Kroenke & Mangelsdorff (1)

Last year marked the 20th anniversary of one of the most frequently quoted studies in the stress illness literature.  The paper reports a discovery that would have shocked me if I had read it during my training years.  Their finding has profound implications for primary care practice.

The authors reviewed a mountain of charts (1000 patients for three years each) from the medical clinic at Brooke Army Medical Center in San Antonio, Texas.  The clinic cares for active-duty personnel but also for their dependents and for retirees and so resembles a civilian practice.  They looked for evidence of 14 common but significant symptoms**.  If these had come on recently they recorded information about medical tests, the diagnosis of the symptoms and their response to treatment.  They did not study longstanding (chronic) symptoms.

Of their 1000 patients, 24% developed one of the 14 symptoms during the three-year study period, 9% developed two symptoms, 3% developed three and 2% developed four or more.  62% developed no significant new symptoms (though many had chronic problems).

Remarkably, the cause of the symptom could not be found in 74% of cases. In another 10% the symptom was attributed to a psychological issue. Only 16% of the symptoms were due to an abnormality of a body organ.  Psychological causes included Depression, Stress, Anxiety and Grief.  Symptoms most often associated with psychological causes were insomnia (50% of cases had a psychological cause), weight loss (28%), fatigue (21%) and headache (15%).

What is responsible for the 74% of symptoms with no known cause?  My experience suggests that nearly all had stress illness.  Unfortunately, there is no indication that a Stress History (see other posts with this tag) was taken from these patients?  More in my next post.

*Kroenke, K & Mangelsdorff, AD. Common Symptoms in Ambulatory Care: Incidence, Evaluation, Therapy and Outcome.  Am J Med 86: 262-266, 1989.

** Chest pain, fatigue, dizziness, headache, leg swelling (edema), back pain, shortness of breath, insomnia, abdominal pain, numbness, erectile dysfunction, weight loss, cough and constipation.

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