Berg, B. van den, Yzermans, C.J., Velden, P.G. van der, Stellato, R.K., Brunekreef, B. Risk factors for unexplained symptoms after a disaster: a five-year longitudinal study in general practice. Psychosomatics: 2009, 50(1), 69-77 This is a NIVEL certified Post Print, more info at http://www.nivel.eu Postprint Version 1.0 Journal website http://psy.psychiatryonline.org/cgi/content/abstract/50/1/69 Pubmed link http://www.ncbi.nlm.nih.gov/pubmed/19213975 DOI 10.1176/appi.psy.50.1.69 This is a NIVEL certified Post Print, more info at http://www.nivel.eu Risk Factors for Unexplained Symptoms After a Disaster: A Five-Year Longitudinal Study in General Practice BELLIS VAN DEN BERG, M.A, C. JORIS YZERMANS, PH.D., PETER G. VAN DER VELDEN, PH.D., REBECCA K. STELLATO, M.S., AND BERT BRUNEKREEF, PH.D. ABSTRACT BACKGROUND: Medically unexplained symptoms (MUS) are a common reason to seek medical care. When presented to the general practitioner (GP), more than three-quarters of symptoms such as stomach ache, headache, and pain in bones and muscles cannot be explained by a medical disorder. OBJECTIVE: The authors examined the course of MUS presented to the GP in the 1 year before the disaster and in the 4 years after a disaster in order to study the risk factors for MUS. METHOD: Data were extracted from the electronic medical records of survivors and from a questionnaire (N=1,216). RESULTS: Although the mean number of MUS was significantly increased statistically in the first 2 years post-disaster, the increase was not clinically significant. CONCLUSION: The authors identified several important risk factors, such as immigrant status and psychological problems, that are easy for GPs to recognize. Despite this, the sensitivity of the regression model was relatively low. INTRODUCTION Medically unexplained symptoms (MUS) are a common reason for seeking medical care. When presented to the general practitioner (GP), more than three-quarters of symptoms such as stomach ache, headache, and pain in bones and muscles cannot be explained by presence of a medical disorder. 1 Despite the lack of a medical diagnosis, these symptoms are associated with impairment in functioning that is similar to that of patients with medical disorders. 2,3 Patients who present these symptoms to their GP may undergo extensive medical investigations, mostly without any result. 4,5 Therefore, knowledge of factors that characterize patients with MUS is useful for identification of these individuals before costly tests are done. Factors associated with MUS can be divided into predisposing, precipitating, and perpetuating factors. 6 Predisposing factors are patient characteristics that make them more at risk for developing symptoms; these include female gender, 7–10 lower education level, 8 unemployment, 7,9 childhood medical illness, and maltreatment. 11,12 Precipitating factors are events in the person’s life, such as stressful life events and psychological problems, which result in the appearance of symptoms. Finally, perpetuating factors are those that maintain or exaggerate symptoms (e.g., financial problems and lack of social support). 6