Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices
In primary care frequent attenders with medically unexplained symptoms (MUS) pose a clinical and health resource challenge. We sought to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachme...
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| Veröffentlicht in: | Psychological medicine 2012-04, Vol.42 (4), p.855-864 |
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| creator | Taylor, R. E. Marshall, T. Mann, A. Goldberg, D. P. |
| description | In primary care frequent attenders with medically unexplained symptoms (MUS) pose a clinical and health resource challenge. We sought to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment.
We undertook a cohort follow-up study of 410 patients with MUS. Baseline questionnaires assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. A telephone interview following consultation assessed health worry, general practitioner (GP) management and satisfaction with consultation. The main outcome was annual GP consultation rate.
Of consecutive attenders, 18% had an MUS. This group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year. The prevalence of insecure attachment was 28 (95% CI 23-33) %. A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]. The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]. A possible model for the relationship between attachment style and frequent attendance is presented.
Patients with MUS who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way. |
| doi_str_mv | 10.1017/S0033291711001589 |
| format | Article |
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We undertook a cohort follow-up study of 410 patients with MUS. Baseline questionnaires assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. A telephone interview following consultation assessed health worry, general practitioner (GP) management and satisfaction with consultation. The main outcome was annual GP consultation rate.
Of consecutive attenders, 18% had an MUS. This group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year. The prevalence of insecure attachment was 28 (95% CI 23-33) %. A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]. The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]. A possible model for the relationship between attachment style and frequent attendance is presented.
Patients with MUS who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.</description><identifier>ISSN: 0033-2917</identifier><identifier>EISSN: 1469-8978</identifier><identifier>DOI: 10.1017/S0033291711001589</identifier><identifier>PMID: 21880165</identifier><identifier>CODEN: PSMDCO</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Adolescent ; Adult ; Adult and adolescent clinical studies ; Aged ; Aged, 80 and over ; Attachment ; Attachment style ; Attitude to Health ; Biological and medical sciences ; Consultation ; Emotional disorders ; Emotions ; Family Practice - statistics & numerical data ; Female ; Follow-Up Studies ; General practice ; General practitioners ; Health ; Humans ; Logistic Models ; Longitudinal Studies ; Male ; Medical sciences ; Middle Aged ; Models, Psychological ; Object Attachment ; Patient Acceptance of Health Care - psychology ; Patient Acceptance of Health Care - statistics & numerical data ; Patients ; Physician-Patient Relations ; Primary care ; Primary Health Care ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Somatoform Disorders - epidemiology ; Somatoform Disorders - psychology ; Somatoform disorders. Psychosomatics ; Stress, Psychological - epidemiology ; Stress, Psychological - psychology ; United Kingdom - epidemiology ; Young Adult</subject><ispartof>Psychological medicine, 2012-04, Vol.42 (4), p.855-864</ispartof><rights>Copyright © Cambridge University Press 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c469t-2302effe5ccc83e39e9101c2fecc3fe5212654cf6b288b654248901eb53a0cd43</citedby><cites>FETCH-LOGICAL-c469t-2302effe5ccc83e39e9101c2fecc3fe5212654cf6b288b654248901eb53a0cd43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0033291711001589/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,12844,27922,27923,30997,30998,55626</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25648299$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21880165$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Taylor, R. E.</creatorcontrib><creatorcontrib>Marshall, T.</creatorcontrib><creatorcontrib>Mann, A.</creatorcontrib><creatorcontrib>Goldberg, D. P.</creatorcontrib><title>Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices</title><title>Psychological medicine</title><addtitle>Psychol Med</addtitle><description>In primary care frequent attenders with medically unexplained symptoms (MUS) pose a clinical and health resource challenge. We sought to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment.
We undertook a cohort follow-up study of 410 patients with MUS. Baseline questionnaires assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. A telephone interview following consultation assessed health worry, general practitioner (GP) management and satisfaction with consultation. The main outcome was annual GP consultation rate.
Of consecutive attenders, 18% had an MUS. This group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year. The prevalence of insecure attachment was 28 (95% CI 23-33) %. A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]. The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]. A possible model for the relationship between attachment style and frequent attendance is presented.
