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Specific Effects of Depression, Panic, and Somatic Symptoms on Illness Behavior

Rief, Winfried PhD; Martin, Alexandra PhD; Klaiberg, Antje PhD; Brähler, Elmar PhD

doi: 10.1097/01.psy.0000171158.59706.e7
Original Articles

Objective: In terms of restricted financial resources, the contribution of mental disorders to health care use and illness behavior is highly relevant. However, the specific contributions of panic disorder, depression, and somatic complaints to illness behavior in unselected samples is unclear.

Methods: A representative sample of 2507 inhabitants of Germany was selected and grouped into people with panic disorder (30), somatic syndrome (102), major depression (24), depressive syndrome (77), and controls (2269). Assessment instruments were the complete version of the Patient Health Questionnaire (PHQ), the Scale for the Assessment of Illness Behavior (SAIB) as well as measures of health care use.

Results: Although all clinical groups showed increased illness behavior, their impact was independent and specific. Subjects fulfilling the criteria of panic disorder showed the highest scores for illness behavior and health care use. People with mental disorders showed a greater increase in visits to general practitioners and medical specialists than to psychiatrists or psychologists. Regression analysis revealed that somatic complaints and depression have independent associations with illness behavior and health care use.

Conclusions: Different mental and psychosomatic disorders contribute independently to health care use and other aspects of illness behavior.

PHQ = Patient Health Questionnaire; SAIB = scale for the assessment of illness behavior; GP = general practitioner.

From the Department of Psychology, University of Marburg, Marburg, Germany (R.W., M.A.); and the Medical School of the University of Leipzig, Leipzig, Germany (K.A., B.E.).

Address correspondence and reprint requests to W. Rief, Clinical Psychology and Psychotherapy, Gutenbergstrasse 18, D-35032 Marburg, Germany. E-mail:

This study was supported by grants from the German Ministry of Education and Research BMBF and from Pfizer Germany, Karlsruhe.

Received for publication July 8, 2004; revision received January 19, 2005.

Copyright © 2005 by American Psychosomatic Society
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