai temi di interesse della medicina psicosomatica sono stati rilevanti negli anni recenti. La potenzialità dei metodi epidemiologici in questo settore è molto importante, sia per sviluppare la conoscenza, sia per migliorare la qualità della pratica clinica.

Keywords

epidemiologypsychosomatic approachepidemiologiaapproccio psicosomatico.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 6 , Issue 1 , April 1997 , pp. 40 - 47
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aromaa, A., Raita-Salo, R., Reunanen, A., Impivaara, O., Heliovaara, M., Knekt, P., Lehtinen, V., Joukamaa, M. & Maatela, J. (1994). Depression and cardiovascular disease. Acta Psychiatrica Scandinavica, Supplementum 377, 77–82.CrossRefGoogle Scholar
Bass, C. (1994). Somatization disorders: the need for effective intervention studies. General Hospital Psychiatry 16, 379–380.CrossRefGoogle ScholarPubMed
Berkman, L.F., Leo-Summers, L. & Horwitz, R.I. (1992). Emotional support and survival following myocardial infarction: a prospective population-based study of the elderly. Annal of Internal Medicine 117, 1003–1009.CrossRefGoogle Scholar
Broadhead, W.E., Blazer, D.G., George, L.K. & Tse, C.K. (1990). Depression, disability days and days lost from work in a prospective epidemiologic survey. Journal of American Medical Association 264, 2524–2528.CrossRefGoogle Scholar
Brown, C, Schulberg, H.C., Madonia, M.J., Shear, M.K. & Houck, P.R. (1996). Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. American Journal of Psychiatry 153, 1293–1300.Google ScholarPubMed
Campos, R. (1993). Estudio de la morbilidad psíquica en el nivel de Atencion Primaria de la ciudad de Zaragoza. Doctoral Thesis, University of Zaragoza.Google Scholar
Carney, R.M., Rich, M.W., Freedland, K.E., Saini, J., Tevelde, A., Simeone, C. & Clark, K. (1988). Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosomatic Medicine 50, 627–633.CrossRefGoogle ScholarPubMed
Carney, R.M., Freedland, K.E., Eisen, S.A., Rich, M.W. & Jaffe, A.S. (1995). Major depression and medication adherence in coronary artery disease. Health Psychology 14, 88–90.CrossRefGoogle ScholarPubMed
Creed, F. (1989). Appendectomy. In Life Events and Illness (ed. Brown, GW and Harris, T.O.), pp. 213–231. Guilford Press: New York.Google Scholar
Creed, F., Mayou, R. & Hopkins, A. (1992). Medical Symptoms not Explained by Organic Diseases. Royal College of Physicians and Psychiatrists: London.Google Scholar
Eastwood, R. (1989). The relationship between physical and psychological morbidity. In The Scope of Epidemiological Psychiatry (ed. Williams, P., Wilkinson, G. and Rawnsley, K.), pp. 210–221. Routledge: London.Google Scholar
Eisenberg, L. (1992). Treating depression and anxiety in primary care. Closing the gap between knowledge and practice. New England Journal of Medicine 326, 1080–1083.Google ScholarPubMed
Engel, G.L. (1977). The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.CrossRefGoogle Scholar
Escobar, J.I., Golding, J.M., Hough, R.L., Karno, M., Burnam, M.A. & Wells, K.B. (1987). Somatization in the community: relationship to disability and use of services. American Journal of Public Health 77, 837–840.CrossRefGoogle ScholarPubMed
Fava, G.A. (1992). Depression in medical settings. In Handbook of Affective Disorders (ed. Paykel, ES), pp. 667–685. Second Edition, Churchill Livingstone: Edinburgh.Google Scholar
Fink, P. (1992). The use of hospitalisations by persistent somatising patients. Psychological Medicine 22, 173–180.CrossRefGoogle Scholar
