Tom Beckman
Director, Health Professionals Program at HeartMath at HeartMath LLC
Published Apr 6, 2016
A statement with many variations found all over the Internet: “60-90% of all doctor’s office visits are for stress-related ailments and complaints (or illnesses, conditions, disorders, or issues.)” (The percentage can also be 70%, 75% or 80%.) The statement is incorrectly attributed to several sources like the Centers for Disease Control and Prevention (CDC), American Medical Association (AMA), National Institute for Mental Health (NIMH), World Health Organization (WHO), the Surgeon General, Herbert Benson MD, or Harvard.
References, when provided, don’t cite peer-reviewed papers, but decades-old USA Today, Time Magazine, Newsweek, U.S. News & World Report articles, or a 1994 Harvard Business Review article by Anne Perkins, or an unavailable American Academy of Family Physicians (AAFP) survey from 1988.
While researching the topic, I found a 2013 JAMA Internal Medicine paper that states:
“The prevalence of stress in primary care is high; 60% to 80% of visits may have a stress-related component.”
The citation for the statistic refers to a 2003 Journal of the National Medical Association paper that states:
“In 1981, a landmark study reviewing the charts of Kaiser-Permanente patients concluded that 60-90% of physician visits reflect emotional distress and somatization.”
Which refers to a 1981 paper by Dr. Nicholas Cummings, Chief Psychologist at Kaiser Permanente from 1959-1979 that states:
“Early investigations confirmed physicians’ fears they were being inundated, for it was found that 60% of all visits were by patients who had nothing physically wrong with them. Add to this the medical visits by patients whose physical illnesses are stress related (peptic ulcer, ulcerative colitis, hypertension, etc.) and the total approaches a staggering 80 to 90% of all physician visits. Surprising as these findings were 25 years ago, nationally accepted estimates today range from 50 to 80% (Shapiro, 1971).”
More information on the relevant research papers:
Nerurkar A, Bitton A, Davis RB, Phillips RS, Yeh G. When Physicians Counsel About Stress: Results of a National Study. JAMA Intern Med. 2013;173(1):76-77.
It cites:
Avey H, Matheny KB, Robbins A, Jacobson TA. Health care providers’ training, perceptions, and practices regarding stress and health outcomes. J Natl Med Assoc. 2003;95(9):833, 836-845.
It cites:
The twenty years Kaiser-Permanente experience with psychotherapy and medical utilization: implications for national health policy and national health insurance. N A Cummings, G R VandenBos, Health policy quarterly 02/1981; 1(2):159-75.
I found the paper as a book chapter in:
The Value of Psychological Treatment: The Collected Papers of Nicholas A. Cummings Hardcover – June, 2000 by J. Lawrence Thomas (Editor), Janet L. Cummings (Editor)
The 60-90% figure is from Kaiser’s twenty-year study described in the 1981 paper.
It cites an earlier, similar statistic from: Shapiro, Arthur K. “Placebo effects in medicine, psychotherapy, and psychoanalysis.” Handbook of psychotherapy and behavior change. New York: Wiley (1971): 21.
The 2003 paper also cites a 1989 paper by Kroenke that 16% of presentations have an organic etiology. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med. 1989 Mar;86(3):262-6.
I hope this helps those who have been searching for the source of this statistic. Oddly enough, this is the only list of references for this statistic on the Internet.
Get a copy of our infographic with stress-related statistics here.
The HeartMath organization has, for the last 27 years, developed psychosocial interventions supported by heart rhythm monitoring feedback. For more information, go to www.heartmath.com
You might also be interested in an article on the quality of HeartMath Institute research.
Tom Beckman, HeartMath LLC, tom@heartmath.com