Cited by 129Psychosomatic Disorders and Their TreatmentsFibromyalgia and Chronic Fatigue Syndrome ResearchMusculoskeletal pain and rehabilitation

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A new questionnaire to identify bodily distress in primary care: the 'BDS checklist

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Budtz-Lilly, Anna, Fink, Per, Ørnbøl, Eva, Vestergaard, Mogens, Moth, Grete, Christensen, Kaj Sparle, Rosendal, Marianne·2015·Journal of Psychosomatic Research

DOI 10.1016/j.jpsychores.2015.03.006

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Abstract

BACKGROUND: Functional symptoms and disorders are common in primary care. Bodily distress syndrome (BDS) is a newly proposed clinical diagnosis for functional disorders. The BDS diagnosis is based on empirical research, and the symptoms stated in the BDS criteria have been translated into a self-report questionnaire called the BDS checklist. The aim of the present study was to investigate the psychometric properties of the checklist and to test the construct of BDS. METHOD: The 30-item BDS checklist was completed by 2480 adult primary care patients in a cross-sectional study on contact and disease patterns in Danish general practice. We performed (internal) validation analyses of the collected checklist data. We also performed factor and latent class analyses to identify both BDS symptom groups and BDS patient groups. RESULTS: Internal validation analyses revealed acceptable and usable psychometric properties of the BDS checklist. The factor analyses identified the four distinct determining factors for BDS: cardiopulmonary, gastrointestinal, musculoskeletal and general symptoms. Results from factor and multi-trait analyses suggested a shortening of the BDS checklist (from 30 to 25 items). The latent class analyses resulted in three severity levels (no, moderate and severe BDS); the best fit index was found for a threshold of ≥4 symptoms in a symptom group. CONCLUSION: The results provide empirical support for the previously described construct of BDS with four symptom groups and three patient groups. The BDS checklist is a self-report instrument that may be used for case finding in both clinical practice and in research.

