High Somatic Symptom Severity Research Articles

Somatic symptom severity association with healthcare utilization and costs in surgical inpatients with an episode of abdominal pain.

BackgroundSomatic syndromes are present in 30 per cent of primary healthcare populations and are associated with increased health service use and health costs. Less is known about secondary care surgical inpatient populations.MethodsThis was a prospective longitudinal cohort study (n = 465) of consecutive adult admissions with an episode of non-traumatic abdominal pain, to the Acute General Surgical Unit at a tertiary hospital in New South Wales, Australia. Somatic symptom severity (SSS) was dichotomized using the Patient Health Questionnaire (PHQ)-15 with a cut-off point of 10 or higher (medium–high SSS) and compared pre-admission and during admission. Total healthcare utilization and direct costs were stratified by a PHQ-15 score of 10 or higher. Linear regression was used to examine differences in costs, and a multivariable linear regression was used to examine the relationship of PHQ-15 scores of 10 or higher to total costs, reported as mean total costs of care and percentage difference (95 per cent confidence intervals).ResultsFifty-two per cent (n = 242) of participants had a medium–high SSS with greater pre-admission and admission interval health service costs. Mean total direct costs of care were 25 per cent (95 per cent c.i. 8 to 44 per cent) higher in the PHQ-15 score of 10 or higher group: mean difference €1401.93 (95 per cent c.i. €512.19 to €2273.67). The multivariable model showed a significant association of PHQ-15 scores of 10 or higher (2.1 per cent; 0.2–4.1 per cent greater for each one-point increase in score) with total hospital costs, although the strongest contributions to cost were older age, operative management, and lower socioeconomic level. There was a linear relationship between PHQ scores and total healthcare costs.ConclusionsMedium to high levels of somatic symptoms are common in surgical inpatients with abdominal pain and are independently associated with greater healthcare utilization.

The relationship of cortical activity induced by pain stimulation with clinical and cognitive features of somatic symptom disorder: A controlled functional near infrared spectroscopy study

ObjectiveThe neurobiological correlates of Somatic Symptom Disorder (SSD) introduced in the DSM-5 has been the focus of a limited investigation. We aimed to examine the cortical response to painful stimuli and its relationship to symptom severity as well as cognitive and psychological characteristics in proposed models of somatoform disorders. MethodsWe measured hemodynamic responses by 52-channel functional near-infrared spectroscopy. We compared the cortical response to painful stimuli in index patients with SSD (N = 21) versus age, and gender matched healthy control subjects (N = 21). We used brush stimulation as the control condition. We analyzed the relationship of cortical activity with SSD symptom severity as well as somatosensory amplification (SSA), alexithymia, dysfunctional illness behaviour, worry, and neuroticism. ResultsPatients with SSD had higher somatic symptom severity, SSA, alexithymia, neuroticism, illness-related worry, and behaviour. Somatic symptom severity was predicted by a model including SSA and subjective feeling of pain in the index patients. Activity in the left-angular and right-middle temporal gyri was higher in the SSD subjects than the controls during pain stimulation. Positive correlations were detected between mean pain threshold levels and left middle occipital gyrus activity, as well as between SSA-scores and right-angular gyrus activity during pain condition in the index patients with SSD. ConclusionWe present the first evidence that representation of pain in terms of cortical activity is different in subjects with SSD than healthy controls. SSA has functional neuroanatomic correlates and predicts symptom severity in SSD and therefore is involved as a valid intermediate phenotype in SSD pathophysiology.

Associations of Internet Addiction Severity With Psychopathology, Serious Mental Illness, and Suicidality: Large-Sample Cross-Sectional Study.

