Ascertaining the size of the symptom iceberg in a UK-wide community-based survey

Anne McAteer, Alison M Elliott, Philip C Hannaford

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The symptom iceberg describes the phenomenon that most symptoms are managed in the community without people Seeking professional health care. The size of the iceberg for many symptoms is unknown, as is their association with personal characteristics, including history of a chronic disease.


To ascertain the size of the symptom iceberg in the UK.

Design of study

A UK-wide community-based postal survey.


Urban and rural communities across the UK.


A postal survey was sent to an age- and sex-stratified random sample of 2474 adults, aged 18-60 years, drawn from 20 practices around the UK. Questions were aimed at investigating adults' experiences of 25 different symptoms in the previous 2 weeks.


The number of symptoms experienced by one individual in the previous 2 weeks ranged from 0 to 22 (mean 3.66). Of the symptoms examined, the three most common were: feeling tired/run down; headaches; and joint pain. Univariate analysis found symptom prevalence to be significantly associated with a wide range of participant characteristics. However, after adjustment, many of these associations no longer remained significant for a number of the symptoms. Presence of a chronic condition, age, and employment status were the three factors most commonly associated with the 2-week prevalence of symptoms. Reported symptom characteristics (severity, duration, interference, and time off work) varied little by sex or age.


Symptoms in the UK community are common. Symptom prevalence was associated with a number of participant characteristics, although the extent of this association was less than has been reported in previous research. This study provides an important current baseline prevalence of 25 symptoms in the community for those who do, and do not, have a chronic condition.
Original languageEnglish
Pages (from-to)e1-e11
Number of pages11
JournalThe British Journal of General Practice
Issue number582
Early online date27 Dec 2010
Publication statusPublished - Jan 2011


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