ABSTRACT
Psychosocial stressors play a significant role in many of the presenting symptoms of primary care patients (Campbell, Seaburn, & McDaniel, 1994; Dalack & Zweifler, 1997; Sloane, 1998). Studies that analyze reasons for seeking medical services indicate that primary care patients frequently seek services secondary to stress-related symptoms and/or disorders, such as headache, gastrointestinal distress, and chest pain (Sobel, 1995). Meyer and Haggerty (1962) showed that chronic stress was positively associated with high rates of streptococcal pharyngitis, with up to one third of streptococcal infections preceded by a stressful family event. Katon (1985) estimated that 50% of primary care visits involve significant psychosocial concerns. Kroenke and Mangelsdorff (1989) analyzed 1,000 patients followed for 3 years in an internal medicine clinic. They targeted the 14 most common symptoms (e.g., fatigue, dizziness, headache, chest pain) for study. Of these symptoms, only 16% were found to be clearly attributable to organic etiologies. The authors concluded that although only 10% of these presenting complaints were identified by physicians as psychological in nature, many of the reported symptoms were likely due to psychosocial factors such as environmental stressors.
