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The contribution of epidemiology to psychosomatic medicine

Published online by Cambridge University Press:  11 October 2011

Antonio Lobo  and
Ricardo Campos
Antonio Lobo*
Affiliation:
Departamento de Medicina y Psiquiatría, Facultad de Medicina de la Universidad de Zaragoza and Servicio de Psicosomática, Hospital Clínico Universitario, Zaragoza, Spain
Ricardo Campos
Affiliation:
Departamento de Medicina y Psiquiatría, Facultad de Medicina de la Universidad de Zaragoza and Servicio de Psicosomática, Hospital Clínico Universitario, Zaragoza, Spain
*
Indirizzo per la corrispondenza: Professor A. Lobo, Servicio de Psicosomática, Hospital Clinico Universitario, planta 11, Zaragoza 50009 (Spain).
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Summary

Objective — To discuss the contribution of epidemiology and epidemiological methods to psychosomatic medicine. Method — Critical review of the literature, including both philosophical concepts and empirical data. Results — The adjective «psychosomatic» has been used in two different ways: in the so called «psychosomatic» or holistic approach to medicine; and in a narrower approach, referring to particular disorders in which psychological factors were considered to have a fundamental aetiological role. While the ideal of the holistic, «humanistic» or «anthropological» approach should probably be never abandoned, the practical limitations of encompassing models, including Engel's bio-psycho-social model are also obvious: they may be heuristically sterile. On the other side, in relation to the narrow psychosomatic approach, psychogenetic views in the so called «psychosomatic illnesses» have been strongly criticized on empirical grounds. The potential of epidemiological methods to study these illnesses, but also «somatopsychic» disorders is shown in a number of papers in the empirical literature. We have grouped such contributions, including our own experience, in the five categories suggested by M. Shepherd for epidemiological methods in general: 1) the completion of the spectrum of disease; 2) the establishment of outcome; 3) the actuarial assessment of morbid risk; 4) the evaluation of the efficacy of treatment; and 5) the conceptual construction of diagnosis and classification. Conclusions — The contribution of epidemiological data to areas of interest in psychosomatic medicine has been relevant in recent years. The potential of epidemiological methods in this area is very important both to increase knowledge and to improve the quality of clinical practice.

Riassunto

Scopo — Discutere il contribute dell'epidemiologia e dei metodi epidemiologici alla medicina psicosomatica. Metodo — Revisione critica della letteratura, comprendente sia concetti filosofici che dati empirici. Risultati — Il termine «psicosomatico» è stato usato in due differenti accezioni: nel cosiddetto approccio «psicosomatico» o olistico alia medicina e in un approccio più ristretto riferito a particolari disturbi nei quali si pensa che i fattori psicologici abbiano un fondamentale ruolo etiologico. Mentre l'ideale di un approccio olistico, «umanistico» o antropologico non dovrebbe mai essere abbandonato, in limiti pratici dei modelli che utilizziamo, incluso il modello bio-psicosociale di Engel, sono evidenti: essi possono essere sterili dal punto di vista euristico. D'altra parte, in relazione all'approccio psicosomatico più ristretto, i punti di vista psicogenetici nei cosiddetti «disturbi psicosomatici» sono stati fortemente criticati su basi empiriche. La potenzialità dei metodi epidemiologici per lo studio di queste malattie, ma anche per quello dei disturbi «somatopsichici», è illustrata in numerosi articoli pubblicati nella letteratura. Abbiamo raggruppato tali contributi, compresi i nostri, nelle 5 categorie suggerite da M. Shepherd per i metodi epidemiologici in generale: 1) la completezza dello spettro del disturbo; 2) l'accertamento dell'esito; 3) la realistica valutazione del rischio di morbidità; 4) la valutazione dell'efficacia del trattamento e 5) la definizione concettuale della diagnosi e della classificazione. Conclusioni — Il contribute dei dati epidemiologici ai temi di interesse della medicina psicosomatica sono stati rilevanti negli anni recenti. La potenzialità dei metodi epidemiologici in questo settore è molto importante, sia per sviluppare la conoscenza, sia per migliorare la qualità della pratica clinica.

Keywords

epidemiologypsychosomatic approachepidemiologiaapproccio psicosomatico.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 6 , Issue 1 , April 1997 , pp. 40 - 47
Copyright
Copyright © Cambridge University Press 1997

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