Psychiatry and Primary CareThe prevalence of somatoform disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China
Introduction
Occurrence of mental disorders in primary care gains more interest in recent years because they involved significantly impaired functioning, increased health care utilization and marked deterioration among different domains of quality of life [1], [2]. It has been estimated that about 20%–42.5% of primary care patients meet the criteria for mental disorders [3], [4]. Somatoform disorders are a group of psychiatric disorders that cause unexplained physical symptoms, including somatization disorder (involving multisystem physical symptoms), undifferentiated somatoform disorder (fewer symptoms than somatization disorder), pain disorder (pain with strong psychological involvement), hypochondriasis (fear of having a life-threatening illness or condition), body dysmorphic disorder (preoccupation with a real or imagined physical defect) and somatoform disorder not otherwise specified (used when criteria are not clearly met for one of the other somatoform disorders).
Somatoform disorders in primary care are less intensely studied compared with other mental disorders, and only a few studies have used standardized criteria to diagnose somatoform disorders in China. Estimate of the prevalence rates of somatoform disorders in primary care as classified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) or the International Classification of Diseases, 10th Revision (ICD-10) range from 16% to 30%, and the female/male ratio was reported as 1:1 [5], [6], [7], [8]. Most research in this area have been conducted in developed countries with an individualized care model of primary care; in contrast, few comprehensive studies have focused on accurate quantification of clinical somatoform disorders in developing countries with a collective care model. In several developing countries, primary care is provided using a collective care model: patients see different clinicians at each visit for short periods of time (often less than 10 min), other persons are present during the consultation, and there is no appointment system.
We have screened a large number of outpatients at departments of internal medicine from 23 general hospitals in Shenyang, China (a city of 6.9 million persons in northeastern China) and determined the prevalence of somatoform disorders in primary care using DSM-IV criteria. A previous report has discussed the results of the study for depressive disorders and anxiety disorders. In this study, we presented the results for somatoform disorders. Gender differences between those with and without somatoform disorders were analyzed.
Section snippets
Sampling
Ninety-six general hospitals in Shenyang municipality were subdivided into 47 primary hospitals (less than 100 inpatient beds), 31 secondary hospitals (100–500 beds) and 18 tertiary hospitals (over 500 beds), respectively, and 20% (total 23) of the involved hospitals from each category were selected using a random number table, which include 10 from primary, 7 from secondary and 6 from tertiary hospitals, and a total of 5750 target samples (990 from primary, 2056 from secondary and 2704 from
Results
Among the 5750 selected subjects, 437 (7.6%) refused to participate and 1 completed only part of the screening process. Compared to the 5312 persons who completed the screening, the 438 noncompleters were more likely to be male (51.6% vs. 39.5%, χ2=24.45, P<.001) and were somewhat younger (45.3±15.3 vs. 48.1±17.7, t=3.55, P<.001).
The characteristics of participating subjects are shown in Table 1. The mean (SD) age was 48.1±17.7 years. Over 60% were female, about 80% were currently married, over
Discussion
This study has several strengths. It is the largest study of the prevalence of somatoform disorders in internal medicine clinics of general hospitals. The samples represent all internal medicine outpatients at general hospitals in a large urban municipality in northern China. The refusal rate was quite low. The gold standard diagnosis was based on the administration of SCID by psychiatrists who had excellent interrater reliability, and rigorous quality control measures were enforced throughout
Limitations
Several issues need to be considered when interpreting our results. Only a small proportion of identified subjects (7.6%) refused to participate, but those who did refuse were younger and more likely to be male. However, there is no compelling reason to suspect that patients who refused have higher rates of somatoform disorder, so it is unlikely that the low refusal rate seriously compromised the representativeness of the sample or the validity of the results. Outpatient departments in urban
Role of funding source
The sponsor did not participate in the design of the project, the conduct of the study or the preparation of the manuscript.
Conflict of interest
None of the authors have any conflict of interest related to the content of this paper.
Acknowledgments
This project was part of the Small Grants Program to Improve the Quality and Implementation of Mental Health Research in China, which was supported by the China Medical Board of New York (grant number 02-777) and coordinated by Professor Michael Phillips of the Beijing Hui Long Guan Hospital and Professor Xue Zhang of the Peking Union Medical College. We also would like to thank the 23 participating hospitals in Shenyang for their active support of the project and Xianyun Li, Zhiqing Wang, Yali
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Population-based prevalence of somatic symptom disorder and comorbid depression and anxiety in Taiwan
2023, Asian Journal of PsychiatryCitation Excerpt :Considering a study focusing on SSD with a similar design to ours, Hauser et al. (2020) found the SSD prevalence to be 4.5% in Germany, which was comparable to our results. The higher prevalence in women than in men is also identical to other studies on somatoform disorders or SSD (Hauser et al., 2013; Hessel et al., 2005; Liu et al., 2012; Wild et al., 2004). As for the results of age-stratification, the population aged 40–49 years had the highest SSD prevalence (6.73%); this can be understood from the distribution of the PHQ-15 and HAQ scores.
The Concept of Health Anxiety
2019, The Clinician's Guide to Treating Health Anxiety: Diagnosis, Mechanisms, and Effective TreatmentInteroception and gender: What aspects should we pay attention to?
2017, Consciousness and CognitionCitation Excerpt :In contrast, Barrett, Quigley, Bliss-Moreau, and Aronson (2004) did not find correaltions between interoceptive accuracy to extraversion and neuroticism. Our results advise that gender be accounted for when subjective evaluation of the manifestations of the disorders associated to bodily sensations (like somatoform disorders (Liu et al., 2012) or pain sensitivity (Wiesenfeld-Hallin, 2005)) and to the emotional/mood states (like depression (Van de Velde et al., 2010), anxiety (McLean et al., 2011), alexithymia (Salminen et al., 1999)) is performed. Interoceptive accuracy is defined as the objective accuracy to detect bodily sensations (Garfinkel et al., 2015).
Depression and anxiety among patients with somatoform disorders, panic disorder, and other depressive/anxiety disorders in Taiwan
2016, Psychiatry ResearchCitation Excerpt :This overlaps medically unexplained symptoms (MUS), as defined by others (Henningsen et al., 2007; Steinbrecher and Hiller, 2011). The prevalence of somatoform disorders is not low: 1.56–20% of patients in internal medicine have conditions compatible with the general definition of somatoform disorders (Fink et al., 2004; Liu et al., 2012); however, the diagnosis of somatoform disorders is not frequently used in psychiatry (Hamilton et al., 2013). Many researchers have pointed out that anxiety disorders and depressive disorders are common comorbidities of somatoform disorders (Bener et al., 2013; Essau, 2007; Haftgoli et al., 2010; Leiknes et al., 2010; Shidhaye et al., 2013; van der Meer et al., 2012), with rates between 20% and 66.7% (Essau, 2007; Grover et al., 2015; Leiknes et al., 2007).
Psychological and behavioral variables associated with the somatic symptom severity of general hospital outpatients in China
2013, General Hospital PsychiatryCitation Excerpt :The major changes in the SSD concept include the omission of the central criterion that the symptoms be medically unexplained and the introduction of positive psychobehavioral criteria in addition to somatic symptoms. In China, studies of patients with high somatic symptom severity are very limited [16–19]. The discussion is shaped by a strong tendency to Chinese psychiatry, not taking into account somatic symptom presentation and somatization as a separate dimension of psychopathology but to primarily subordinate it to depression and anxiety [18,20–22].