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Joustra, M. L., Janssens, K. A. M., Schenk, H., & Rosmalen, J. G. M. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.11.006 · Cited by 10
Symptom perceptions in functional disorders, major health conditions, and healthy controls: A general population study
Weigel, A., Dantoft, T. M., Jørgensen, T., Carstensen, T. B. W., Löwe, B., Weinman, J. A., & Frostholm, L. (2022) · Clinical Psychology in Europe · doi:10.32872/cpe.7739 · Cited by 9
“The Bodily Distress Syndrome (BDS) checklist (Budtz-Lilly et al., 2015) uses a Likert-scale to assess 25 symptoms related to the cardiopulmonary, gastrointestinal, musculoskaletal and general symptom clusters of the diagnostic concept of the Bodily Distress Syndrome.”
Method
Functional Somatic Disorders, Their Subtypes, and Their Association With Self-Rated Health in the German General Population
Sattel, H. C., Häuser, W., Schmalbach, B., Brähler, E., Henningsen, P., & Hausteiner‐Wiehle, C. (2023) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001187 · Cited by 9
“In accordance to the BDS operationalization (9,10), we included symptoms reported as “bothering somewhat,” “bothering quite a bit,” or “bothering a lot,” and four symptom clusters (cardiopulmonary, gastrointestinal, musculoskeletal, and general symptoms) were used to further distinguish and specify single-system and m…”
BackgroundMethodInfluential
Factors associated with having previously received a diagnosis of fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome: A cross sectional DanFunD study
Tattan, M., Ørnbøl, E., Wellnitz, K. B., Hanssen, D. J. C., Dantoft, T. M., Rosmalen, J. G. M., Fink, P., & Petersen, M. W. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111693 · Cited by 8
Somatoforme Störungen – somatoforme Belastungsstörung und verwandte Störungen
Kapfhammer, H. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_74 · Cited by 8
Five-factor personality traits and functional somatic disorder: A systematic review and meta-analysis
Lamm, T. T., von Schrottenberg, V., Rauch, A., Bach, B., Pedersen, H. F., Rask, M. T., Ørnbøl, E., Wellnitz, K. B., & Frostholm, L. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102529 · Cited by 10
Application and validation of the bodily distress syndrome checklist in a psychosomatic outpatient sample
Wertenbruch-Rocke, T., Hüsing, P., Löwe, B., & Toussaint, A. C. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.12.005 · Cited by 7
Conditioned pain modulation and pain sensitivity in functional somatic disorders: The DanFunD study
Petersen, M. W., Skovbjerg, S., Jensen, J. S., Carstensen, T. B. W., Dantoft, T. M., Fink, P., Benros, M. E., Mortensen, E. L., Jørgensen, T., & Gormsen, L. K. (2021) · European Journal of Pain · doi:10.1002/ejp.1847 · Cited by 7
“…who did not fulfil any of the criteria of either FSS or BDS but still reported musculoskeletal pain symptoms to be either (a) 'somewhat', 'quite a bit', or 'a lot' bothering (Budtz- Lilly et al., 2015), or (b) 'often' or 'almost constantly' bothering (White et al., 1999), a 'non- FSD pain group'.”
Background
Coping strategies among individuals with multiple physical symptoms: A general population-based cross-sectional study
Raasthøj, I., Rasmussen, S., Carstensen, T. B. W., Wehberg, S., Rosendal, M., & Jarbøl, D. E. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.111140 · Cited by 7
Designing and Developing an eHealth Program for Patients With Persistent Physical Symptoms: Usability Study
Christensen, O. R., Hedegaard, L., Rask, M. T., Clemensen, J., Frostholm, L., & Rosendal, M. (2023) · JMIR Human Factors · doi:10.2196/42572 · Cited by 7
Missingness mechanisms and generalizability of patient reported outcome measures in colorectal cancer survivors – assessing the reasonableness of the “missing completely at random” assumption
Lyhne, J. D., Smith, A. B., Jensen, L. H., Hansen, T. F., Frostholm, L., & Timm, S. (2024) · BMC Medical Research Methodology · doi:10.1186/s12874-024-02236-z · Cited by 9
“The BDS Checklist [33] 1.”
Autonomic arousal and heart rate variability in functional somatic disorder - a cross-sectional population-based study
Gormsen, L. K., Mølgaard, H., Dantoft, T. M., Bjerregaard, A. A., Fink, P., & Petersen, M. W. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112193 · Cited by 6
Is reduced heart rate variability associated with functional somatic disorders? A cross-sectional population-based study; DanFunD
Jørgensen, T., Dantoft, T. M., Petersen, M. W., Gormsen, L. K., Winther‐Jensen, M., Fink, P., Linneberg, A. R., Benros, M. E., Eplov, L. F., Bjerregaard, A. A., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-073909 · Cited by 6
Association between infections and functional somatic disorders: a cross-sectional population-based cohort study
Schovsbo, S. U., Møllehave, L. T., Petersen, M. W., Bjerregaard, A. A., Eliasen, M., Brix, S., Eplov, L. F., Kårhus, L. L., Fink, P., Linneberg, A. R., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-066037 · Cited by 6
Associations of long‐term clinical recovery and improved quality of life across ICD ‐11 chronic pain categories in a real‐world registry study
Farnes, N., Granan, L., Jacobsen, H. B., Stubhaug, A., & Vambheim, S. M. (2024) · European Journal of Pain · doi:10.1002/ejp.2250 · Cited by 4
“Functional disorders were measured using the Bodily Distress Syndrome (BDS) checklist (Budtz-Lilly et al., 2015), a 25-item questionnaire grouped into cardio-pulmonary, gastrointestinal, musculoskeletal, and general symptoms.”
Can internal medicine specialists diagnose functional somatic disorders (FSDs)? Training and comparison with FSD specialists
