Psychosomatic Symptom Checklist Research Articles

Psychosomatic symptoms and stressful working conditions among Palestinian nurses: a cross-sectional study

Background: High levels of perceived stressful working conditions have been found to have an adverse effect on physical and mental health. Objectives: To examine the associations between self-reported stressful working conditions and Psychosomatic Symptoms (PSS), and to investigate possible gender differences. Methods: The present cross-sectional study comprises 430 nurses employed in Hebron district, Palestine. Self-reported stressful working conditions were recorded, and a Psychosomatic Symptoms Check list was used to assess prevalence of PSS. Findings: Median score on the psychosomatic symptom checklist for the group was 11, (range 1–21). Women reported more symptoms than men, with medians 11.6 and 10.0, respectively (p = .0001). PSS were associated with more self-reported stressful working conditions for both men (p < .0001) and women (p < .0001). The association was strongest among men. Conclusions: PSS were associated with high self-reported stressful working conditions, and this association was strongest among the men.

Su2026 PPI Use and Small Intestinal Bacterial Overgrowth Detected on Lactulose Breath Testing: Results of a Prospective Cross Sectional Study Among U.S. Veterans With Irritable Bowel Syndrome

Background/Aims: Proton Pump Inhibitors (PPIs) have been proposed to be the missing link in the controversy surrounding Small Intestinal Bacterial Overgrowth (SIBO) and Irritable Bowel Syndrome (IBS). Recent studies examining the relationship between PPIs and SIBO have been limited by retrospective analysis and failure to control for confounding factors such as somatization which may be common to both PPI use and SIBO. Consequently, the aims of this prospective cross sectional study were: 1) To calculate adjusted Odds Ratios (ORs) for hydrogen (H2) and methane (CH4) SIBO based upon PPI use 2) To determine the impact of PPI use on Lactulose Breath Testing (LBT) parameters. Methods: 149 nondiabetic veterans (67 PPI users, 82 non-users, 82% male, mean age 45) meeting Rome III IBS criteria undergoing LBT were recruited. Data on IBS subtype and severity (IBS Severity Scoring System), bloating, depression/anxiety (Hospital Anxiety Depression Score) and somatization (Psychosomatic Symptom Checklist) were obtained by questionnaire. Use of PPIs, fiber, laxatives, probiotics, H2-Blockers, anti-cholinergics, diagnoses of GERD and BMI were obtained from the medical record. LBT's were defined as positive using different criteria: 1) Two H2 Peaks (Increase .20 ppm over the baseline by 90 min with a single peak occurring at least 15 min prior to the second peak with a trough after the first peak of . 5ppm) 2) Increase in H2 by . 20 ppm by 90 min. 3) Any CH4 . 5 ppm 4) Rise in CH4 by. 20 ppm by 90 min. Adjusting for confounding factors using logistic regression, adjusted ORs for PPI use and SIBO were calculated. LBT parameters including baseline H2 and CH4, amplitude of rise to first H2 peak (P1), and time to P1 were compared between PPI and non-PPI groups using Wilcoxon rank sum and t-tests. Results: The prevalence of H2-SIBO using Two H2 Peak criteria was 36.9% in PPI vs. 17.9% in Non-PPI groups (p=0.01). Adjusted OR for PPI Use and Two Peak H2-SIBO was 4.3 (95% CI 1.4-12.9, p=0.01). PPI use of . 180 days was found to be associated with Two Peak H2-SIBO with OR 3.2 (95% CI 1.2-8.9, p=0.02). ORs for PPI use and SIBO were not statistically significant using the other H2 or CH4 criteria (Table). Among LBT parameters, there was a trend towards a shorter time to P1 in the PPI group (Fig 1). However, a statistically significant difference was found in time to P1 when comparing PPI use of .180 days vs. , 180 days (58.7 vs. 75.7 min, p=0.02) (Fig 1). Comparisons between PPI vs. Non-PPI groups did not find differences in baseline H2 (0 vs. 0 ppm, p=0.45), CH4 (1 vs.1.2 ppm, p=0.70) or amplitude to P1 (50 vs. 45 ppm, p=0.55). Conclusions: PPI use is associated with an increased prevalence of H2-SIBO on LBT but only when using the Two H2 Peak criteria. This may be caused by an earlier rise in H2 in the proximal small bowel seen with prolonged PPI use. (Table) Adjusted Odds Ratios for PPI Use and SIBO Using Different H2 and CH4 Criteria

Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the VSP-A (Vécu et Santé Perçue de l'Adolescent), a health-related quality of life (HRQoL) instrument for adolescents, in a healthy Brazilian population

BackgroundHealth-related quality of life (HRQoL) assessment, encompassing the adolescents' perceptions of their mental, physical, and social health and well-being is increasingly considered an important outcome to be used to identify population health needs and to provide targeted medical care. Although validated instruments are essential for accurately assessing HRQoL outcomes, there are few cross-culturally adapted tools for use in Brazil, and none designed exclusively for use among adolescents. The Vécu et Santé Perçue de l'Adolescent (VSP-A) is a generic, multidimensional self-reported instrument originally developed and validated in France that evaluates HRQoL of ill and healthy adolescents.PurposeTo cross-culturally adapt and validate the Brazilian-Portuguese version of the VSP-A, a generic HRQoL measure for adolescents originally developed in France.MethodsThe VSP-A was translated following a well-validated forward-backward process leading to the Brazilian version. The psychometric evaluation was conducted in a sample of 446 adolescents (14-18 years) attending 2 public high schools of São Gonçalo City. The adolescents self-reported the Brazilian VSP-A, the validated Psychosomatic Symptom Checklist and socio-demographic information. A retest evaluation was carried out on a sub-sample (n = 195) at a two-week interval.The internal construct validity was assessed through confirmatory factor analysis (CFA), multi-trait scaling analyses, Rasch analysis evaluating unidimensionality of each scale and Cronbach's alpha coefficients. The reproducibility was evaluated by intra-class correlation coefficients (ICC). Zumbo's ordinal logistic regression analysis was used to detect differential item functioning (DIF) between the Brazilian and the French items. External construct validity was investigated testing expected differences between groups using one-way analysis of variance (ANOVA), Mann-Whitney tests and the univariate general regression linear model.ResultsCFA showed an acceptable fit (RMSEA=0.05; CFI=0.93); 94% of scaling success was found for item-internal consistency and 98% for item discriminant validity. The items showed good fit to the Rasch model except 3 items with an INFIT at the upper threshold. Cronbach's Alpha ranged from 0.60 to 0.85. Test-retest reliability was moderate to good (ICC=0.55-0.82). DIF was evidenced in 4 out of 36 items. Expected patterns of differences were confirmed with significantly lower physical, psychological well being and vitality reported by symptomatic adolescents.ConclusionsAlthough DIF in few items and responsiveness must be further explored, the Brazilian version of VSP-A demonstrated an acceptable validity and reliability in adolescents attending school and might serve as a starting point for more specific clinical investigations.

Inconsistent association of esophageal symptoms, psychometric abnormalities and dysmotility

OBJECTIVES: The aim of this study was to characterize the psychometric profiles of symptomatic patients with abnormal esophageal motility and symptomatic patients with normal manometric findings compared to asymptomatic controls. METHODS: A total of 113 patients with abnormal esophageal motility (7 achalasia, 8 diffuse esophageal spasm, 27 nutcracker esophagus, 37 hypertensive lower esophageal sphincter, 21 hypotensive peristalsis, 13 failed peristalsis), 23 symptomatic controls with similar esophageal symptoms but normal manometry, and 27 asymptomatic controls were enrolled. Validated questionnaires assessing depression (Beck Depression Inventory), anxiety (Spielberger State Anxiety Inventory or Trait Anxiety Inventory), and somatization (Psychosomatic Symptom Checklist) were administered to all subjects. RESULTS: Patients with both esophageal symptoms and either hypertensive lower esophageal sphincter, nutcracker esophagus, or hypotensive contractions exhibited increased somatization, acute anxiety, or depression compared to asymptomatic controls but not compared to symptomatic controls. On the other hand, the psychometric profiles of patients with achalasia and diffuse esophageal spasm were strikingly normal. Among esophageal symptoms, chest pain was closely correlated with psychometric abnormalities. CONCLUSIONS: The esophageal symptoms of patients with abnormal esophageal motility may relate to the underlying psychological abnormalities, independent of manometric abnormalities.

