More than half of all outpatient visits are trigged by physical symptoms which, in turn, are not adequately explained by medical disorders at least half of the time. Further, the presence and severity of somatic symptoms often correlate more strongly with psychological, cognitive and behavioral factors than with physiological or biological findings. Finally, our understanding of the etiology, evaluation, and management of somatic symptoms and functional syndromes is less advanced than our knowledge of many defined medical and psychiatric disorders. This special section, edited by Kurt Kroenke, M.D., will highlight original studies that advance the science and clinical care of somatic symptoms. Symptom Research Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population Ricarda Mewes, M.Sc. a, ⁎ , Winfried Rief, Ph.D. a , Elmar Brähler, Ph.D. b , Alexandra Martin, Ph.D. c , Heide Glaesmer, Ph.D. b a Department of Clinical Psychology, University of Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany b Medical Psychology and Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany c Department of Psychosomatic Medicine and Psychotherapy, University Erlangen-Nürnberg, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany Received 19 March 2008; accepted 21 April 2008 Abstract Objective: Somatization is related to elevated health care utilization (HCU) and high health care costs. However, it is unclear whether HCU in somatizers and nonsomatizers in the general population is determined by existing symptoms or by lower thresholds for doctor visits. Method: A representative sample of the German general population (N=2510) was screened for psychopathology and HCU in the prior 12 months. The sample was subdivided into somatizers (n=712) and controls (n=1796), using the Patient Health Questionnaire (PHQ-15). A general tendency to visit doctors even for minor reasons was assessed. Demographic and psychopathological variables were additionally entered into regression analyses to predict HCU for the whole investigated sample and the two subsamples. Results: Higher somatization, unemployment or retirement, a lower decision threshold for doctor visits and higher posttraumatic symptomatology were consistent and unique positive predictors of HCU in the prior 12 months. Conclusion: Not only symptoms per se but also a lower decision threshold for doctor visits contribute to increased HCU. Psychopathological and demographic variables can further predict HCU in somatizing persons and controls. Although somatization and reduced thresholds for doctor visits are associated, they have to be distinguished from each other and contribute independently to increased costs. © 2008 Elsevier Inc. All rights reserved. Keywords: Decision threshold for doctor visits; General population; Health care utilization; Predictors; Somatization 1. Introduction Somatoform (i.e., medically unexplained) symptoms are common in the general population [1–3]. They are of special interest for investigations because of their influence on health care utilization (HCU). Many studies have found that people with diagnosed somatoform disorders are high utilizers of primary and secondary health care, without improvement in many cases [4–8]. In addition, individuals who are screened as high somatizers (i.e., they fulfill the cutoff criteria of a self- rating instrument) but who are not known to fulfill the diagnostic criteria for somatoform disorders show elevated HCU and increased health care costs [9–16]. Available online at www.sciencedirect.com General Hospital Psychiatry 30 (2008) 349 – 355 ⁎ Corresponding author. E-mail address: mewesr@staff.uni-marburg.de (R. Mewes). 0163-8343/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.genhosppsych.2008.04.007