Madsen, M. M., Trolle, C., Fynne, L. V., Ørnbøl, E., Fink, P., & Gormsen, L. K. (2024) · PLoS ONE · doi:10.1371/journal.pone.0307057 · Cited by 5
“Specifically, the battery included the BDS Checklist [24], Whiteley-6R [25] health anxiety index, and several symptom checklists: SCL-8 [26], SCL-4anx [27], and SCL-6dep [28].”
Method
Welfare benefit utilization for people with functional somatic disorder. A population-based cohort study
Petersen, M. W., Wellnitz, K. B., Carstensen, T. B. W., Dantoft, T. M., Ørnbøl, E., Bjerregaard, A. A., Jørgensen, T., & Fink, P. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112073 · Cited by 7
Multiple physical symptoms and coping strategies over the last decade – Knowledge from two Danish population-based cross-sectional studies in 2012 and 2022
Raasthøj, I., Jarbøl, D. E., Rasmussen, S., Wehberg, S., Sætre, L. M. S., Rosendal, M., & Carstensen, T. B. W. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111832 · Cited by 5
Statistical complexity of reasons for encounter in high users of out of hours primary care: analysis of a national service
Stegink, S., Elliott, A. M., & Burton, C. D. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-3938-z · Cited by 5
Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial
Pedersen, H. F., Lamm, T. T., Fink, P., Ørnbøl, E., & Frostholm, L. (2023) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2023.101069 · Cited by 4
E-Health Intervention for Fear of Cancer Recurrence
Lyhne, J. D., Smith, A. B., Timm, S., Klein, B., Thewes, B., Girgis, A., Bamgboje‐Ayodele, A., Beatty, L., Fardell, J. E., Fink, P., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.42112 · Cited by 7
Hair cortisol and self-perceived stress in adolescents with multi-system functional somatic disorders
Nyengaard, R., Kallesøe, K. H., Rimvall, M. K., Ørnbøl, E., Wellnitz, K. B., Olsen, E. M., Wyller, V. B., & Rask, C. U. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05518-4 · Cited by 4
“…symptoms were assessed by the 25-item BDS checklist, a validated self-report questionnaire developed to identify individuals with probable FSD by assessing physical symptoms from four symptom clusters: cardiopulmonary/autonomic, gastrointestinal, musculoskeletal and general symptoms [11, 46, 47].”
Method
Fluctuation of functional somatic disorders in a population-based cohort. The DanFunD study
Schovsbo, S. U., Kårhus, L. L., Bjerregaard, A. A., Petersen, M. W., Frostholm, L., Fink, P., Carstensen, T. B. W., Eplov, L. F., Benros, M. E., Brix, S., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0312031 · Cited by 4
Comparison of prevalence and mental health problems across symptom frequency of self‐reported symptoms of binge‐eating disorder in a community sample of adolescents
Andersen, S. T., Strandberg‐Larsen, K., Skovgaard, A. M., Rimvall, M. K., Meyer, L. B., & Olsen, E. M. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.24023 · Cited by 4
Psychosomatic symptoms questionnaire (PSQ-39): a psychometric study among general population of Iranian adults
Heidari, Z., Feizi, A., Rezaei, S., Roohafza, H., & Adibi, P. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03278-z · Cited by 5
Lipid metabolism and functional somatic disorders in the general population. The DanFunD study
Jørgensen, T., Jacobsen, R. K., Sæbye, D., Petersen, M. W., Fink, P., Gormsen, L. K., Linneberg, A. R., Bjerregaard, A. A., Schovsbo, S. U., Benros, M. E., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0296799 · Cited by 4
“In the analysis, BDS-total encompassed persons with either single/oligo or multi-BDS [22].”
Method
Exploring the interplay between psychotic experiences, functional somatic symptoms and health anxiety in childhood and adolescence - A longitudinal cohort study.
Rimvall, M., Rask, C., Jensen, J., Olsen, E., Clemmensen, L., Skovgaard, A. M., Verhulst, F. C., van Os, J., & Jeppesen, P. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.03.028 · Cited by 2
Validation of the Chinese version bodily distress syndrome checklist in Chinese out-patients of general hospitals
Huang, M., Chen, R., Wei, J., Fritzsche, K., Toussaint, A. C., Zhang, Y., Chen, H., Wu, H., Ma, X., Li, W., et al. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110702 · Cited by 4
Can the Whiteley Index be used to assess health anxiety in adolescents from the general population?
Duholm, C. S., Højgaard, D. R. M. A., Ørnbøl, E., Wellnitz, K. B., Thomsen, P. H., Rimvall, M. K., & Rask, C. U. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111946 · Cited by 3
Cohort profile: The BiCoVac cohort - a nationwide Danish cohort to assess short and long-term symptoms following COVID-19 vaccination
Jensen, C. B., Hansen, K. T., Nielsen, C. M., Hansen, S. N., Nielsen, H. I., Rask, C. U., Fink, P., Dantoft, T. M., Jørgensen, T., Bech, B. H., et al. (2025) · European Journal of Epidemiology · doi:10.1007/s10654-025-01204-1 · Cited by 3
“We used validated questionnaires including the 25-item Bodily Distress Syndrome (BDS) checklist [ 15 ], the Symptom Check-list 13 (SCL-13) [ 16 ], Cohen’s Perceived Stress Scale (PSS) [ 17 , 18], and the Whiteley-6-R scale [19].”
Lifestyle factors as predictors of incident functional somatic disorder. Five-year follow-up of The DanFunD study
Jørgensen, T., Jacobsen, R. K., Petersen, M. W., Bjerregaard, A. A., Schovsbo, S. U., Gormsen, L. K., Eplov, L. F., Linneberg, A. R., Fink, P., Benros, M. E., et al. (2024) · Scandinavian Journal of Public Health · doi:10.1177/14034948241283545 · Cited by 3
“The BDS concept is defined by the 25-item BDS checklist [17], and comprises four symptom clusters: cardiopulmonary, gastrointestinal, musculoskeletal and general symptoms.”
Infancy predictors of Functional Somatic Symptoms in pre- and late adolescence: a longitudinal cohort study