Familial Association in Adults With Functional Gastrointestinal Disorders

To evaluate the association between functional gastrointestinal (GI) symptoms and a family history of abdominal pain or bowel problems. A valid self-report questionnaire that records GI symptoms and spouse's and first-degree relatives' history of abdominal pain or bowel troubles and includes the psychosomatic symptom checklist (a measure of somatization) was mailed to an age- and sex-stratified random sample of Olmsted County, Minnesota, residents aged 30 to 64 years. A logistic regression model that adjusted for age, sex, and somatic symptom score was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of a positive family history for each functional GI disorder. Six hundred forty-three (72%) of 892 eligible subjects returned the survey. Reporting a first-degree relative with abdominal pain or bowel problems was significantly associated with reporting of irritable bowel syndrome (OR, 2.3; 95% CI, 1.3-3.9) and dyspepsia (OR, 1.8; 95% CI, 1.05-3.0) but not constipation, diarrhea, or gastroesophageal reflux. The reporting of a spouse with abdominal pain or bowel problems was not associated with any of these disorders. A history of abdominal pain or bowel troubles in first-degree relatives was significantly associated with irritable bowel syndrome and dyspepsia. Whether the familial associations represent similar exposures in a shared environment, heightened familial awareness of GI symptoms (reporting bias), or genetic factors remains to be determined.

Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities.

Symptoms of irritable bowel syndrome (IBS) are reported by 10% of the general population; however, evaluation of traditional risk factors has not provided any insight into the pathogenesis of this condition. The objective of this study was to identify additional risk factors for irritable bowel syndrome. A valid self-report questionnaire that records the gastrointestinal (GI) symptoms required for a diagnosis of IBS, self-reported measures of potential risk factors, and a psychosomatic symptom checklist was mailed to an age-and gender-stratified random sample of Olmsted County, Minnesota residents aged 30-64 yr. A logistic regression model that adjusted for age, gender, and psychosomatic symptom score was used to identify factors significantly associated with IBS. A total of 643 (72%) of 892 eligible subjects returned the survey. IBS symptoms were reported by 12% of the respondents. IBS was significantly associated with use of analgesics (acetaminophen, aspirin, or nonaspirin nonsteroidal antiinflammatory drugs) for reasons other than IBS, reporting a food allergy or sensitivity, and ratings of somatic symptoms. No association was detected for age, gender, body mass index, smoking history, alcohol use, educational level, exposure to pets in the household, or water supply. Among subjects reporting the use of just one type of analgesic, IBS was associated with acetaminophen but not aspirin or nonaspirin nonsteroidal antiinflammatory drugs used alone. The odds of having IBS were higher among subjects reporting more reasons for taking analgesics and intolerance to a higher number of foods. IBS is significantly associated with analgesic use. However, this is confounded by other somatic pain complaints. IBS symptoms are associated with the reporting of many food allergies or sensitivities. The role of food-induced symptoms in IBS requires further investigation.

Risk factors for irritable bowel syndrome: role of analgesics and food sensitivities

OBJECTIVE: Symptoms of irritable bowel syndrome (IBS) are reported by 10% of the general population; however, evaluation of traditional risk factors has not provided any insight into the pathogenesis of this condition. The objective of this study was to identify additional risk factors for irritable bowel syndrome. METHODS: A valid self-report questionnaire that records the gastrointestinal (GI) symptoms required for a diagnosis of IBS, self-reported measures of potential risk factors, and a psychosomatic symptom checklist was mailed to an age- and gender-stratified random sample of Olmsted County, Minnesota residents aged 30–64 yr. A logistic regression model that adjusted for age, gender, and psychosomatic symptom score was used to identify factors significantly associated with IBS. RESULTS: A total of 643 (72%) of 892 eligible subjects returned the survey. IBS symptoms were reported by 12% of the respondents. IBS was significantly associated with use of analgesics (acetaminophen, aspirin, or nonaspirin nonsteroidal antiinflammatory drugs) for reasons other than IBS, reporting a food allergy or sensitivity, and ratings of somatic symptoms. No association was detected for age, gender, body mass index, smoking history, alcohol use, educational level, exposure to pets in the household, or water supply. Among subjects reporting the use of just one type of analgesic, IBS was associated with acetaminophen but not aspirin or nonaspirin nonsteroidal antiinflammatory drugs used alone. The odds of having IBS were higher among subjects reporting more reasons for taking analgesics and intolerance to a higher number of foods. CONCLUSIONS: IBS is significantly associated with analgesic use. However, this is confounded by other somatic pain complaints. IBS symptoms are associated with the reporting of many food allergies or sensitivities. The role of food-induced symptoms in IBS requires further investigation.