BackgroundInternet addiction has become a major global concern and a burden on mental health. However, there is a lack of consensus on its link to mental health outcomes.ObjectiveThe aim of this study was to investigate the associations between internet addiction severity and adverse mental health outcomes.MethodsFirst-year undergraduates enrolled at Sichuan University during September 2015, 2016, 2017, and 2018 were invited to participate in the current study survey, 85.13% (31,659/37,187) of whom fully responded. Young’s 20-item Internet Addiction Test, Patient Health Questionnaire-15, Patient Health Questionnaire-9, Symptom Checklist 90, Six-Item Kessler Psychological Distress Scale, and Suicidal Behaviors Questionnaire-Revised were used to evaluate internet addiction, four psychopathologies (high somatic symptom severity, clinically significant depression, psychoticism, and paranoia), serious mental illness, and lifetime suicidality.ResultsThe prevalence of students with mild, moderate, and severe internet addiction was 37.93% (12,009/31,659), 6.33% (2003/31,659), and 0.20% (63/31,659), respectively. The prevalence rates of high somatic symptom severity, clinically significant depression, psychoticism, paranoid ideation, and serious mental illness were 6.54% (2072/31,659), 4.09% (1294/31,659), 0.51% (160/31,659), 0.52% (165/31,659), and 1.88% (594/31,659), respectively, and the lifetime prevalence rates of suicidal ideation, suicidal plan, and suicidal attempt were 36.31% (11,495/31,659), 5.13% (1624/31,659), and 1.00% (315/31,659), respectively. The prevalence rates and odds ratios (ORs) of the four psychopathologies and their comorbidities, screened serious mental illness, and suicidalities in the group without internet addiction were much lower than the average levels of the surveyed population. Most of these metrics in the group with mild internet addiction were similar to or slightly higher than the average rates; however, these rates sharply increased in the moderate and severe internet addiction groups. Among the four psychopathologies, clinically significant depression was most strongly associated with internet addiction after adjusting for the confounding effects of demographics and other psychopathologies, and its prevalence increased from 1.01% (178/17,584) in the students with no addiction to 4.85% (582/12,009), 24.81% (497/2,003), and 58.73% (37/63) in the students with mild, moderate, and severe internet addiction, respectively. The proportions of those with any of the four psychopathologies increased from 4.05% (713/17,584) to 11.72% (1408/12,009), 36.89% (739/2003), and 68.25% (43/63); those with lifetime suicidal ideation increased from 24.92% (4382/17,584) to 47.56% (5711/12,009), 67.70% (1356/2003), and 73.02% (46/63); those with a suicidal plan increased from 2.59% (456/17,584) to 6.77% (813/12,009), 16.72% (335/2003), and 31.75% (20/63); and those with a suicidal attempt increased from 0.50% (88/17,584) to 1.23% (148/12,009), 3.54% (71/2003), and 12.70% (8/63), respectively.ConclusionsModerate and severe internet addiction were strongly associated with a broad group of adverse mental health outcomes, including somatic symptoms that are the core features of many medical illnesses, although clinically significant depression showed the strongest association. This finding supports the illness validity of moderate and severe internet addiction in contrast to mild internet addiction. These results are important for informing health policymakers and service suppliers from the perspective of resolving the overall human health burden in the current era of “Internet Plus” and artificial intelligence.

Internet addiction severity and risk for psychopathology, serious mental illness, and suicidalities: a cross-sectional study

