Epidemiology and organization of care in medically unexplained symptoms:
a systematic review with a focus on cultural diversity and migrants
Background: Since the pathophysiology of medically unexplained symptoms
(MUS) remains unclear, health care providers often struggle with these
patients, especially with a different ethnic and/or cultural background.
These challenges are insufficiently addressed in their training and in
the organization of care. Aim: To improve health care provider-patient
interaction focused on MUS patients in general and in ethnic minorities
and refugees in particular through a systematic review of syndromal
definitions and epidemiology and organization of care of MUS patients.
Methods: Screening of PubMed, Web of Science, Cinahl and Cochrane
Library on the keywords ‘Medical unexplained (physical) symptoms
(MUPS)’, ‘Somatoform disorder’, ‘Functional syndrome’, ‘Diversity’,
‘Migrants’, ‘Ethnicity’, ‘Care models’, ‘Medical education’,
‘Communication skills’, ‘Health literacy’ Results: Different case
definitions result in markedly different epidemiologic estimates for MUS
patients. Nevertheless, they are prevalent in a wide range of health
care settings. Literature offers evidence of the effectiveness of
structural frameworks in approaching MUS patients. Organization of MUS
care needs to transcend different levels of care: specialist tertiary
and secondary care and primary care involving different qualifications
of caregivers need to be aligned. Conclusion: The systematic review
identified significant gaps and shortcomings in organization of care.
These need to be addressed in order to improve outcomes. Keywords:
Medical unexplained (physical) symptoms (MUPS), Somatoform disorder,
Functional syndrome, Diversity, Migrants, Ethnicity, Care models Message
for the clinic: - Medically unexplained symptoms are highly prevalent
but case definitions hamper both recognition and a proper approach. -
MUS are ill understood in both the general population as in migrants and
refugees. - Interdisciplinary and integrated care through a
biopsychosocial model is mandatory.