Risk factors associated with symptoms of gastroesophageal reflux

BACKGROUND: Although patients with gastroesophageal reflux are often instructed to change their lifestyle, population-based data on the risk factors for reflux in the United States are lacking. METHODS: We performed a cross-sectional study in an age- and gender-stratified random sample of the population of Olmsted County, Minnesota. Residents aged 25 to 74 years were mailed a valid self-report questionnaire that measured reflux symptoms and potential risk factors. Logistic regression was used to estimate the odds ratios (OR) with 95% confidence intervals (CI) for reflux symptoms (heartburn or acid regurgitation) associated with potential risk factors. RESULTS: Overall, 1,524 (72%) of 2,118 eligible subjects responded. A body mass index >30 kg/m 2 (OR = 2.8; CI, 1.7 to 4.5), reporting an immediate family member with heartburn or disease of the esophagus or stomach (OR = 2.6; CI, 1.8 to 3.7), a past history of smoking (OR = 1.6; CI, 1.1 to 2.3), consuming more than seven drinks per week (OR = 1.9; CI, 1.1 to 3.3), and a higher psychosomatic symptom checklist score (OR per 5 units = 1.4; CI, 1.3 to 1.6) were independently associated with frequent (at least weekly) reflux symptoms. CONCLUSION: Obesity is a strong risk factor for gastroesophageal reflux, although the value of weight reduction remains to be proven. That family history was also a risk factor suggests that there may be a genetic component to the disorder.

Relationship Between Social Desirability and Self-Report in Chronic Pain Patients

To examine the relationship between social desirability and self-report in data collected from chronic pain patients. A multidisciplinary pain management center located in a major university medical center. Two hundred persons presenting with chronic pain, including low back, head/neck, and extremity pain. Marlowe-Crowne Social Desirability Scale, Beck Depression Inventory--Short Form, Spielberger Trait Anxiety Inventory, Psychosomatic Symptom Checklist, McGill Pain Questionnaire, Pain Disability Index, Quality of Life Scale, Pain Drawing. Correlations showed that patients with greater social desirability response bias reported less depression and anxiety but higher levels of pain severity. When depression effects were controlled in a regression analysis, social desirability correlated positively with self-reported disability. These results show systematic response patterns associated with social desirability, suggesting that social desirability response biases should be considered in both research and clinical assessments of chronic pain patients.

The utility of the Psychosomatic Symptom Checklist among hospitalized patients

We examined the utility of the Psychosomatic Symptom Checklist in an inpatient medical setting with particular emphasis on the putative ability of the PSC to discriminate psychosomatic from nonpsychosomatic patients. First, 80 hospitalized psychosomatic patients were compared to 80 hospitalized medical patients on the PSC. Second, a sample of 187 psychosomatic patients was studied to examine the relationship among psychosomatic distress, depression, and functional impairment. The results indicate that while psychosomatic patients scored significantly higher than comparable medical patients on the PSC, discriminant analyses indicate that the PSC is not able to identify psychosomatic patients in an inpatient medical setting. Factor analyses and correlations show that the PSC is positively related to increased depression and decreased functional status. Results are interpreted in light of current psychosomatic theory.

A preliminary comparison of healthy elderly and young adults on the sunya revision of the psychosomatic symptom checklist

Elderly ( n = 30) and young ( n = 30) subjects, equated in terms of general physical health, education and depression, were compared in terms of Total, Frequency and Intensity scores on the psychosomatic symptom checklist (PSC). Elderly subjects scored significantly lower than young subjects for both PSC Total and PSC Intensity scores. These results call into question the practice of aggregating PSC data from age heterogeneous samples and indicate the importance of reporting all three PSC scores.

Two studies of the occurrence of psychophysiological symptoms in chronic headache patients

Two separate, but related, studies are described in which psychophysiological symptoms associated with chronic headache were examined. In the first study, the Psychosomatic Symptom Checklist (PSC) was administered to evaluate the presence of 15 different psychophysiological symptoms in 3 types of chronic headache patients (migraine, tension, and combined migraine and tension). Over 97% of these 438 patients reported at least one other symptom occurring at least monthly and 75% reported another intense symptom occurring at least once a week. The tension and combined headache groups reported significantly higher overall symptomatic distress than the migraine headache patients. The tension patients reported significantly higher scores on the backache and weakness items, while the migraine and combined headache patients reported significantly more nausea. The differences between the diagnostic groups is more a function of the intensity of the symptoms than the presence of the symptoms, since, for many individual symptoms, the percentage of patients reporting is nearly equal. In the second study, 150 patients from the original sample (50 from each diagnostic group) were reassesssed using the PSC after psychological treatment of headache. There were significant decreases in total scores for all 3 groups with no significant differences between groups seen at post treatment. Different treatment effects were seen on the individual symptoms with 7 of the 15 showing significant reduction. Chronic headache does not occur in isolation and headache diagnostic groups do not differentiate well on other individual psychophysiological symptoms.

