Chronic widespread pain in the community: The influence of psychological symptoms and mental disorder on healthcare seeking behavior

Objective. To determine whether psychological symptoms and mental disorder are an intrinsic part of the chronic widespread pain syndrome or whether th ey have been observed in clinic attenders primarily because of their influe nce on the decision to seek a medical consultation. Methods. A population survey of 1953 subjects was conducted in the Greater Manchester area of the United Kingdom. The survey included a postal questio nnaire, and in a subgroup of respondents with high levels of distress, the presence of mental disorder was assessed by a semistructured standardized i nterview. Subjects with chronic widespread pain were classified according t o whether they had sought a medical consultation for the reported pain ("co nsulters") or not ("nonconsulters"), Results, In all, 252 subjects (13%) satisfied American College of Rheumatol ogy criteria for chronic widespread pain, and of these 72% reported having consulted a general practitioner about this pain. There was a clear differe nce in levels of psychological distress, measured by the General Health Que stionnaire (GHQ), between consulters, nonconsulters, and those with no pain . Consulters did not differ from nonconsulters in terms of levels of fatigu e, social dysfunction, or number of somatic symptoms reported. Although con sulters (among whom one in 4 had a mental disorder) were more likely to hav e a mental disorder than subjects without pain [OR = 4.9, 95% CI (2.6, 9.5) ] the increase in risk comparing consulters to nonconsulters [OR = 2.1, 95% CI(0.7, 5.9)] and nonconsulters to subjects without pain [OR = 1,4, 95% CI (0.7, 2.6)] was not significant. Conclusion. The results suggest that psychological distress is associated w ith chronic widespread pain in addition to any effect on whether consultati on is sought for symptoms. The finding that one-quarter of consulters to pr imary care with chronic widespread pain have a mental disorder should alert primary care physicians and rheumatologists to screen for mental disorder in this group.