Münker, L., Rimvall, M. K., Frostholm, L., Ørnbøl, E., Wellnitz, K. B., Jeppesen, P., Rosmalen, J. G. M., & Rask, C. U. (2024) · European Journal of Pediatrics · doi:10.1007/s00431-024-05850-7 · Cited by 2
“At age 16–17, the Bodily distress syndrome (BDS) 25-checklist [45] was used to assess FSS.”
Understanding General Somatic Symptom Burden: Insights from a Systematic Review of Factor Analyses Pertaining to the Patient Health Questionnaire 15 (PHQ-15) and Somatic Symptom Scale 8 (SSS-8)
Hybelius, J., Kosic, A., Salomonsson, S., Wachtler, C., Wallert, J., Nordin, S., & Axelsson, E. (2025) · International Journal of Behavioral Medicine · doi:10.1007/s12529-025-10365-y · Cited by 2
Are Sexual Assaults Related to Functional Somatic Disorders? A Cross-Sectional Study
Jacobsen, S. A., Frostholm, L., Buhmann, C., Petersen, M. W., Ørnbøl, E., Dantoft, T. M., Bjerregaard, A. A., Eplov, L. F., & Carstensen, T. B. W. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20206947 · Cited by 2
“FSD was measured with the 25-item Bodily Distress checklist [48,49], which is a self-report measure to assess symptoms from four clusters (cardiopulmonary, gastrointestinal, musculoskeletal, and general/fatigue symptoms) experienced during the last 12 months.”
Method
Efficacy of patient education and duloxetine, alone and in combination, for patients with multisystem functional somatic disorder: Study protocol for the EDULOX trial
Jespersen, C. P., Pedersen, H. F., Kleinstäuber, M., Fink, P., Wellnitz, K. B., Ørnbøl, E., Schröder, A., Agger, J. L., Vase, L., Finnerup, N. B., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107524 · Cited by 2
Is development and persistence of multiple physical symptoms associated with coping? A longitudinal study over a decade
Raasthøj, I., Jarbøl, D. E., Rasmussen, S., Carstensen, T. B. W., & Rosendal, M. (2024) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2024.10.005 · Cited by 2
Validity and responsiveness of GHC-index in patients with amalgam-attributed health complaints
Lamu, A. N., Robberstad, B., Hamre, H. J., Alræk, T., Musial, F., & Bjorkman, L. L. (2021) · Acta Odontologica Scandinavica · doi:10.1080/00016357.2021.1989032 · Cited by 2
A multicenter study of bodily distress syndrome in Chinese outpatient hospital care: prevalence and associations with psychosocial variables
Ma, J., Zheng, L., Chen, R., Ren, J., Chen, H., Zhang, Y., Li, W., Ma, X., Lu, W. D., Wu, H., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04342-y · Cited by 2
Fibromyalgia revisited: do latent class analyses of symptom profiles in the general population confirm 2016 fibromyalgia diagnostic criteria?
Schmalbach, B., Häuser, W., Brähler, E., Henningsen, P., & Wolfe, F. (2021) · Clinical and Experimental Rheumatology · doi:10.55563/clinexprheumatol/bexjsm · Cited by 1
The Relationship Between Childhood Traumatic Experiences and Bodily Distress Syndrome: The Mediating Role of Somatoform Dissociation
Doustmohammadi, F., Tavoli, A., Reshvanloo, F. T., & Abaszad, A. (2024) · The Journal of Genetic Psychology · doi:10.1080/00221325.2024.2315932 · Cited by 2
“Cronbach’s alpha was reported for the four groups of symptoms as 0.83, 0.82, 0.86, and 0.82 (in the respective order mentioned in this paragraph) and as 0.92 for all the items together (Budtz-Lilly et al., 2015).”
Influential
Post-acute non-specific symptoms following COVID-19 vaccination: a Danish population-based study
Jensen, C. B., Hansen, K. T., Bech, B. H., Hansen, S. N., Nielsen, H. I., Rask, C. U., Fink, P., Dantoft, T. M., Jørgensen, T., Labrecque, J. A., et al. (2025) · International Journal of Epidemiology · doi:10.1093/ije/dyaf173 · Cited by 1
Recruiting patients with persistent physical symptoms and no specific diagnosis for clinical trials in primary care: a qualitative study of four scenarios
Frumer, M., Andersen, J. H., Rask, M. T., Frostholm, L., & Rosendal, M. (2025) · Primary Health Care Research & Development · doi:10.1017/s1463423625100583 · Cited by 1
Healthcare use and costs of functional somatic disorder in Denmark: a population-based cohort study (DanFunD)
Petersen, M. W., Wellnitz, K. B., Oernboel, E., Carstensen, T. B. W., Dantoft, T. M., Bjerregaard, A. A., Joergensen, T., & Fink, P. (2025) · BMJ Public Health · doi:10.1136/bmjph-2025-003318 · Cited by 1
“Individuals with FSD were identified with the self-reported Bodily Distress Syndrome Checklist, 26 including bothersome physical symptoms within the last 12 months.”
Who benefits from multidisciplinary care in functional somatic disorders? Identifying cost-effective patient selection through diagnostic classification groups
Hammerman, O., Rasooly, A., Greenberg, D., Kushnir, T., Yaakobi, E., & Ezra, Y. (2026) · Israel Journal of Health Policy Research · doi:10.1186/s13584-026-00750-7 · Cited by 1
“[1, 39, 42] Three categories emerged from the FSD assessing how likely symptoms are to persist, impacting patients’ quality of life and HUC [43] (1) Multi-system FSD (also termed “symptom disorder”): patients experiencing multiple persistent symptoms across different physiological systems causing…”
Measuring ICD-11 bodily distress disorder symptoms: The development and initial validation of the bodily distress inventory (BoDI)
Levin, Y., Rahamim, T., Bachem, R., Hyland, P., Karatzias, T., Ben‐Ezra, M., & Shevlin, M. E. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.03.020 · Cited by 1
Acute symptoms and subsequent post-acute symptoms following COVID-19 vaccination: A Danish population-based study
Jensen, C. B., Sørensen, A. S., Hansen, K. T., Hansen, S. N., Josiasen, M., Marc, A. H. L., Gram, S. A., Fahnøe, C. L., Nielsen, H., Rask, C. U., et al. (2026) · Public Health · doi:10.1016/j.puhe.2026.106429 · Cited by 1