The Psychosomatic Symptom Checklist revisited: reliability and validity in a chronic pain population.

A psychometric evaluation of the SUNYA Revision of the Psychosomatic Symptom Checklist (PSC) was conducted with 405 chronic pain patients who completed the PSC as part of a diagnostic battery. Several properties of the measure were examined, including its reliability, internal consistency, discriminant validity, and factor structure. Contrary to a previous study, the measure demonstrated a modest reliability, a poor discriminant validity, and a multifactor structure that accounted for only a small proportion of the variance in the measure. Thus, the PSC did not appear to be an adequate measure of general psychosomatic distress when used with chronic pain patients. For these patients, the PSC may measure symptom clusters rather than general psychosomatic symptomatology. Since the PSC is used in various clinical populations, the results underscore the importance of investigating the properties of the measure in these populations.

Psychometric properties of a Children's Psychosomatic Symptom Checklist.

The psychometric properties of the Children's Psychosomatic Symptom Checklist, developed for this study, were examined. When administered to 196 sixth-, seventh-, and eighth-grade students who ranged in age from 11 to 14 years (M = 12.1, SD = .94), the scale items demonstrated a good internal consistency. Item-total correlations were generally significant and exceeded .60, and a coefficient alpha of .83 was obtained. Results of a factor analysis indicated that 70% of the total variance was accounted for by the first factor, best interpreted as general psychosomatic distress. Divergent validity was additionally demonstrated through only modest correlations with measures of anxiety and depression. Use of the checklist is discussed.

Psychological functioning of children who have recurrent migraine

Thirty-two children experiencing recurrent migraine, aged 8–17, were compared to 32 non-headache peer controls matched for age, sex, and social class. Each child completed an extensive battery of psychological tests, which consisted of 1. (1) the Children's Depression Inventory (for children aged 8–13) or the Beck Depression Inventory (for children 14 and above), 2. (2) the State-Trait Anxiety Inventory for Children (ages 8–12) or the State-Trait Anxiety Inventory, Form X (ages 13 and above), 3. (3) the Children's Depression Rating Scale, 4. (4) the Personality Inventory for Children, 5. (5) the Child Behavior Checklist, 6. (6) the Psychosomatic Symptom Checklist, SUNYA Revision, 7. (7) the Children's Social Readjustment Rating Questionnaire, 8. (8) the Wide Range Achievement Test for Reading, and 9. (9) the Peabody Picture Vocabulary Test, Form L. Children with migraine revealed higher scores on all scales measuring depression and somatic complaints; adolescent headache sufferers also revealed increased levels of trait anxiety. Older male headache sufferers revealed the poorest overall level of adjustment as reflected by scores on the Adjustment scale of the Personality Inventory for Children. It was argued that the psychological differences were most likely a consequence of the migraineurs having to live with frequent, unpredictable attacks of intense pain. However, the correlational nature of this study does not make it possible to rule out alternative explanations.

ANXIETY AND ITS RELATIONSHIP TO SOMATIC COMLAINTS IN COLLEGE STUDENTS

The following study was undertaken to elucidate the relationships between psychosomatic symptoms and anxiety in college-age adolescents. 194 subjects, students at an Ivy League college and patients of its health service, were studied. Half of the subjects were making visits to the health service and half were randomly selected university students who ware recruited for the study. 63% of the subjects were female; 23% were freshmen, 26% sophomores, 19% juniors, 26% seniors and 6% fifth year or greater. 8% of students listed a chronic health problem such as asthma. All subjects completed the State-Trait Anxiety Inventory (STAI) and the SUNYA Ravision of the Psychosomatic Symptom Checklist (PSC) a measure of somatic symptoms (e.g. headache, abdcminal pain, etc.) assessed for frequency and intensity. Mean State anxiety score was 40.3 (40.8 in fanales--76th percentile, 38.3 in males--61st percentile). Mean Trait anxiety score was 39.7 (40.3 for females--65th percentile and 37.3 for males--53rd percentile). The mean PSC score was 24.6 (60th percentile). There were no significant differences between the health center visit group and the recruited group for any of these scores. There was a significant correlation between the total PSC score and the State (r=.51, P<.001) and Trait (r=.60, p<.001) anxiety scores, respectively. There were also significant correlations (at P≤.01) between 10 of the 17 individual somatic symptoms on the PSC and State and Trait scores. There ware no significant differences in STAI and PSC scores between different classes, nor between those with/without reported chronic health problems. A significant correlation between some psychosomatic complaints and anxiety in one group of college students suggests that nonorganically based somatic complaints should prompt sane discussion of anxiety in this age group.