BackgroundInternet addiction is a major global concern and health burden, compounded by the advances of Internet Plus and artificial intelligence. There is controversy on the question of recognising some types of internet addiction as mental illness, largely because there is no consensus on its link to mental health outcomes. We investigated the associations between internet addiction severity and several mental health outcomes including four psychopathologies, serious mental illness, and suicidalities. MethodsIn this cross-sectional study, all first-year undergraduate students enrolled in Sichuan University (Chengdu, China) during 2015–18 were invited to participate in the study survey. Participants were required to finish the whole questionnaire (online) by Oct 31 of their enrolment year. We excluded participants who did not respond completely, did not complete the questionnaire by the deadline, were not aged 15–23 years, or who provided obviously dishonest information (eg, selecting the same choice for all questions or several users having the same unique ID). The severities of internet addiction were categorised using Young's 20-item internet addiction test (normal 0–30 points, mild 31–49, moderate 50–79, and severe 80–100). The four psychopathologies were defined according to the recommended cutoff points of the 15-item Patient Health Questionnaire (high somatic symptom severity), the 9-item Patient Health Questionnaire (clinically significant depression), and the Symptom Checklist-90 (psychoticism and paranoia). Serious mental illness was screened using the 6-item Kessler Psychological Distress Scale (cutoff 12–13 points), and lifetime suicidal ideation, planning, and attempts were measured with the Suicidal Behaviours Questionnaire-Revised. Prevalence among student demographics or internet addiction severity groups was compared with the χ2 test, adjusted odds ratios (ORs) of mental health outcomes in addiction severity groups were compared using binary logistic regression adjusted for demographic confounders (ie, age, sex, and enrolment year), and interactions between psychopathologies were assessed using a two-tailed alpha of 0·05. Findings37 187 undergraduate students enrolled in the university during the study years. 34 140 (91·8%) of them agreed to participate and accessed the online survey system, and 32 269 (86.8%) responded fully. 12 254 (38·0%) students had mild internet addiction, 2057 (6·4%) had moderate addiction, and 67 (0·2%) had severe addiction. The prevalence and risks of the four psychopathologies and their comorbidities, serious mental illness, and suicidalities increased significantly with internet addiction severity (p values from 0·0003 to <0·0001), and most increments in risk were large (ORs increasing more than four times, except for suicidalities) for students with moderate and severe internet addiction. Prevalence of clinically significant depression, most strongly associated with internet addiction after adjustment for demographics and psychopathologies, increased from 1·0% (95% CI 0·9–1·2) for students with no addiction to 4·9% (4·5–5·3) for those with mild addiction, 24·8% (22·9–26.7) for those with moderate addiction, and to 56·7% (44·5–68·9) for those with severe addiction. Risk for the three addiction groups compared with the no-addiction group increased accordingly (OR 4·2 [95% CI 3·6–5·0] for mild, 18·9 [15·7–22·9] for moderate, and 59·9 [33·5–107·2] for severe addiction). Prevalence of the four psychopathologies increased from 4.1% (3·8–4·4) in students with no addiction to 36.8% (34·7–38·9) in those moderately addicted and to 67.2% (55·6–78·7) for those severely addicted. Similarly, prevalence increased from 25.0% (24·4–25·6) to 67·5% (65·6–69·6) and 71·6% (60·6–82·7) for suicidal ideation, from 2·6% (2·4–2·8) to 16·5% (14·9–18·1) and 32·8% (21·3–44·4) for suicidal plans, and from 0·5% (0·4–0·6) to 3·6% (1·1–1·5) and 11·9% (4·0–20·0) for suicidal attempts. InterpretationOur study format does not allow us to identify possible causal relationships between internet addiction and mental health comorbidities, but allows us to compare the prevalence and risk of these outcomes through our large population size (to our knowledge, the largest to date in such a study) and methodology. Internet addiction was strongly associated with several adverse mental health outcomes, supporting the validity of defining moderate and severe, but not mild, internet addiction as mental illness. FundingNational Scientific and Technical Fund of China (grant 81571305), Department of Science and Technology of Sichuan Provincial Government (grant 2019YFS0153), and 1.3.5 Project for Disciplines of Excellence, West China Hospital.

25 Hydroxyvitamin D levels, quality of life, and disability in long-standing patients of somatization.

Introduction:Somatization disorder is a debilitating condition, in which patients have multiple physical complaints with no explained cause and no relief even after consultations.Aim:The present study examined the association of 25-hydroxyvitamin D (25[OH]D) levels, quality of life, disability, and symptom profile in long standing with somatization disorder.Methods:One-hundred three patients of somatization disorder suffering for ≥2 years, visiting psychiatry outpatient clinic during two consecutive summer season (April to June) of 2015–2016 were recruited. Symptom profile was studied using Patient-Health-Questionnaire (PHQ-15) items (somatic symptoms), PHQ-9 items (depressive symptoms), Generalized Anxiety Disorder-7 (GAD-7) item (anxiety symptoms).quality of life was assessed using the World Health Organization Quality of Life BREF 26 item, and disability measure was World Health Organization Disability Assessment Schedule (WHODAS) 2.0. 25(OH) D levels were estimated using chemiluminescence binding assay.Results:The poor quality of life in somatization disorder was significantly associated with disability, symptom profile using PHQ-15, PHQ-9, and GAD-7. 25(OH)D levels were deficient in 56.31% of the study population.Conclusion:The high somatic symptom severity in majority of patients suffering from somatization disorder needs more attention from psychiatrists across cultures so that functional status and quality of life can be improved. Routine estimation of Vitamin D levels and correction of its deficiency may bring about symptomatic relief at an early stage, thereby reducing the morbidity associated with the disorder.

