BMJ 2001;323:86 ( 14 July )

Primary care

Randomised controlled trial of disclosure of emotionally important events in somatisation in primary care

Albert F Schilte, general practitioner, ^a Piet J M Portegijs, general practitioner, ^a Annette H Blankenstein, general practitioner, ^b Henriëtte E van der Horst, general practitioner, ^b Monique B F Latour, research assistant, ^a Jacques Th M van Eijk, professor of medical sociology, ^c J André Knottnerus, professor. ^a

^a Department of General Practice, University of Maastricht, PO Box 616, 6200 MD Maastricht, Netherlands, ^b Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, Netherlands, ^c Department of Medical Sociology, University of Maastricht

Correspondence to: A F Schilte Bert.Schilte{at}hag.unimaas.nl

Objective: To test whether a disclosure intervention improves subjective health and reduces medical consumption and sick leave in somatising patients in general practice.
Design: Non-blind randomised controlled trial.
Setting: 10 general practices in the Netherlands.
Participants: 161 patients who frequently attended general practice with somatising symptoms.
Intervention: Patients in the intervention group were visited two to three times and invited to disclose emotionally important events in their life. Control patients received normal care from their general practitioners.
Main outcome measures: Use of medical services (drugs and healthcare visits), subjective health, and sick leave assessed by self completion questionnaires after 6, 12, and 24 months.
Results: Of the 161 patients, 137 completed the trial (85%). Both groups were comparable at baseline. The intervention had no effect on the main outcome measures at any point. Intervention patients made one more visit to health care (95% confidence interval 4 to 6); the use of medicines did not change in both groups (1 to 1); subjective health improved 3.6 points more in the control group (11.2 to 4.3); and disclosure patients were on sick leave one more week (1 to 3). Patients often had a depression or anxiety disorder for which they were not receiving adequate care.
Conclusion: Although the intervention was well received by patients and doctors, disclosure had no effect on the health of somatising patients in general practice.

What is already known on this topic Up to 5% of patients in general practice attend frequently with somatising symptoms Emotional expression techniques have been shown to have favourable effects on subjective health, visits to the doctor, and symptoms in healthy people What this study adds A disclosure intervention does not improve somatisation in primary care About 45% of patients had an anxiety or depressive disorder, which was often unrecognised

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