Psychological changes associated with self-regulatory treatments of irritable bowel syndrome.

The psychological "side effects" of self-regulatory treatment (a combination of relaxation, thermal biofeedback, and cognitive therapy) for irritable bowel syndrome (IBS) were compared among 20 "successfully" treated patients, 12 "unsuccessfully" treated patients, and 9 patients who merely monitored symptoms for 12 weeks. Pretreatment and posttreatment scores on the Beck Depression Inventory, State-Trait Anxiety Inventory, and Psychosomatic Symptom Checklist were examined. "Successfully" treated patients had significant (p less than .01) reductions on all measures and significantly greater reductions on depression and state anxiety than the symptom monitoring group. Interestingly, the failures also showed a significant (p = .027) reduction in trait anxiety and no significant increases on other measures.

STRESS IN PRISON STAFF: AN OCCUPATIONAL STUDY*

A survey was conducted into the sources of occupational stress and their effects on levels of health for a group of New Zealand prison staff: Staff were categorized into three groups: Prison Officers. Ranking Prison Officers, and Instructors In addition, a control group of noncommissioned Army personnel was used as a comparison sample. Subjects were administered a job‐specific “sources of stress” questionnaire, a life events measure, a personality measure (the Neuroticism Scale Questionnaire), and three health measures‐the General Health Questionnaire, a medical visit checklist, and a psychosomatic symptom checklist. Factor analysis of the stress questionnaire revealed six job‐specific sources of stress factors These were identified as staff relationships, task pressures, relationships with inmates, promotion, the work environment, and the impact on family life of living in a prison village. Results showed that the levels of stress experienced by staff varied across the three groups. In addition, on the three health measures all staff groups were found to score significantly higher than the control group. Further analysis showed that the variables isolated could be related to a general model of stress.

Psychometric properties of the SUNYA revision of the Psychosomatic Symptom Checklist.

The Psychosomatic Symptom Checklist (PSC), a questionnaire assessing psychosomatic symptoms, was administered to two separate samples of college students. For Sample 1 (N = 698), the questionnaire was readministered to three separate subsets at intervals of either 1 week (N = 143), 4 weeks (N = 74), or 8 weeks (N = 48). Each subset of subjects recompleted the PSC on only one of the three retest intervals. Based on the initial administration an analysis of the normative data revealed a mean total score of 23.7, suggesting a relatively low degree of psychosomatic symptoms in this group. Although total scores decreased slightly over time, test-retest correlations remained high (r greater than 0.80, P less than 0.0001). Individual item correlations was greater than r = 0.50 throughout. Sample 2 (N = 249) completed the PSC, Beck Depression Assertiveness Scale (RAS), and intercorrelations were computed between these measures. This analysis revealed little overlap between the psychosomatic complaints assessed by the PSC and other commonly used measures of psychological distress. Finally, a factor analysis revealed one major factor on which all but 2 of the 17 questionnaire items loaded significantly. These results suggest that the PSC is sensitive to psychosomatic distress and remains reliable over time.

Psychological functioning in headache sufferers.

The present study examined the psychological test responses of 99 headache sufferers and 30 matched nonheadache controls. Headache subjects were of four types: migraine (n = 26), muscle contraction (n = 39), combined migraine-muscle contract ion (n = 22), and cluster (n = 12). Measures consisted of the Minnesota Multiphasic Personality Inventory, a modified hostility scale derived from the MMPI, Back Depression Inventory, State-Trait Anxiety Inventory, Autonomic Perception Questionnaire, Rathus Assertiveness Schedule, Social Readjustment Rating Scale, Psychosomatic Symptom Checklist, Schalling-Sifneos Scale, Need for Achievement, and Hostile Press. Significant differences were found on five clinical scales of the MMPI--1, 2, 3, 6, and 7. Of the non-MMPI scales, only the Psychosomatic Symptom Checklist and Trait Anxiety Inventory were significant. Control subjects revealed no significant findings on any tests. The headache groups fell along a continuum, beginning with cluster subjects, who showed only minimal distress, continuing through migraine and combined migraine-muscle contraction, and ending with muscle contraction subjects, who revealed the greatest degree of psychological disturbance. However, none of the headache groups could be characterized by marked elevations on any of the psychological tests, which contrasts with past research findings. It is suggested that the present results may be more representative of the "typical" headache sufferer.