Rief Winfried, Nanke Alexandra, Emmerich Julia, Bender Andrea, Zech Thomas
Philipps-University of Marburg, Marburg, Germany.
J Psychosom Res. 2004 Oct;57(4):367-71. doi: 10.1016/j.jpsychores.2004.02.015.
To compare causal illness beliefs between patients with unexplained physical symptoms and different comorbid disorders and to assess the association of causal illness beliefs with illness behavior.
We examined a sample of 233 patients attending treatment in primary care. Inclusion criteria were "unexplained physical symptoms." All patients were investigated using structured interviews and self-rating scales [Screening for Somatoform Symptoms (SOMS), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and a 12-item instrument to assess causal attributions]. By means of factor analysis, the following illness attributions were considered: vulnerability to infection and environmental factors, psychological factors, organic causes including genetic and aging factors, and distress (including exhaustion and time pressure).
Most patients reported multiple illness attributions. The more somatoform symptoms patients had, the more explanations in general they considered. Especially for vulnerability and organic illness beliefs, patients with somatoform symptoms had increased scores. Comorbidity with depression and with anxiety disorders was associated with more psychological attributions. Even when the influence of somatization, depression, and anxiety is controlled for, illness beliefs still showed associations with illness behavior. Organic causal beliefs and vulnerability attributions were associated with a need for medical diagnostic examinations, increased expression of symptoms, increased illness consequences, and bodily scanning.
Multiple causal attributions can coexist demonstrating different associations with comorbid depression and illness behavior.
比较有不明原因身体症状的患者与不同共病障碍患者之间的病因性疾病信念，并评估病因性疾病信念与疾病行为之间的关联。
我们对233名在初级保健机构接受治疗的患者进行了研究。纳入标准为“不明原因的身体症状”。所有患者均通过结构化访谈和自评量表[躯体形式症状筛查量表（SOMS）、贝克抑郁量表（BDI）、贝克焦虑量表以及一个用于评估因果归因的12项工具]进行调查。通过因子分析，考虑了以下疾病归因：易感染性和环境因素、心理因素、包括遗传和衰老因素在内的器质性原因以及痛苦（包括疲惫和时间压力）。
大多数患者报告了多种疾病归因。患者的躯体形式症状越多，他们总体上考虑的解释就越多。特别是对于易感性和器质性疾病信念，有躯体形式症状的患者得分更高。与抑郁症和焦虑症共病与更多的心理归因相关。即使控制了躯体化、抑郁和焦虑的影响，疾病信念仍与疾病行为存在关联。器质性因果信念和易感性归因与医学诊断检查的需求、症状表达增加、疾病后果增加以及身体扫描有关。
多种因果归因可以共存，显示出与共病抑郁症和疾病行为的不同关联。
