Kolk A M M, Hanewald G J F P, Schagen S, Gijsbers van Wijk C M T
Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB, Amsterdam, The Netherlands.
J Psychosom Res. 2002 Jan;52(1):35-44. doi: 10.1016/s0022-3999(01)00307-5.
The present study investigated the contribution of demographic characteristics (age, gender, socioeconomic status [SES]) and symptom-perception variables to unexplained physical symptoms and health care utilization. In addition, the consequences of the use of four frequently applied symptom-detection methods for relations among study variables were examined.
A group of 101 men and women were administered a standardized interview and several questionnaires. Their general practitioners (GPs) rated (un)explained symptoms and consultations over the previous year.
Path analyses showed that direct and indirect effects on symptoms and GP consultations depend on method of symptom detection, the largest difference being between self-reported symptoms and registered symptoms. The model including self-reported common symptoms demonstrated the direct and indirect effects of the symptom-perception variables: chronic disease, negative affectivity, selective attention to bodily sensations, and somatic attribution. In the model including registered symptoms, only chronic disease and SES showed effects on symptoms and GP consultations.
This study demonstrates the usefulness of a symptom-perception approach to the experience of unexplained symptoms, the importance of selection of a symptom-detection method, and the need for different models for the explanation of daily experienced symptoms and their presentation in health care.
本研究调查了人口统计学特征（年龄、性别、社会经济地位[SES]）和症状感知变量对不明原因身体症状及医疗保健利用的影响。此外，还研究了四种常用症状检测方法的使用对研究变量之间关系的影响。
对101名男性和女性进行了标准化访谈并发放了几份问卷。他们的全科医生（GP）对其前一年的（不明）症状及诊疗情况进行了评分。
路径分析表明，对症状和全科医生诊疗的直接和间接影响取决于症状检测方法，其中自我报告症状和记录症状之间的差异最大。包含自我报告常见症状的模型显示了症状感知变量的直接和间接影响：慢性病、消极情感、对身体感觉的选择性关注以及躯体归因。在包含记录症状的模型中，只有慢性病和社会经济地位对症状和全科医生诊疗有影响。
本研究证明了症状感知方法在解释不明原因症状方面的有用性、选择症状检测方法的重要性，以及需要不同模型来解释日常经历的症状及其在医疗保健中的表现。