Authors: Budtz-Lilly, A., Fink, P., Ørnbøl, E., Vestergaard, M., Moth, G., Christensen, K. S., & Rosendal, M.
Affiliations: Aarhus University (DK)
Aarhus University Hospital (DK)
Corresponding author: Budtz-Lilly, Anna
ORCID: Fink, Per
Ørnbøl, Eva
Vestergaard, Mogens
Moth, Grete
Christensen, Kaj Sparle
Rosendal, Marianne
Venue: Journal of Psychosomatic Research
Publisher: Elsevier BV
Published: 2015-06
Volume: 78
Issue: 6
Pages: 536-545
ISSN: 0022-3999 (ISSN-L)
DOI: 10.1016/j.jpsychores.2015.03.006
OpenAlex: W2086815936
Cited by: 129
References: 38
Citations by year: 2026: 13 · 2025: 15 · 2024: 24 · 2023: 7 · 2022: 12 · 2021: 14 · 2020: 13 · 2019: 6 · 2018: 5 · 2017: 10 · 2016: 6 · 2015: 4
FWCI: 6.76
Type: journal article
Language: en
Open access: green
pure.au.dk
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychosomatic Research (publishedVersion)
PubMed (publishedVersion)
Funders: Health Research Fund of the Central Denmark Region (1-5-72-4-09)
Committee for Quality Improvement and Continuing Medical Education in the Central Denmark Region (1-30-72-270-08)
Lundbeck Foundation (R155-2012-11280)
TrygFonden (FL-48)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Keywords: bodily distress syndrome, functional symptoms, functional disorders, psychometric validation, questionnaire development, symptom groups, case finding, primary care patients, general practice, symptom severity classification, cardiopulmonary symptoms, gastrointestinal symptoms, musculoskeletal symptoms
MeSH terms: Adult, Cardiovascular System, Cross-Sectional Studies, Denmark, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Musculoskeletal System, Primary Health Care, Psychometrics, Surveys and Questionnaires, Respiratory System, Syndrome, Reproducibility of Results, Gastrointestinal Tract, Checklist, General Practice

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A new questionnaire to identify bodily distress in primary care: the 'BDS checklist

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