Contents lists available at ScienceDirect Journal of Psychosomatic Research journal homepage: www.elsevier.com/locate/jpsychores Personality and psychopathology as predictors of patient-initiated overuse in general practice Montserrat Gomà-i-Freixanet a, ⁎ , Valentín Calvo-Rojas b , Mariona Portell c a Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Catalonia, Spain b Centre d'Atenció Primària Montnegre, Institut Català de la Salut, Barcelona, Catalonia, Spain c Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Catalonia, Spain ARTICLE INFO Keywords: Frequent attenders Healthcare utilization Mental health Overusers Personality Primary care ABSTRACT Objective: We aimed to characterize, by means of the MCMI, the psychopathological profile of users above the 95th percentile in the distribution of patient-initiated, face-to-face consultations. Additionally, we sought to determine the specific contribution of the patterns assessed by the Millon inventory in differentiating between the groups above or below this cut-off point. Methods: A total of 16803 users who initiated at least one face-to-face consultation with a GP at any of 13 PHC practices over one year, were eligible. After discarding those meeting our exclusion criteria, 129 cases and 109 controls matched by gender and age completed the MCMI-III. Results: The profile of users above the 95th percentile showed elevated scores for compulsivity and narcissism, reflecting rigidity and perfectionism with anxious symptomatology but with no physical or psychosomatic complaints. Regarding differentiation between the two groups, the results showed elevated scores for de- pendency to increase the probability of belonging to the group above the 95th percentile; conversely, elevated scores for compulsivity appeared to be protective, decreasing the probability of belonging to this same group. Furthermore, elevated scores for anxiety and major depression also increased the probability of belonging to this group. The results for clinical syndromes present a profile of overusers reporting anxiety and somatic complaints associated with low self-esteem. Conclusions: Excessive patient-initiated consultations can be an easily detectable marker for underlying psy- chological problems. The results suggest that overusers of patient-initiated consultations above the 95th per- centile show an MCMI profile associated with dependency, compulsivity, anxiety, and major depression. 1. Introduction It is recognized in the literature that the overuse of public primary healthcare (PHC) services is related to various circumstances, such as social factors, health problems, chronic diseases, and psychological conditions that may generate the highest number of general practi- tioner (GP) consultations [1–4]. This overuse of resources places a disproportionate burden on the healthcare system, with unjustified expenditure and saturation of services leading to discontent on both sides: health professionals reporting high levels of burnout, and users declaring low levels of satisfaction with the attention they receive [5,6]. Most studies of overusing have focused mainly on sociodemographic variables [7,8]; nevertheless, in recent decades the psychological characteristics of patients have been gaining recognition, as they have also been found to be related to this phenomenon [9–11]. The results of other studies have pointed out that patients who overuse public health services concurrently suffer from social problems and affective dis- orders [12–14]. To study the phenomenon of overusing, most studies have con- sidered numerous kinds of consultations to calculate attendance rates [15,16]. However, not all consultations are generated by the GP; the user [17] can also initiate a huge volume of consultations. GP-generated consultations are mostly concerned with controlling chronic disease or ensuing closer follow-up, while patient-initiated consultations are mostly about responding to a patient's characteristics, either social or psychological. Consequently, studies of the psychological profile of overusers that do not differentiate between these two initiators of consultations—the GP and the patient—may provide inconclusive re- sults because consultations instigated on the patient's own initiative are not specifically addressed. https://doi.org/10.1016/j.jpsychores.2019.03.009 Received 7 November 2018; Received in revised form 6 March 2019; Accepted 6 March 2019 ⁎ Corresponding author at: Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona 08193, Catalonia, Spain. E-mail address: montserrat.goma@uab.cat (M. Gomà-i-Freixanet). Journal of Psychosomatic Research 120 (2019) 53–59 0022-3999/ © 2019 Elsevier Inc. All rights reserved. T