Are illness perceptions related to future healthcare expenditure in patients with somatoform disorders?

BACKGROUND: Somatoform disorders are costly for society in terms of increased healthcare expenditure. Patients' illness perceptions have been found to play a role in somatoform disorders. However, it is unclear whether illness perceptions predict higher health costs in these patients. METHOD: A total of 1785 primary care patients presenting a new health complaint completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics after the consultation. In a stratified subsample, physician interviewers established diagnoses of DSM-IV somatization and undifferentiated somatoform disorders (n = 144) using the Schedules for Clinical Assessment in Neuropsychiatry. Healthcare expenditure was obtained from Danish health registers for a 2-year follow-up period. RESULTS: Patients had more negative perceptions of their well-defined physical health problems when they had a co-morbid somatoform disorder. A strong illness identity [ß = 0.120, 95% confidence interval (CI) 0.029-0.212, p = 0.012], perceived negative consequences (ß = 0.010, 95% CI 0.001-0.019, p = 0.024), a long timeline perspective (ß = 0.013, 95% CI 0.005-0.021, p = 0.001), low personal control (ß = - 0.009, 95% CI -0.015 to -0.002, p = 0.011) and negative emotional representations (ß = 0.009, 95% CI 0.002-0.017, p = 0.020) predicted healthcare expenditure in somatoform disorders. CONCLUSIONS: The results suggest that illness perceptions play a role in the perpetuation of symptoms in somatoform disorders and predict higher future healthcare expenditure among a subgroup of these patients.

Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials.

UNLABELLED: Fjorback LO, Arendt M, Ørnbøl E, Fink P, Walach H. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy - a systematic review of randomized controlled trials. OBJECTIVE: To systematically review the evidence for MBSR and MBCT. METHOD: Systematic searches of Medline, PsycInfo and Embase were performed in October 2010. MBSR, MBCT and Mindfulness Meditation were key words. Only randomized controlled trials (RCT) using the standard MBSR/MBCT programme with a minimum of 33 participants were included. RESULTS: The search produced 72 articles, of which 21 were included. MBSR improved mental health in 11 studies compared to wait list control or treatment as usual (TAU) and was as efficacious as active control group in three studies. MBCT reduced the risk of depressive relapse in two studies compared to TAU and was equally efficacious to TAU or an active control group in two studies. Overall, studies showed medium effect sizes. Among other limitations are lack of active control group and long-term follow-up in several studies. CONCLUSION: Evidence supports that MBSR improves mental health and MBCT prevents depressive relapse. Future RCTs should apply optimal design including active treatment for comparison, properly trained instructors and at least one-year follow-up. Future research should primarily tackle the question of whether mindfulness itself is a decisive ingredient by controlling against other active control conditions or true treatments.