Risk factors of symptom underestimation by physicians
Abstract Objective The aims of this study were to characterize patient–physician agreement on various psychological and somatic symptoms in internal medicine inpatients and to identify predictors of symptom severity underestimation by physicians. Methods Consecutive adult inpatients of two internal...
Gespeichert in:
| Veröffentlicht in: | Journal of psychosomatic research 2008-05, Vol.64 (5), p.543-551 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 551 |
|---|---|
| container_issue | 5 |
| container_start_page | 543 |
| container_title | Journal of psychosomatic research |
| container_volume | 64 |
| creator | Zastrow, Arne Faude, Verena Seyboth, Franziska Niehoff, Dorothea Herzog, Wolfgang Löwe, Bernd |
| description | Abstract Objective The aims of this study were to characterize patient–physician agreement on various psychological and somatic symptoms in internal medicine inpatients and to identify predictors of symptom severity underestimation by physicians. Methods Consecutive adult inpatients of two internal medicine wards of a university hospital completed visual analogue scales (VASs) for severity of disability, anxiety, depression, somatic symptoms, and pain at the time of admission ( n =639, participation rate=70%) and 5 days thereafter ( n =401, participation rate=82%). In addition, the Patient Health Questionnaire 9 (PHQ-9) depression scale and the Clinical Global Impression Scale—Revised were used. At the same time, the six treating physicians independently rated the complaints of their patients using the same VAS. Rates of overestimation, concordance, and underestimation of symptom severity were analyzed. Logistic regression analyses were used to identify predictors of symptom underestimation by physicians. Results Concordance between patients and physicians regarding disability, anxiety, depression, somatic symptom severity, and pain reached 50–60%. Symptom severity of patients suffering from major depressive episode was significantly more often underestimated than that of nondepressed patients (all P |
| doi_str_mv | 10.1016/j.jpsychores.2007.11.010 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69142315</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022399907004539</els_id><sourcerecordid>69142315</sourcerecordid><originalsourceid>FETCH-LOGICAL-c554t-18bdcebb4e5953435824d78087a4bdc5433b17f25955dc625782b0431615a9cb3</originalsourceid><addsrcrecordid>eNqNkkuL1TAUgIMozp3RvyDd6K71nDz62Ag6qCMMCD7WIU1TJp22qTntQP-9udyLA250lcX5zuvLYSxDKBCwfDsUw0K7vQvRUcEBqgKxAIQn7IB11eQoSnjKDgCc56Jpmgt2STQAQNlw9ZxdYC0lSKgPTH3zdJ_1xq4hUhb6jPZpWcOUbXPnUvXVT2b1Yc7aPVvudvLWm5lesGe9Gcm9PL9X7Oenjz-ub_Lbr5-_XL-_za1Scs2xbjvr2lY61Sghhaq57Koa6srIFFFSiBarnqeo6mzJVVXzFqTAEpVpbCuu2JtT3SWGX1uaRk-erBtHM7uwkS4blFyg-ieoKi4qKGUC6xNoYyCKrtdLTCvGXSPoo1s96Ee3-uhWI-rkNqW-OvfY2sl1j4lnmQl4fQYMWTP20czW0x-Og1CY_Cfuw4lzSd2Dd1GT9W62rvPR2VV3wf_PNO_-KmJHP_vU997tjoawxTl9jUZNXIP-fryF4ylABSCVaMRvbgiwqQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>57237064</pqid></control><display><type>article</type><title>Risk factors of symptom underestimation by physicians</title><source>MEDLINE</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>Access via ScienceDirect (Elsevier)</source><creator>Zastrow, Arne ; Faude, Verena ; Seyboth, Franziska ; Niehoff, Dorothea ; Herzog, Wolfgang ; Löwe, Bernd</creator><creatorcontrib>Zastrow, Arne ; Faude, Verena ; Seyboth, Franziska ; Niehoff, Dorothea ; Herzog, Wolfgang ; Löwe, Bernd</creatorcontrib><description>Abstract Objective The aims of this study were to characterize patient–physician agreement on various psychological and somatic symptoms in internal medicine inpatients and to identify predictors of symptom severity underestimation by physicians. Methods Consecutive adult inpatients of two internal medicine wards of a university hospital completed visual analogue scales (VASs) for severity of disability, anxiety, depression, somatic symptoms, and pain at the time of admission ( n =639, participation rate=70%) and 5 days thereafter ( n =401, participation rate=82%). In addition, the Patient Health Questionnaire 9 (PHQ-9) depression scale and the Clinical Global Impression Scale—Revised were used. At the same time, the six treating physicians independently rated the complaints of their patients using the same VAS. Rates of