Emotional distress and dysfunctional illness perception are associated with low mental and physical quality of life in Chinese breast cancer patients

BackgroundTo evaluate the relationship between quality of life (QOL) and physical as well as psychological variables in Chinese breast cancer patients.MethodsThis multicenter cross-sectional study enrolled 254 Chinese breast cancer patients in different stages and treatment phases. They answered standard instruments assessing QOL (EORTC), somatic symptom severity (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health-related anxiety (WI-7), illness perception (BIPQ), and sense of coherence (SOC-9). Canonical correlation was applied to identify the strongest correlates between the physical, emotional and social QOL scales and the physical and psychological variables.ResultsIn our sample, a low global QOL was significantly associated with the following physical and psychological variables: symptom-related disability (Karnofsky Index) (r = .211, p < .01), somatic symptom severity (r = −.391, p < .001), depression (r = −.488, p < .001), anxiety (r = −.439, p < .001), health-related anxiety (r = −.398, p < .001), dysfunctional illness perception (r = −.411, p < .001), and sense of coherence (r = .371, p < .001). In the canonical correlation analysis, high somatic symptom severity, depression, anxiety, dysfunctional illness perception, and low sense of coherence showed the strongest correlations with low physical, emotional and social functioning. The first three significant canonical correlations between these two sets of variables were .78, .56, and .45.ConclusionsQOL in Chinese breast cancer patients is strongly associated with psychological factors. Our results suggest that Chinese physicians and nurses should incorporate these factors into their care for women with breast cancer to improve patients’ QOL.

Prevalence and strong association of high somatic symptom severity with depression and anxiety in a Chinese inpatient population.

The prevalence of the high somatic symptom severity (HSSS) and its associations with sociodemographic factors, depression, and anxiety has not been surveyed in inpatient populations at general hospitals. A sample including 1329 inpatients in a Chinese general hospital was surveyed using Chinese version of 15-item patient health questionnaire (PHQ-15), 9-item patient health questionnaire, and generalized anxiety disorder 7-item scale. A total of 27.8% (n=369) of the participants had HSSS (PHQ-15≥10). The multivariate regression showed that HSSS was significantly associated with depression (adjusted odds ratio [aOR], 5.219), anxiety (aOR, 5.810), or depression or anxiety (aOR, 5.338) but neither with sex, age, marital status, education status, household income, nor 7 kinds of physical disease systems. The symptom profile and high prevalence of HSSS, and its association with clinically significant depression and anxiety in this inpatient population were mostly consistent to that documented by studies in other populations.

Physical and psychological correlates of high somatic symptom severity in Chinese breast cancer patients.

We researched associations between somatic symptom severity (SSS), and physical and psychological factors in Chinese breast cancer patients. This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (Patient Health Questionnaire [PHQ]-15), depression (PHQ-9), anxiety (General Anxiety Disorder [GAD]-7), health anxiety (Whiteley-7 [WI-7]), illness perception (Brief-Illness Perception Questionnaire [IPQ]), illness attribution (Illness Perception Questionnaire-Revised [IPQ-R]), and sense of coherence (Sense of Coherence [SOC]-9). Logistic regression was applied to identify the strongest correlates with SSS. Our sample of high (PHQ-15≥10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r=0.339, P<.001), symptom-related disability (Karnofsky Index) (r=0.182, P<.001), depression (r=0.556, P<.001), anxiety (r=0.433, P<.001), health anxiety (r=0.400, P<.001), illness perception (r=0.349, P<.001), psychological illness attributions (r=0.217, P<.01), and sense of coherence (r=-0.254, P<.001). In an adjusted stepwise multiple binary logistic regression analysis, higher health anxiety (WI-7, B=0.388, P=.002), higher depression (PHQ-9, B=0.158, P<.001), younger age (B=-0.042, P=.048), higher impairment in daily life (B=1.098, P=.010), and longer symptom duration (Wald=18.487, P=.001) showed a significant association with high SSS; the model explained 55.1% of the variance. High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, SSD concept in cancer patients and to better operationalize psychobehavioral factors in this patient group.