Goldberg, D. (1992). The treatment of mental disorders in general medicine settings. General Hospital Psychiatry 14, 83–85.CrossRefGoogle ScholarPubMed
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders: a Bio-social Model. Tavistock: London (Trad. it. Disturbi Psichici Comuni. Un Modello Bio-sociale. II Pensiero Scientifico Editore, Roma, 1995).Google Scholar
Goldberg, D.P., Gask, L. & O'Dowd, T. (1989). The treatment of somatisation: teaching techniques of reattribution. Journal of Psychosomatic Research 33, 689–695.CrossRefGoogle ScholarPubMed
Gonzàlez-Torrecillas, J.L., Mendlewicz, J. & Lobo, A. (1995). Repercussion of early treatment of post-stroke depression on neuropsychological rehabilitation. International Journal Psychogeriatrics 7, 547–560.CrossRefGoogle Scholar
Guthrie, E., Creed, F., Dawson, D. & Tomenson, B. (1991). A controlled trial of pschological treatment for the irritable bowel syndrome. Gastroenterology 100, 450–457.CrossRefGoogle Scholar
Hardman, A., Maguire, P. & Crowther, D. (1989). The recognition of psychiatric morbidity on a medical oncology ward. Journal of Psychosomatic Research 33, 235–239.CrossRefGoogle ScholarPubMed
Hinkle, L.E. & Wolff, H.G. (1957). The nature of man's adaptation to his total environment and the relation of this to illness. Archives of International Medicine 99, 442–460.CrossRefGoogle ScholarPubMed
Huyse, F.J.Herzog, T., Malt, U.F. & Lobo, A. (1993). The effectiveness of mental health service delivery in the general hospital. In Health Services Research (ed. Fracchia, G.N. and Theofilatou, M.), pp. 227–242. IOS Press: Amsterdam.Google Scholar
Huyse, F., Herzog, T., Lobo, A., Slaets, J.P.J., Malt, U.F., Creed, F., Rigatelli, M. & Cardoso, G. (1995). A screening instrument for the detection of psychosocial risk factors in patients admitted to general hospital wards (BMH1-CT93-1180). In European Union: Biomedical and Health Research. The Biomed I Program, pp. 496–497. IOS Press: Amsterdam.Google Scholar
Katon, W. (1996). The impact of major depression on chronic medical illness. General Hospital Psychiatry 18, 215–219.CrossRefGoogle ScholarPubMed
Katon, W. & Gonzales, J. (1994). A review of randomized trials of psychiatric consultation-liaison studies in primary care. Psychosomatics 35, 268–278.CrossRefGoogle ScholarPubMed
Katon, W., Lin, E. & Von Korff, M. (1991). Somatization: a spectrum of severity. American Journal of Psychiatry 148, 34–40.Google ScholarPubMed
Katon, W., Von Korff, M., Lin, E., Bush, T., Russo, J., Lipscomb, P. & Wagner, E. (1992). A randomized trial of psychiatric consultation with distressed high utilizers. General Hospital Psychiatry 14, 86–98.CrossRefGoogle ScholarPubMed
Kissely, S.R. & Goldberg, D.P. (1996). Physical and psychiatric comorbidity in general practice. British Journal of Psychiatry 169, 236–242.CrossRefGoogle Scholar
Klimes, I., Mayou, R.A., Pearce, M.J., Coles, L. & Fagg, J.R. (1990). Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychological Medicine 20, 605–611.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R.L., Williams, J.B., Linzer, M., Hahn, S.R., Degruy, F.V. III & Brody, D. (1994). Physical symptoms in primary care. Predictors of psychiatric disorders and functional impairment. Archives of Family Medicine 3, 774–779.CrossRefGoogle ScholarPubMed
Larrubia, J., Garcia-Campayo, J.J., Campos, R., Marcos, G. & Lobo, A. (1996). A Follow-up of Somatizers and Psychologizers: Study in Primary Care in Spain. Paper read at the American Psychiatric Asssociation Annual Meeting, New York, USA.Google Scholar
