Somatic symptoms and associations with common psychological diagnoses: a retrospective cohort study from Norwegian urban general practice

Background: Patients with mental health problems often present with somatic symptoms when visiting their general practitioner (GP). Somatic presentations may challenge correct diagnosing of mental health disorders in general practice, where most of these disorders are treated. Objective: Explore the associations between common psychological diagnoses and somatic symptom diagnoses in Norwegian urban general practice. Methods: A retrospective cohort study including electronic medical data from 15 750 patients aged 16-65 years from 35 GPs in six GP offices in Oslo, Norway, during 12 months in 2014-2015. We explored prevalences and associations between anxiety-, depression-, and stress-related diagnoses, and somatic symptom diagnoses. Results: Patients with anxiety-, depression- and stress-related diagnoses had a mean number of 2.9 +/- 3.6 somatic symptom diagnoses during the 12 months, compared to 1.9 +/- 2.5 for patients without any psychological diagnoses (P < 0.001). The mean number of somatic symptoms was significantly higher for the different psychological diagnoses viewed separately, for both sexes and different age groups.There was an increase in probability for anxiety, depression, or stress-related diagnoses with an increasing number of somatic symptom diagnoses during the 12 months. We found a significant increase in somatic symptom diagnoses from ICPC-2 chapters: General and unspecified, digestive, cardiovascular, musculoskeletal, neurological, urological, female genital disorders and social problems. Associated symptom patterns were different for each of the included psychological diagnoses. Conclusions: This study shows that patients with anxiety, depression- and stress-related diagnoses present with increased and characteristic somatic symptoms compared to patients without these diagnoses in general practice. Lay summary Patients in general practice often present with diffuse and unexplained symptoms that are not always easily separated into mental or physical categories. In this study, we found that patients with anxiety-, depression- and stress-related diagnoses have more bodily symptoms than patients without these diagnoses. We observed different bodily symptom patterns for the various psychological diagnoses included in this study. Also, we found a higher risk of having a psychological diagnosis with increasing bodily symptoms.