overestimation, concordance, and underestimation of symptom severity were analyzed. Logistic regression analyses were used to identify predictors of symptom underestimation by physicians. Results Concordance between patients and physicians regarding disability, anxiety, depression, somatic symptom severity, and pain reached 50–60%. Symptom severity of patients suffering from major depressive episode was significantly more often underestimated than that of nondepressed patients (all P <.01). Of all the variables, greater depression on the PHQ depression score was the most important risk factor for symptom underestimation by physicians (OR ranging from 1.29 to 1.57; all P <.05, except underestimation of disability). Symptom underestimation of pain severity was also associated with panic disorder symptoms (odds ratio, 2.44; P =.01). Conclusion Depressed patients seem to be at greater risk of symptom underestimation by their physicians—a finding bearing implications for avoidance of underdiagnosis and insufficient treatment. Mutual understanding could be improved by better doctor–patient communication skills. Brief self-report depression screeners might help to reliably identify patients at risk for symptom underestimation by physicians.</description><identifier>ISSN: 0022-3999</identifier><identifier>EISSN: 1879-1360</identifier><identifier>DOI: 10.1016/j.jpsychores.2007.11.010</identifier><identifier>PMID: 18440408</identifier><identifier>CODEN: JPCRAT</identifier><language>eng</language><publisher>Amsterdam: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Anxiety-Depression ; Attitude of Health Personnel ; Biological and medical sciences ; Concordance ; Consensus ; Depression ; Depression - psychology ; Dissent and disputes ; Doctor-Patient communication ; Female ; Humans ; Inpatients ; Male ; Medical sciences ; Middle Aged ; Physicians ; Physician–patient relations ; Psychiatry ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Risk Assessment ; Risk factors ; Severity ; Somatic symptoms ; Somatoform Disorders - psychology ; Surveys and Questionnaires ; Therapeutical relation and framework ; Treatments</subject><ispartof>Journal of psychosomatic research, 2008-05, Vol.64 (5), p.543-551</ispartof><rights>Elsevier Inc.</rights><rights>2008 Elsevier Inc.</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c554t-18bdcebb4e5953435824d78087a4bdc5433b17f25955dc625782b0431615a9cb3</citedby><cites>FETCH-LOGICAL-c554t-18bdcebb4e5953435824d78087a4bdc5433b17f25955dc625782b0431615a9cb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpsychores.2007.11.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,31009,46004</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20351925$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18440408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zastrow, Arne</creatorcontrib><creatorcontrib>Faude, Verena</creatorcontrib><creatorcontrib>Seyboth, Franziska</creatorcontrib><creatorcontrib>Niehoff, Dorothea</creatorcontrib><creatorcontrib>Herzog, Wolfgang</creatorcontrib><creatorcontrib>Löwe, Bernd</creatorcontrib><title>Risk factors of symptom underestimation by physicians</title><title>Journal of psychosomatic research</title><addtitle>J Psychosom Res</addtitle><description>Abstract Objective The aims of this study were to characterize patient–physician agreement on various psychological and somatic symptoms in internal medicine inpatients and to identify predictors of symptom severity underestimation by physicians. Methods Consecutive adult inpatients of two internal medicine wards of a university hospital completed visual analogue scales (VASs) for severity of disability, anxiety, depression, somatic symptoms, and pain at the time of admission ( n =639, participation rate=70%) and 5 days thereafter ( n =401, participation rate=82%). In addition, the Patient Health Questionnaire 9 (PHQ-9) depression scale and the Clinical Global Impression Scale—Revised were used. At the same time, the six treating physicians independently rated the complaints of their patients using the same VAS. Rates of overestimation, concordance, and underestimation of symptom severity were analyzed. Logistic regression analyses were used to identify predictors of symptom underestimation by physicians. Results Concordance between patients and physicians regarding disability, anxiety, depression, somatic symptom