Lesperance, F. & Frasure-Smith, N. (1996). Negative emotions and coronary heart disease: getting to the heart of the matter. Lancet 347, 414–415.CrossRefGoogle Scholar
Lipowski, Z.J. (1967). Review of consultation psychiatry and psychosomatic medicine. II. Clinical aspects. Psychosomatic Medicine 29, 201–224.CrossRefGoogle ScholarPubMed
Lipsey, J.R., Robinson, R.G., Pearlson, G.D., Rao, K. & Price, T.R. (1984). Nortriptyline treatment of post stroke depression: A double-blind study. Lancet i, 272–282.CrossRefGoogle Scholar
Lloyd, G. & Cawley, R.H. (1983). Distress or illness? A study of psychological symptoms after myocardial infarction. British Journal of Psychiatry 142, 120–125.CrossRefGoogle ScholarPubMed
Lobo, A. (1986). Philosophical humanism and empirical science: Spanish perspectives on psychosomatics. In Advances, Institute for the Advancement of Health (ed. Temoshock, L. and Fox, B.H.), Special International Issue, Supplement No. 3, vol. 4, pp. 58–76.Google Scholar
Lobo, A. (1989). On multiaxial psychiatric diagnosis for general medical patients. British Journal of Psychiatry 154, Suppl. 4, 38–41.CrossRefGoogle Scholar
Lobo, A. (1990). Mental health in general medical clinics. In The Public Health Impact of Mental Illness (ed. Goldberg, D. and Tantam, D.), pp. 45–53. Hofrege and Huber: Toronto.Google Scholar
Lobo, A. (1995). La contributión del Profesor Michael Shepherd a la psiquiatria de enlace y medicina psicosomática. Cuadernos de Medicina Psicosomática y Psiquiatria de Enlace 36, 61–73.Google Scholar
Lobo, A. (1996). Elucidating mental disorders in Liaison Psychiatry: The Johns Hopkins «perspectives». Editorial. Journal of Psychosomatic Research 41, 7–11.CrossRefGoogle Scholar
Lobo, A. & Campos, R. (in press) Managing the psychiatry/general practice interface. In Depression and Physical Illness (ed. Katona, C. and Robertson, M.). John Wiley & Sons: Chichester.Google Scholar
Lobo, A., Folstein, M.F. & Abeloff, M.D. (1979). Incidencia, prevalencia y detectión de morbilidad psiquiátrica en un hospital oncológico. In Folia Neuropsiquiatriaca 1–4, 270–284.Google Scholar
Lobo, A., Huyse, F., Herzog, T., Malt, U. & the E.C.L.W. (1992). Profiles of Psychiatric and Physical Comorbidity. Paper read at the ECLW Health Service Study Conference, Amsterdam.Google Scholar
Lobo, A., Campos, R., Perez-Echeverria, M.J., Izuzquiza, J., Garcia-Campayo, J.J., Saz, P. & Marcos, G. (1993). A new interview for the multiaxial assessment of psychiatric morbidity in medical settings. Psychological Medicine 23, 505–510.CrossRefGoogle ScholarPubMed
Lobo, A., Garcia-Campayo, J.J., Campos, R., Marcos, G., Pérez-Echeverría, M.J. & the G.M.P.Z.Z. (1996). Somatization in primary care in Spain. I: Estimates of prevalence and clinical characteristics. British Journal of Psychiatry 168, 334–348.CrossRefGoogle Scholar
Malt, U.M., Huyse, F.J., Herzog, T., Lobo, A., Rijssenbeek, A.P.M.M. & the E.C.L.W. (1996). The European Consultation-Liaison Workgroup (E.C.L.W.) Collaborative Study. III. Training of reliability and assessing of ICD-10 psychiatric diagnosis in the general hospital setting. Journal of Psychosomatic Research 41, 451–463.CrossRefGoogle Scholar
Mayou, R. & Hawton, K. (1986). Psychiatric disorder in the general hospital. British Journal of Psychiatry 149, 172–190.CrossRefGoogle ScholarPubMed
