DYSPEPSIA AND HEALTH-CARE SEEKING IN A COMMUNITY - HOW IMPORTANT ARE PSYCHOLOGICAL-FACTORS

The factors that drive subjects with dyspepsia in the community to see k medical care are uncertain. We aimed to identify whether psychologic al factors explain health care utilization among subjects with dyspeps ia. A sample of residents of western Sydney selected randomly from the electoral rolls was mailed a validated self-report questionnaire. Dys pepsia was defined as pain or discomfort centered in the upper abdomen . Potential predictors of physician visits tested included gastrointes tinal symptoms, neuroticism (by the Eysenck Personality Questionnaire) , psychological morbidity (General Health Questionnaire), and sexual, physical, and emotional abuse (based on standardized criteria). Among 730 subjects, 13% (95% CI 10.3-15.2%) had dyspepsia and 70% (95% CI 59 .8-79.5%) had sought medical care. Subjects with dyspepsia had signifi cantly higher neuroticism and psychological morbidity scores and repor ted childhood emotional abuse more often than those without dyspepsia tall P < 0.05), but none of these were independent predictors. Male ge nder (OR = 0.58, 95% CI 0.37-0.91), greater pain severity (OR = 2.49, 95% CI 2.12-2.91, P < 0.01), and meeting the Rome criteria for irritab le bowel (OR = 2.0, 95% CI 1.06-3.78) were associated with dyspepsia s ubjects seeing a physician or alternative therapist for abdominal pain or discomfort, explaining 32% of the deviance. Pain severity (OR = 1. 39, 95% CI 1.22-1.58) and symptoms of five or more years duration (OR = 5.73, 95% CI 3.71-8.87) were predictive of dyspepsia subjects ever s eeking care for abdominal pain or discomfort, explaining 15% of the de viance. Psychological factors were not significant predictors of seeki ng medical attention in dyspepsia. Health care seeking among community subjects with dyspepsia is explained in part by symptom severity and duration but not by neuroticism, psychological morbidity, or a history of abuse.