Here is another interesting article which Didi found:

Originally Posted By: Didi

I found this article in the Oxford Health Journal..

Originally Posted By: Oxford Health Journal

Youth experiences of frequent attenders in general practice

Bert Schilte, Piet Portegijs and Nettie Blankenstein

Universiteit Maastricht, Dept Of General Practice, PO Box 616, 6200 MD Maastricht, The Netherlands

It is well known that major difficulties in childhood such as deprivation or abuse can influence physical and mental health throughout life. Frequent attenders with stress-related complaints are known with a higher prevalence of childhood difficulties. During the busy consultation hours of GPs, there is usually not enough time to explore the patient's life story, and often patient and GP do not recognize the interrelations of difficulties in childhood with mental and physical health in later life. We aimed to determine, within the group of frequent attenders in general practice with stress-related complaints, the size of the subgroup with major difficulties in childhood, and the extent of the contribution of different types of childhood difficulties to medical, social and psychological variables. Those participating in the study were 403 patients, between the ages of 20 and 45 years, in 18 GP practices, who frequently visited their GP (>15 consultations in the previous 3 years) with more than four medically unexplained symptoms. The patients filled in a questionnaire on their complaints, quality of life, use of medication, number of referrals, disability, coping style, chronic difficulties, life events and difficulties in childhood. Childhood difficulties were divided into deprivation of parental care, emotional overburdening (bearing too large a responsibility in the family or parents having involved them a lot in their own problems), and traumatizing events (such as physical or sexual abuse). Medical problem lists were obtained from the Registration Network of Family Practices (RNH). The validity of the youth questionnaire was assessed with in-depth interviews in a subset of 75 patients. A majority of our frequent attenders reported difficulties in childhood: abuse (sexual and physical) as well as emotional overburdening related to gender (women more than men) and lower level of work. Patients with abuse and emotional overburdening had higher scores on lifetime somatization, a higher medical consumption, often had passive coping styles and listed more chronic difficulties in relationships. They also reported at present more physical and mental complaints (depressive and anxiety), a lower quality of life and a lower subjective health. Deprivation in childhood was not related to any of the variables in our study. Problems in childhood, such as abuse and emotional overburdening, are important contributing factors to somatization, medical consumption, mental health, coping style and chronic difficulties in relationships. In spite of our practical experience, we were struck by the frequency and consequences of unfavourable youth experiences in frequently visiting patients. We would like to get feedback on our presentation and to share experience on this subject with GPs in other countries.


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