Mc Hugh, P.R. (1992). A structure for psychiatry at the century's turn: the view from Johns Hopkins. Journal of the Royal Society of Medicine 85, 483–487.CrossRefGoogle ScholarPubMed
Mc Hugh, P.R. & Slavney, P.R. (1983). The Perspectives of Psychiatry. Johns Hopkins University Press: Baltimore.Google Scholar
Morris, P.L., Robinson, R.G., Andrzejewski, P., Samuels, J. & Price, T.R. (1993). Association of depression with 10 year poststroke mortality. American Journal of Psychiatry 150, 124–129.Google ScholarPubMed
Ormel, J. & Costa e Silva, J.A. (1995). The impact of psychopathology on disability and health perceptions. In Mental illness in General Health Practice: an International Study (ed. Ustun, B.T. and Sartorius, N.), pp. 335–346. John Wiley & Sons: Chichester.Google Scholar
Ormel, J. & Tiemens, B. (1995). Recognition and treatment of mental illness in primary care. Towards a better understanding of a multifaceted problem. General Hospital Psychiatry 17, 160–164.CrossRefGoogle ScholarPubMed
Ormel, J., Van den Brink, W., Koete, M.W.J., Giel, R., Van der Meer, K., Van den Willige, G. & Wilmink, F.W. (1990). Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychological Medicine 20, 909–923.CrossRefGoogle ScholarPubMed
Ormel, J., Koeter, M.W.J., Van den Brink, W. & Van den Willige, G. (1991). Recognition, management and course of anxiety and depression in general practice. Archives of General Psychiatry 48, 700–706.CrossRefGoogle ScholarPubMed
Ormel, J., Von Korff, M., Van der Brink, W., Katon, W., Brihnan, E. & Oldehinkel, T. (1993). Depression, anxiety and social disability show synchrony of change in Primary Care. American Journal of Public Health 83, 385–389.CrossRefGoogle ScholarPubMed
Patience, D.A., McGuire, R.J., Scott, A.I.F. & Freeman, C.P.L. (1995). The Edinburgh Primary Care Depression Study: personality disorder and outcome. British Journal of Psychiatry 167, 324–330.CrossRefGoogle ScholarPubMed
Paykel, E.S., Hollyman, J.A., Freeling, P. & Sedgwick, P. (1988). Predictors of therapeutic benefit from amytriptiline in mild depression: a general practice placebo controlled trial. Journal of Affective Disorders 14, 83–95.CrossRefGoogle Scholar
Pérez-Echeverría, M.J., Campos, R., García-Campayo, J.J., Marcos, G., Montón, C, Lobo, A. & G.Z.E.M.P.P.(A.P.) (1993). Evaluatión multiaxial de pacientes en atencion primaria: el estudio epidemiológico Zaragoza. In Abstracts Book of the XXIX Congreso Nacional de la Sociedad Española de Medicina Psicosomática y II Symposium International sobre dementias (ed. Sociedad Española de Medicina Psicosomática), pp. 54. Zaragoza.Google Scholar
Rifkin, A. (1992). Depression in physically ill patients. Postgraduated Medicine 92, 147–154.CrossRefGoogle ScholarPubMed
Rost, K., Kashner, T.M. & Smith, R.G. (1994). Effectiveness of psychiatric interventions with somatization disorders patients: improved outcomes at reduced costs. General Hospital Psychiatry 16, 381–387.CrossRefGoogle ScholarPubMed
Rundell, J.R. & Wise, T.N.(1996). Consultation-liaison psychiatry research. In Textbook of Consultation-Liaison Psychiatry (Rundell, J.R. and Wise, M.G.), pp. 207–226. American Psychiatric Press: Washington DC.Google Scholar
Sartorius, N. (1989). Forewood 2. In The Scope of Epidemiological Psychiatry (ed. Williams, P., Wilkinson, G. and Rawnsley, K.), p. 5. Routledge: London.Google Scholar
Saz, P., Launer, L.J., Dia, J.L., De la Cámara, C, Marcos, G. & Lobo, A. (in press). High mortality in depressed urban elderly. In The Zaragoza Study: Dementia and Depression in the Elderly Community (ed. Lobo, A., Saz, P., Marcos, G. and the GZEMPP(PG)). Masson: Barcelona.Google Scholar