Validation of the Chinese version of the PHQ-15 in a tertiary hospital.

BackgroundThis study aimed to investigate the reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-15) in a tertiary hospital.MethodsUsing a cross-sectional study design, the Chinese version of the PHQ-15 was administered to a total of 1329 inpatients. To examine the discriminant validity of this questionnaire, we investigated the correlation of the PHQ-15 score with sociodemographic data and the PHQ-9 and GAD-7 scale scores. Exploratory factor analysis was performed to assess the internal consistency of the PHQ-15. To evaluate the consistency of this questionnaire with item response theory (IRT), IRT analysis was performed.ResultsThe Chinese version of the PHQ-15 showed good reliability (Cronbach’s alpha = 0.83). The correlations of the PHQ-15 scores with the PHQ-9 depression scale scores (r = 0.565) and the GAD-7 anxiety scale scores (r = 0.512) were moderate; these results suggested that the PHQ-15 had discriminant validity. We identified three factors, referred to as “cardiopulmonary,” “gastrointestinal,” and “pain/neurological,” which explained 56 % of the total variance. A second-order factor analysis including these three factors produced an acceptable model. Several items (4, 8 and 11) displayed extreme floor effects. Additionally, item 4 displayed a very small variance of 0.35 and showed very small differences in its thresholds based on IRT analysis.ConclusionsThe PHQ-15 scale had good reliability and high validity to detect patients with high somatic symptom severity in a Chinese tertiary hospital. Several of the current findings were consistent with previous research on the PHQ-15 in Western countries and in China. To improve the diagnostic quality of this questionnaire, items 4, 8 and 11 can be omitted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0798-5) contains supplementary material, which is available to authorized users.

Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China

Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China

Quality of doctor–patient relationship in patients with high somatic symptom severity in China

Quality of doctor–patient relationship in patients with high somatic symptom severity in China

Quality of doctor–patient relationship in patients with high somatic symptom severity in China

High somatic symptom severity (SSS) is associated with reduced health-related function and may affect doctor-patient interactions. This study aimed to explore the quality of the doctor-patient relationship (DPR) and its association with SSS in Chinese general hospitals outpatients. This multicenter cross-sectional study assessed the quality of DPR from both the doctor's and patient's perspective in general outpatients (n=484) from 10 departments of Psychosomatic Medicine (PM), Traditional Chinese Medicine (TCM), and Biomedicine (BM). SSS was assessed with the PHQ-15. The quality of the DPR was measured with the CARE, PDRQ-9, and DDPRQ-10 questionnaires. In addition, several standard instruments were used to assess psychosocial variables such as depression, anxiety, sense of coherence and quality of life. From the doctor's perspective, patients with high SSS were rated as significantly more difficult than patients with low SSS. No differences were noted from the perspective of the patients. Patients from the TCM department rated the quality of their DPR significantly higher than those in BM and PM and were rated from doctor's perspective as less difficult than those in BM and PM. Multiple regression analysis revealed satisfaction of treatment, time of treatment and psychosocial variables, such as age, health related anxiety, depression, mental quality of life and sense of coherence as predictors for DPR. PM and BM departments should learn from TCM departments to be empathic, to manage patients with high SSS and to establish long-term relationships with their patients.

Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China

ObjectiveIn primary care populations in Western countries, high somatic symptom severity (SSS) and low quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients. MethodsThis multicentre cross-sectional study enrolled 404 patients from 10 outpatient departments, including Neurology, Gastroenterology, Traditional Chinese Medicine [TCM] and Psychosomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15<10, n=203, SOM−) were compared to patients who reported high SSS (PHQ-15≥10, n=201, SOM+). ResultsAs compared to SOM− patients, SOM+ patients showed significantly more frequently adverse psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS was significantly associated with “catastrophising” and “illness vulnerability”; low physical QoL was associated with “avoidance of physical activities” and “disuse of body parts”; low mental QoL was associated with “need for immediate medical help.” ConclusionIn accordance with the results from Western countries, high SSS was associated with negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.

Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia

PurposeTo describe and evaluate somatic symptoms in patients with rheumatoid arthritis (RA) and fibromyalgia, determine the relation between somatization syndromes and fibromyalgia, and evaluate symptom data in light of the Diagnostic and Statistical Manual-5 (DSM-5) criteria for somatic symptom disorder.MethodsWe administered the Patient Health Questionnaire-15 (PHQ-15), a measure of somatic symptom severity to 6,233 persons with fibromyalgia, RA, and osteoarthritis. PHQ-15 scores of 5, 10, and 15 represent low, medium, and high somatic symptom severity cut-points. A likely somatization syndrome was diagnosed when PHQ-15 score was ≥10. The intensity of fibromyalgia diagnostic symptoms was measured by the polysymptomatic distress (PSD) scale.Results26.4% of RA patients and 88.9% with fibromyalgia had PHQ-15 scores ≥10 compared with 9.3% in the general population. With each step-wise increase in PHQ-15 category, more abnormal mental and physical health status scores were observed. RA patients satisfying fibromyalgia criteria increased from 1.2% in the PHQ-15 low category to 88.9% in the high category. The sensitivity and specificity of PHQ-15≥10 for fibromyalgia diagnosis was 80.9% and 80.0% (correctly classified = 80.3%) compared with 84.3% and 93.7% (correctly classified = 91.7%) for the PSD scale. 51.4% of fibromyalgia patients and 14.8% with RA had fatigue, sleep or cognitive problems that were severe, continuous, and life-disturbing; and almost all fibromyalgia patients had severe impairments of function and quality of life.ConclusionsAll patients with fibromyalgia will satisfy the DSM-5 “A” criterion for distressing somatic symptoms, and most would seem to satisfy DSM-5 “B” criterion because symptom impact is life-disturbing or associated with substantial impairment of function and quality of life. But the “B” designation requires special knowledge that symptoms are “disproportionate” or “excessive,” something that is uncertain and controversial. The reliability and validity of DSM-5 criteria in this population is likely to be low.

Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease

ObjectiveSomatic symptoms are widespread in clinical practice. The association of somatic symptom severity with impaired health status holds both when symptoms are medically unexplained and when they are medically explained. The role of personality dimensions in the formation of somatic symptoms in patients with established, chronic diseases when compared to healthy participants had not been investigated prior to this study. MethodsIn samples of 411 healthy subjects and 810 participants with any of 9 established, chronic medical conditions, we measured psychological distress (SCL-90-R), personality traits (Zuckerman–Kuhlman Personality Questionnaire), defensive profiles (Defense Style Questionnaire), individual defenses (Life Style Index) and hostility features (Hostility and Direction of Hostility Questionnaire). Hierarchical multivariate models were used to assess the independent associations between personality dimensions and somatic symptom severity in both samples. The SCL-90-R somatization scale served as the outcome variable. ResultsIn both samples, older age, less education, higher neuroticism, adoption of the displacement defense and depressive symptoms were independently and positively associated with somatic symptom severity. Higher somatic symptom severity was also associated with more “introverted” features (i.e., the self-sacrificing defensive style and self-criticism) among participants with established, chronic medical conditions. ConclusionsThese data suggest that similar personality traits and defense mechanisms are associated with somatic symptom severity in health and disease, indicating that somatic symptoms are not simply consequences of having a medical condition. The specific associations of the self-sacrificing defensive profile and self-criticism with somatic symptom severity in the patient sample may have important clinical implications.