severity, and pain reached 50–60%. Symptom severity of patients suffering from major depressive episode was significantly more often underestimated than that of nondepressed patients (all P <.01). Of all the variables, greater depression on the PHQ depression score was the most important risk factor for symptom underestimation by physicians (OR ranging from 1.29 to 1.57; all P <.05, except underestimation of disability). Symptom underestimation of pain severity was also associated with panic disorder symptoms (odds ratio, 2.44; P =.01). Conclusion Depressed patients seem to be at greater risk of symptom underestimation by their physicians—a finding bearing implications for avoidance of underdiagnosis and insufficient treatment. Mutual understanding could be improved by better doctor–patient communication skills. Brief self-report depression screeners might help to reliably identify patients at risk for symptom underestimation by physicians.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anxiety-Depression</subject><subject>Attitude of Health Personnel</subject><subject>Biological and medical sciences</subject><subject>Concordance</subject><subject>Consensus</subject><subject>Depression</subject><subject>Depression - psychology</subject><subject>Dissent and disputes</subject><subject>Doctor-Patient communication</subject><subject>Female</subject><subject>Humans</subject><subject>Inpatients</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Physicians</subject><subject>Physician–patient relations</subject><subject>Psychiatry</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Risk Assessment</subject><subject>Risk factors</subject><subject>Severity</subject><subject>Somatic symptoms</subject><subject>Somatoform Disorders - psychology</subject><subject>Surveys and Questionnaires</subject><subject>Therapeutical relation and framework</subject><subject>Treatments</subject><issn>0022-3999</issn><issn>1879-1360</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkkuL1TAUgIMozp3RvyDd6K71nDz62Ag6qCMMCD7WIU1TJp22qTntQP-9udyLA250lcX5zuvLYSxDKBCwfDsUw0K7vQvRUcEBqgKxAIQn7IB11eQoSnjKDgCc56Jpmgt2STQAQNlw9ZxdYC0lSKgPTH3zdJ_1xq4hUhb6jPZpWcOUbXPnUvXVT2b1Yc7aPVvudvLWm5lesGe9Gcm9PL9X7Oenjz-ub_Lbr5-_XL-_za1Scs2xbjvr2lY61Sghhaq57Koa6srIFFFSiBarnqeo6mzJVVXzFqTAEpVpbCuu2JtT3SWGX1uaRk-erBtHM7uwkS4blFyg-ieoKi4qKGUC6xNoYyCKrtdLTCvGXSPoo1s96Ee3-uhWI-rkNqW-OvfY2sl1j4lnmQl4fQYMWTP20czW0x-Og1CY_Cfuw4lzSd2Dd1GT9W62rvPR2VV3wf_PNO_-KmJHP_vU997tjoawxTl9jUZNXIP-fryF4ylABSCVaMRvbgiwqQ</recordid><startdate>20080501</startdate><enddate>20080501</enddate><creator>Zastrow, Arne</creator><creator>Faude, Verena</creator><creator>Seyboth, Franziska</creator><creator>Niehoff, Dorothea</creator><creator>Herzog, Wolfgang</creator><creator>Löwe, Bernd</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>20080501</creationdate><title>Risk factors of symptom underestimation by physicians</title><author>Zastrow, Arne ; Faude, Verena ; Seyboth, Franziska ; Niehoff, Dorothea ; Herzog, Wolfgang ; Löwe, Bernd</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c554t-18bdcebb4e5953435824d78087a4bdc5433b17f25955dc625782b0431615a9cb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anxiety-Depression</topic><topic>Attitude of Health Personnel</topic><topic>Biological and medical sciences</topic><topic>Concordance</topic><topic>Consensus</topic><topic>Depression</topic><topic>Depression - psychology</topic><topic>Dissent and disputes</topic><topic>Doctor-Patient communication</topic><topic>Female</topic><topic>Humans</topic><topic>Inpatients</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Physicians</topic><topic>Physician–patient relations</topic><topic>Psychiatry</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Risk Assessment</topic><topic>Risk factors</topic><topic>Severity</topic><topic>Somatic symptoms</topic><topic>Somatoform Disorders - psychology</topic><topic>Surveys and Questionnaires</topic><topic>Therapeutical relation and framework</topic><topic>Treatments</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zastrow, Arne</creatorcontrib><creatorcontrib>Faude, Verena</creatorcontrib><creatorcontrib>Seyboth, Franziska</creatorcontrib><creatorcontrib>Niehoff, Dorothea</creatorcontrib><creatorcontrib>Herzog, Wolfgang</creatorcontrib><creatorcontrib>Löwe, Bernd</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of psychosomatic