What can we learn from a cross-national study of somatic distress?
Introduction
Even though the literature is replete with reports describing association of culture with various aspects of somatization [1], [2], [3], [4], there is little empirical evidence that observed variations in, for example, the occurrence of the disorders across countries lend themselves to obvious cultural explanations [5], [6].
To draw reliable inferences in regard to cross-national variations in somatoform disorders, studies need to meet a set of conditions. One, it is important that cross-national comparisons be drawn from data that utilize identical ascertainment procedure in the countries of interest. Two, the assessment tools should be developed in such a way that they allow for the inclusion of symptoms that may be peculiar to study sites. Third, the assessment should be comprehensive, allowing not just for examination of the frequency of somatic distress but also its correlates in regard to demographic attributes and impact. When differences are obtained in these areas, attempts could thereafter be made to examine whether such differences bear associations with study sites in a manner that may suggest plausible cultural explanation.
The study Psychological Problems in General Health Care (PPGHC), a World Health Organization collaborative project that was conducted in 15 centers in 14 countries located in four continents [7], provides an opportunity to address the following questions: To what extent do differences in the experience of somatic distress across countries lend themselves to cultural interpretations? Are there factors related to the nature of patient–doctor interaction that may be associated with the reporting of somatization symptoms?
Section snippets
Aims and methods
The aims of the PPGHC were to investigate the nature, impact, and course of common psychological problems presenting in primary care settings. Designed as a two-stage cross-cultural epidemiological survey of people contacting general health settings, the study was conducted in Ankara (Turkey), Athens (Greece), Berlin and Mainz (Germany), Bangalore (India), Ibadan (Nigeria), Groningen (the Netherlands), Manchester (United Kingdom), Nagasaki (Japan), Paris (France), Rio de Janeiro (Brazil),
Results
Across the sites, the samples were composed of predominantly young to middle-aged people with a mean age of 40±14 years. Patients in Ankara, Bangalore, and Ibadan, with respective mean ages of 32±13, 31±13, and 33±11 years, tended to be younger in keeping with the age structures of these countries. Patients from developing countries (Ankara, Bangalore, Rio de Janeiro, Santiago, and Ibadan) also had lower means of education than those from more developed ones (Athens, Paris, and Seattle): 5–7
Discussion
The results of the PPGHC, a project conducted in primary care settings in 15 countries drawn from five continents and with the use of identical ascertainment procedures, showed that there is a wide variability in the occurrence of somatoform disorders across the cultures studied [7], [8]. This variability was true of both prevalence and incidence over a 12-month period. On the other hand, associations of somatization with demographic attributes with health perception were generally less
Acknowledgements
The data reported in this paper were collected as part of a World Health Organization's Psychological Problems in General Health Care project. Participating investigators include Orhan Ozturk, MD and Murat Rezaki, MD, Ankara, Turkey; Costas Stefanis, MD and Venetsanos Mavreas, MD, PhD, Athens, Greece; S. M. Channabasavanna, MB, BS, MD and T. G. Sriram, MB, BS, MD, Bangalore, India; Hanfried Helmchen, MD and Michael Linden, PD, Berlin; Wim van den Brink, MD and Bea Tiemens, PhD, Groningen, The
References (14)
- et al.
Course of hypochondriasis in an international primary care study
Gen Hosp Psychiatry
(2001) Cultural components in response to pain
J Soc Issues
(1952)Culture and symptoms: an analysis of patients presenting problems
Am Sociol Rev
(1966)The study of disease in relation to culture
Behav Sci
(1972)- et al.
Somatization: the interconnections in Chinese society among culture, depressive experiences, and the meaning of pain
(1985) - et al.
Somatization in cross-cultural perspective: a World Health Organization study in primary care
Am J Psychiatry
(1997) - et al.
The syndrome of hypochondriasis: a cross-national study in primary care
Psychol Med
(1997)
Cited by (42)
Cultural differences in symptom representation for depression and somatization measured by the PHQ between Vietnamese and German psychiatric outpatients
2017, Journal of Psychosomatic ResearchCitation Excerpt :The concept of “Western psychologization” has been suggested to counterpart “Asian somatization” when comparing Chinese and Western samples [5,6]. Studies with qualitative designs [7] and in part opposing results of increased or comparable somatization in Westerners [7–10] raise questions on how context, samples, and methods may influence results regarding somatization. The concept and understanding of somatization in Asian populations is multilayered and should be extended to further Asian ethnic groups.
Postsurgical pain in low- and middle-income countries
2016, British Journal of AnaesthesiaSomatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry?
2015, Journal of Psychosomatic ResearchCitation Excerpt :A large WHO study of the mid '90s analysed the incidence and prevalence of somatization in 15 centres in four continents [2]. The results showed 1) a high variability in the occurrence of somatoform disorders across the different sites; that 2) “neither differences nor similarities in the rates of occurrence of somatization nor their correlates are easily explainable on the basis of cultural or developmental differences alone”; and that 3) differences appeared to be closely related to the doctor–patient relationship and organization of care [3]. Somatization is ubiquitous and presents universally across very different cultural backgrounds.
Medically unexplained symptoms
2014, Medical Clinics of North AmericaCitation Excerpt :A history of rape victimization is also strongly associated with the development of MUS.20 Somatization occurs across cultures, and no significant differences between cultural groups with regard to prevalence have been found.23–25 However, there can be differences in specific symptoms between cultural groups.26
The prevalence of somatoform disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China
2012, General Hospital PsychiatryCitation Excerpt :Our data are similar to the study by de Waal and colleagues who reported that the percentage of individuals with hypochondriasis was 1.1% and the percentage of those with somatization was 0.5% in their study of somatic distress in primary care [7]. A cross-national study of 5438 primary care patients used the GHQ-12 as screening tests and the Composite International Diagnostic Interview (CIDI) to determine the prevalence of somatoform disorder with comorbidity; the reported point prevalence was 2.8% for somatization and 0.8% for hypochondriasis [24]. Significant gender differences in prevalence rates of somatoform disorder have been consistently reported.
Psychometric Properties of the Turkish Form of Codependency Assessment Tool
2009, Archives of Psychiatric Nursing