Shapiro, S., German, P.S., Skinner, E.A., Von Korff, M., Turner, R.W., Klein, L.E., Teitelbaum, M.L., Kramer, M., Burke, J.D. & Burns, B.J. (1987). An experiment to change detection aand management of mental morbidity in primary care. Medical Care 25, 327–339.CrossRefGoogle Scholar
Shepherd, M. (1959). Evaluation of drugs in the treatment of depression. Canadian Psychiatric Association Journal, Suppl. S120.CrossRefGoogle Scholar
Shepherd, M. (1978a). Epidemiological perspective. Psychosomatic medicine. International Journal of Epidemiology 7, 201–205.CrossRefGoogle ScholarPubMed
Shepherd, M. (1978b). Epidemiology and clinical psychiatry. British Journal of Psychiatry 133, 289–298.CrossRefGoogle ScholarPubMed
Shepherd, M. (1985). Psychiatric epidemiology and epidemiological psychiatry. American Journal of Public Health 75, 275–276.CrossRefGoogle ScholarPubMed
Shepherd, M., Cooper, B., Brown, A.C. & Kalton, G.W. (1966). Psychiatric Illness in General Practice. Oxford University Press: London.Google Scholar
Shepherd, M., Brooke, E.M., Cooper, J.E. & Lin, T. (1968). An Experimental Approach to Psychiatric Diagnosis. Acta Psychiatrica Scandinavica, Supplementum 201. Munksgaard: Copenhagen.Google Scholar
Simon, G. & Von Korff, M. (1991). Somatization and psychiatric disorders in the NIMH Epidemiologic Catchment Area Study. American Journal of Psychiatry 148, 1494–1500.Google ScholarPubMed
Simon, G.E., Von Korff, M. & Barlow, W. (1995). Health care costs of primary care patients with recognized depression. Archives of General Psychiatry 52, 850–856.CrossRefGoogle ScholarPubMed
Stoudemire, A. & Fogel, B.S. (1995). Psychopharmacology in medical patients: an update. In Medical-Psychiatric Practice (ed. Stoudemire, A. and Fogel, B.S.). Vol.3, pp. 79–149. American Psychiatric Press: Washington.Google Scholar
Strain, J.J. (1981). Diagnostic considerations in the medical setting. Psychiatric Clinics of North America 4, 287–300CrossRefGoogle ScholarPubMed
Tansella, M. (1993). The Research Unit of the Servizio di Psicologia Medica at the Institute of Psychiatry of the University of Verona, 1980-1991. Psychological Medicine 23, 239–247.CrossRefGoogle Scholar
Tansella, M. & Williams, P. (1989). The spectrum of psychiatric morbidity in a defined geographical area. Psychological Medicine 19, 765–770.CrossRefGoogle Scholar
Ustün, B.T. & Sartorius, N. (1995). Mental Illness in General Health Practice: An International Study. John Wiley & Sons: Chichester.Google Scholar
Vázquez-Barquero, J.L., Diez-Manrique, J.F., Mufioz, J., Menendez, J., Gaite, L., Herrera, S. & Der, G.J. (1992). Sex differences in mental illness: a community study of the influence of physical health and sociodemographic factors. Social Psychiatry and Psychiatric Epidemiology 27, 62–68.CrossRefGoogle ScholarPubMed
Von Korff, M., Ormel, J., Katon, W. & Lin, E.H.B. (1992). Disability and depression among high utilizers of health care a longitudinal analysis. Archives of General Psychiatry 49, 91–100.CrossRefGoogle ScholarPubMed
World Health Organization (1964). Psychosomatic Disorders. Technical Report series No 275.Google Scholar
Zimmermann-Tansella, Ch. & Siciliani, O. (1990). Social problems, social support and emotional distress in the comunity. In The Public Health Impact of Mental Disorder (ed. Goldberg, D. and Tantam, D.), pp. 136–144. Hofrege and Huber: Toronto.Google Scholar