Estimated prevalence of medically unexplained physical symptoms in the medicine outpatient department of a tertiary care hospital in India

Abstract

Purpose: There is a paucity of scientific evidence from the Indian subcontinent regarding the magnitude and burden of Medically Unexplained Physical Symptoms (MUPS). This study aims to fill the evidence gap by assessing the prevalence and pattern of MUPS amongst patients attending the Medicine Out-Patient Department (OPD).

Methodology: The study assessed all consecutive new patients, presenting to the Medicine OPD of a tertiary care center in India over a period of nine months. All consenting patients, between 18 and 60 years of age, irrespective of their reason for consultation were included for the study. The diagnosis in subjects was established by a combination of clinical history, physical examination, and relevant investigations. A diagnosis of MUPS was made in cases with no demonstrable organic cause, and after agreement in the opinion of two independent physicians. All recruited patients with MUPS were subsequently evaluated on a pre-validated symptom checklist of 23 symptoms.

Results: Out of 976 subjects included, a diagnosis of MUPS was established in 24.6% [95% CI = 21.9-27.3] of the sample. An additional 20.6% met the criteria of persistent MUPS (symptoms >2 months), and 19.7% of subjects had symptom duration of more than three months, meeting the stricter definition for 'persistent MUPS'. Prevalence was significantly higher in females (p = 0.02), and patients of MUPS were significantly younger (p = 0.004) than patients with other diagnoses. MUPS patients on average complained of 13 ± 5 symptoms and sought multiple medical consultations [Median (IQR) = 3 (2 - 6)] in the last one year. Non-specific, general symptoms (94.6%) and various types of pain (93.7%) were the most frequent complaints. Pain symptoms, genitourinary symptoms, palpitation, and nausea were more frequent in females as compared to males.

Discussion: Medically unexplained symptoms are as common in India as in the west and therefore pose a significant burden on the healthcare delivery systems. There is a need to sensitize the medical fraternity and policymakers for this condition to develop effective services.

Keywords: India; MUPS; Medically unexplained symptoms; Prevalence; Somatoform disorder.