Negative illness perceptions associated with low mental and physical health status in general hospital outpatients in China

In western countries, negative illness perceptions are associated with poor health status and affect health outcomes in primary care populations. The aim of this study is to examine the relationship between illness perception and mental and physical health status in general hospital outpatients in China. This multicentre, cross-sectional study analysed a total of 281 consecutive patients from four general hospital outpatient departments of internal medicine and traditional Chinese medicine in Beijing and Kunming. The patients answered questionnaires concerning illness perception (Brief-IPQ), somatic symptom severity (Patient Health Questionnaire-15), illness behaviour (Scale for the Assessment of Illness Behaviour), emotional distress (Hospital Anxiety and Depression Scale) and health-related quality of life (Twelve-Item Short Form Health Survey). Negative illness perception, especially negative emotional reactions, perceived illness consequences, encumbering illness concerns, and strong illness identity were significantly associated with high emotional distress, impairing illness consequences, and a low mental and physical quality of life. Using a multiple linear regression model, five strongest correlates of negative illness perception were high anxiety, seeking diagnosis verification, low mental and physical quality of life and high somatic symptom severity. The variance explained by this model was 35%. Chinese general hospital outpatients showed associations between negative illness perceptions and poor mental and physical health status that were similar to those of primary care patients in western countries. The main difference was that no association with perceived illness control was found in Chinese patients. Chinese physicians should be sensitised to their patients’ negative illness perceptions and should focus on helping patients cope with uncertainty and anxiety by providing an understandable illness model and increasing control beliefs.

Affective temperaments and ego defense mechanisms associated with somatic symptom severity in a large sample

BackgroundSeveral complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown. MethodsWe obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable. ResultsAmong 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense. LimitationsThe data was collected from a convenience web-based sample. The study was cross-sectional. There was no information on the presence of established physical illness. ConclusionsAffective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.

Psychological and behavioral variables associated with the somatic symptom severity of general hospital outpatients in China

ObjectiveIn high-income countries, the number and severity of somatic symptoms — irrespective of etiology — are associated with adverse psychobehavioral and functional characteristics. This study aimed to assess these key features among Chinese general hospital outpatients with high levels of somatic symptoms. MethodsThis multicenter, cross-sectional study evaluated four outpatient departments of internal medicine and Traditional Chinese Medicine in Beijing and Kunming and enrolled a total of 281 consecutive patients. The patients answered questionnaires concerning somatic symptom severity [Patient Health Questionnaire (PHQ-15)], illness perception (Brief Illness Perception Questionnaire), illness behavior (Scale for the Assessment of Illness Behavior), emotional distress (Hospital Anxiety and Depression Scale) and health-related quality of life (12-Item Short Form Health Survey). Subsamples reporting high scores of somatic symptom severity (PHQ-15 ≥10, SOM+) versus low scores (PHQ-15 <10, SOM−) were compared. ResultsTwenty-eight percent (79/281) of all outpatients showed high somatic symptom severity. The strongest correlations between high somatic symptom severity and psychobehavioral variables were found for high emotional distress, female gender, living alone, low physical quality of life and high dysfunctional illness behavior. The proportion of the explained variance was 36.1%. ConclusionIn Chinese outpatients, high somatic symptom severity is frequent and associated with psychobehavioral characteristics. With the PHQ-15 cutoff of 10, SOM+ patients could be differentiated from SOM− patients using these characteristics.