Patients with MUS who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Attachment</subject><subject>Attachment style</subject><subject>Attitude to Health</subject><subject>Biological and medical sciences</subject><subject>Consultation</subject><subject>Emotional disorders</subject><subject>Emotions</subject><subject>Family Practice - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General practice</subject><subject>General practitioners</subject><subject>Health</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Models, Psychological</subject><subject>Object Attachment</subject><subject>Patient Acceptance of Health Care - psychology</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Patients</subject><subject>Physician-Patient Relations</subject><subject>Primary care</subject><subject>Primary Health Care</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Somatoform Disorders - epidemiology</subject><subject>Somatoform Disorders - psychology</subject><subject>Somatoform disorders. Psychosomatics</subject><subject>Stress, Psychological - epidemiology</subject><subject>Stress, Psychological - psychology</subject><subject>United Kingdom - epidemiology</subject><subject>Young Adult</subject><issn>0033-2917</issn><issn>1469-8978</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkluL1TAQx4Mo7nH1A_giARF8qebWNvFNFi-LCz7oPh_SdHo2S5vUJAXP5_GLOnXrBUX0JclkfvOfTGYIecjZM854-_wDY1IKw1vOGeO1NrfIjqvGVNq0-jbZre5q9Z-QezlfIyO5EnfJieBaM97UO_LlPGRwSwJqS7HuaoJQqA09HRJ8Wr4ZpUDobXBAfaBz8pNNR-psghfU0jGGgy9L74MdqYtXMRWa0T7SONAJeu_sOB7pEuDzPFofoKf5OM0lTigFGRPY4mPIqzbmoZfv6AECJFSbk3XFO8j3yZ3BjhkebPspuXz96uPZ2-ri_Zvzs5cXlcOaSyUkEzAMUDvntARpwOAvOTGAcxKvBRdNrdzQdELrDo9CacM4dLW0zPVKnpKnN7pzilh7LvvJZwfjaAPEJe-5bKUyzBj5H2jdGNkoZf6NMi5a1eKK6OPf0Ou4JPxZpETTtG0rVIMUv6FcijknGPZbU1BqVWv3f8wFxjzalJcOu_Ij4vsgIPBkA2zGlg0JG-7zT65ulBZmFZJbcjt1yfcH-OWNf03_FXCW0PY</recordid><startdate>20120401</startdate><enddate>20120401</enddate><creator>Taylor, R. 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E. ; Marshall, T. ; Mann, A. ; Goldberg, D. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c469t-2302effe5ccc83e39e9101c2fecc3fe5212654cf6b288b654248901eb53a0cd43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Attachment</topic><topic>Attachment style</topic><topic>Attitude to Health</topic><topic>Biological and medical sciences</topic><topic>Consultation</topic><topic>Emotional disorders</topic><topic>Emotions</topic><topic>Family Practice - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General practice</topic><topic>General practitioners</topic><topic>Health</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Models, Psychological</topic><topic>Object Attachment</topic><topic>Patient Acceptance of Health Care - psychology</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Patients</topic><topic>Physician-Patient Relations</topic><topic>Primary care</topic><topic>Primary Health Care</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Somatoform Disorders - epidemiology</topic><topic>Somatoform Disorders - psychology</topic><topic>Somatoform disorders. Psychosomatics</topic><topic>Stress, Psychological - epidemiology</topic><topic>Stress, Psychological - psychology</topic><topic>United Kingdom - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Taylor, R. E.</creatorcontrib><creatorcontrib>Marshall, T.</creatorcontrib><creatorcontrib>Mann, A.</creatorcontrib><creatorcontrib>Goldberg, D. 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E.</au><au>Marshall, T.</au><au>Mann, A.</au><au>Goldberg, D. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices</atitle><jtitle>Psychological medicine</jtitle><addtitle>Psychol Med</addtitle><date>2012-04-01</date><risdate>2012</risdate><volume>42</volume><issue>4</issue><spage>855</spage><epage>864</epage><pages>855-864</pages><issn>0033-2917</issn><eissn>1469-8978</eissn><coden>PSMDCO</coden><abstract>In primary care frequent attenders with medically unexplained symptoms (MUS) pose a clinical and health resource challenge. We sought to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment.
We undertook a cohort follow-up study of 410 patients with MUS. Baseline questionnaires assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. A telephone interview following consultation assessed health worry, general practitioner (GP) management and satisfaction with consultation. The main outcome was annual GP consultation rate.
Of consecutive attenders, 18% had an MUS. This group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year. The prevalence of insecure attachment was 28 (95% CI 23-33) %. A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]. The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]. A possible model for the relationship between attachment style and frequent attendance is presented.
Patients with MUS who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>21880165</pmid><doi>10.1017/S0033291711001589</doi><tpages>10</tpages></addata></record> |
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| ispartof | Psychological medicine, 2012-04, Vol.42 (4), p.855-864 |
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| subjects | Adolescent Adult Adult and adolescent clinical studies Aged Aged, 80 and over Attachment Attachment style Attitude to Health Biological and medical sciences Consultation Emotional disorders Emotions Family Practice - statistics & numerical data Female Follow-Up Studies General practice General practitioners Health Humans Logistic Models Longitudinal Studies Male Medical sciences Middle Aged Models, Psychological Object Attachment Patient Acceptance of Health Care - psychology Patient Acceptance of Health Care - statistics & numerical data Patients Physician-Patient Relations Primary care Primary Health Care Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Somatoform Disorders - epidemiology Somatoform Disorders - psychology Somatoform disorders. Psychosomatics Stress, Psychological - epidemiology Stress, Psychological - psychology United Kingdom - epidemiology Young Adult |
| title | Insecure attachment and frequent attendance in primary care: a longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices |
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