research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zastrow, Arne</au><au>Faude, Verena</au><au>Seyboth, Franziska</au><au>Niehoff, Dorothea</au><au>Herzog, Wolfgang</au><au>Löwe, Bernd</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors of symptom underestimation by physicians</atitle><jtitle>Journal of psychosomatic research</jtitle><addtitle>J Psychosom Res</addtitle><date>2008-05-01</date><risdate>2008</risdate><volume>64</volume><issue>5</issue><spage>543</spage><epage>551</epage><pages>543-551</pages><issn>0022-3999</issn><eissn>1879-1360</eissn><coden>JPCRAT</coden><abstract>Abstract Objective The aims of this study were to characterize patient–physician agreement on various psychological and somatic symptoms in internal medicine inpatients and to identify predictors of symptom severity underestimation by physicians. Methods Consecutive adult inpatients of two internal medicine wards of a university hospital completed visual analogue scales (VASs) for severity of disability, anxiety, depression, somatic symptoms, and pain at the time of admission ( n =639, participation rate=70%) and 5 days thereafter ( n =401, participation rate=82%). In addition, the Patient Health Questionnaire 9 (PHQ-9) depression scale and the Clinical Global Impression Scale—Revised were used. At the same time, the six treating physicians independently rated the complaints of their patients using the same VAS. Rates of overestimation, concordance, and underestimation of symptom severity were analyzed. Logistic regression analyses were used to identify predictors of symptom underestimation by physicians. Results Concordance between patients and physicians regarding disability, anxiety, depression, somatic symptom severity, and pain reached 50–60%. Symptom severity of patients suffering from major depressive episode was significantly more often underestimated than that of nondepressed patients (all P <.01). Of all the variables, greater depression on the PHQ depression score was the most important risk factor for symptom underestimation by physicians (OR ranging from 1.29 to 1.57; all P <.05, except underestimation of disability). Symptom underestimation of pain severity was also associated with panic disorder symptoms (odds ratio, 2.44; P =.01). Conclusion Depressed patients seem to be at greater risk of symptom underestimation by their physicians—a finding bearing implications for avoidance of underdiagnosis and insufficient treatment. Mutual understanding could be improved by better doctor–patient communication skills. Brief self-report depression screeners might help to reliably identify patients at risk for symptom underestimation by physicians.</abstract><cop>Amsterdam</cop><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>18440408</pmid><doi>10.1016/j.jpsychores.2007.11.010</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-3999 |
| ispartof | Journal of psychosomatic research, 2008-05, Vol.64 (5), p.543-551 |
| issn | 0022-3999 1879-1360 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_69142315 |
| source | MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA); Access via ScienceDirect (Elsevier) |
| subjects | Adolescent Adult Anxiety-Depression Attitude of Health Personnel Biological and medical sciences Concordance Consensus Depression Depression - psychology Dissent and disputes Doctor-Patient communication Female Humans Inpatients Male Medical sciences Middle Aged Physicians Physician–patient relations Psychiatry Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Risk Assessment Risk factors Severity Somatic symptoms Somatoform Disorders - psychology Surveys and Questionnaires Therapeutical relation and framework Treatments |
| title | Risk factors of symptom underestimation by physicians |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-03T11%3A59%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20factors%20of%20symptom%20underestimation%20by%20physicians&rft.jtitle=Journal%20of%20psychosomatic%20research&rft.au=Zastrow,%20Arne&rft.date=2008-05-01&rft.volume=64&rft.issue=5&rft.spage=543&rft.epage=551&rft.pages=543-551&rft.issn=0022-3999&rft.eissn=1879-1360&rft.coden=JPCRAT&rft_id=info:doi/10.1016/j.jpsychores.2007.11.010&rft_dat=%3Cproquest_cross%3E69142315%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=57237064&rft_id=info:pmid/18440408&rft_els_id=S0022399907004539&rfr_iscdi=true |