Multiple Physical Illnesses Common In Iraq War Veterans With PTSD

Back to table of contents Previous article Next article Professional NewsFull AccessMultiple Physical Illnesses Common In Iraq War Veterans With PTSDAaron LevinAaron LevinSearch for more papers by this authorPublished Online:19 Jan 2007https://doi.org/10.1176/pn.42.2.0004aPosttraumatic stress disorder (PTSD) is closely linked to physical symptoms in soldiers a year after their return from Iraq, even after controlling for wounds or injuries.Combat veterans reporting significant symptoms of either physical illness or PTSD should be evaluated for both conditions, said the latest report on postcombat mental health from the Walter Reed Institute of Research in Silver Spring, Md. The study was published in the January American Journal of Psychiatry.The researchers sur veyed 2,863 soldiers from four U.S. Army combat infantry brigades a year after their return from duty in Iraq. The soldiers were asked about their overall health, as well as alcohol misuse, symptoms of depression and PTSD, sick-call visits, missed work days, and somatic symptoms. Unlike with most screening questionnaires, the soldiers responded anonymously. Soldiers completed the 17-item National Center for PTSD Checklist, the Patient Health Questionnaire Depression Scale–9, and an alcohol screening test. The Patient Health Questionnaire–15 was used to assess somatic symptoms.About 80 percent of the participants were under age 30, 97 percent were male, 56 percent were enlisted personnel, and 17 percent had been injured or wounded.Overall prevalence of PTSD was 16.6 percent. A comparable group of soldiers recorded a prevalence of 5 percent before deployment. However, of those wounded or injured at least once, 31.8 percent (150 of 471) met PTSD criteria, compared with 13.6 percent (311 of 2,287) of unwounded troops (odds ratio=2.97).The veterans who screened positive for PTSD also had poor self-rated health, two or more sick-call visits, and two or more missed workdays even after controlling for combat injuries.About 47 percent of soldiers screening positive for PTSD rated their physical health as fair or poor, compared with 20 percent of those who screened negative. Also, 71 percent of those with PTSD reported sleep problems, compared with 26 percent without PTSD (see chart).“Approximately one-third of the soldiers who screened positive for PTSD had high somatic symptom severity.. .confirming the strong association between PTSD and indicators of physical health independent of physical injury,” wrote Charles Hoge, M.D., and colleagues from Walter Reed.This association may be mediated by biological, psychological, behavioral, or attentional processes, they suggested.The study may be limited by its reliance on self-reports rather than clinician interviews. Although the respondents were not selected randomly, they do represent soldiers who have been most heavily exposed to combat.The results may also be a conservative reflection of the soldiers' health since those who might have been hospitalized or going to medical appointments on the days the surveys were taken were excluded.Physicians and other health professionals in the military services, the Department of Veterans Affairs, and civilian primary and specialty practices should evaluate both the physical and mental health of combat veterans, Hoge and his team concluded.“Association of Posttraumatic Stress Disorder With Somatic Symptoms, Health Care Visits, and Absenteeism Among Iraq War Veterans” is posted at<www.ajp.psychiatryonline.org/cgi/content/full/164/1/150>.▪ ISSUES NewArchived

High prevalence of somatic symptoms and depression in women with disabling chronic headache

To better define, in women with headache, the relationship of depression and somatic symptoms to headache, characterized by diagnoses, frequency, and disability. At six headache specialty clinics, women with headache were classified using ICHD-II criteria, and frequency was recorded. A questionnaire addressing demographics, age at onset of headache, headache-related disability, somatic symptom, and depression severity was completed. Logistic regression was performed to measure the associations of headache frequency and headache-related disability with somatic symptom and depression severity. A total of 1,032 women with headache completed the survey, 593 with episodic (96% with migraine) and 439 with chronic headache (87% with migraine). Low education and household income was more common in chronic headache sufferers and in persons with severe headache disability. Somatic symptom prevalence and severity was greater in persons with chronic headache and with severe headache-related disability. Significant correlation was observed between PHQ-9 and PHQ-15 scores (r = 0.62). Chronic headache, severe disability, and high somatic symptom severity were associated with major depressive disorder (OR = 25.1, 95% CI: 10.9 to 57.9), and this relationship was stronger in the subgroup with a diagnosis of migraine (OR = 31.8, 95% CI: 12.9 to 78.5). High somatic symptom severity is prevalent in women with chronic and severely disabling headaches. Synergistic relationship to major depression exists for high somatic symptom severity, chronic headache, and disabling headache, suggesting a psychobiological underpinning of these associations.