From the Department of Psychosomatic Medicine and Psychotherapy (Toussaint, Hüsing, Kohlmann, Löwe), University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Psychosomatic Medicine and Psychotherapy (Brähler), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Psychosom Med. 2021;83(2):164-170. doi: 10.1097/PSY.0000000000000903.
The diagnostic criteria of somatic symptom disorder (SSD) emphasize that somatic symptoms receive disease value once they are accompanied by excessive thoughts, feelings, or behaviors. The main objective of this study was to examine what constitutes excessiveness in psychological reactions to somatic complaints and how excessive symptom-related behavior influences self-reported health status and health care utilization.
A national, representative general population survey was performed between January and March 2016 in Germany, including 2395 individuals older than 13 years. Self-report questionnaires (Somatic Symptom Scale-8, Somatic Symptom Disorder-B Criteria Scale) were used to operationalize the SSD criteria. Group differences in the daily amount of time dedicated to physical complaints were analyzed between individuals with and without SSD. Stepwise linear regression analyses were performed to predict general mental and physical health status, and health care utilization.
There was a significant effect of group (SSD yes/no) in daily time spent on symptoms, after controlling for age, sex, depression, and anxiety (F(1,2336) = 447.53, p < .001). The SSD group (n = 213) reported an average of 4 hours, whereas individuals without SSD reported 30 minutes. Results of the regression analyses showed that the combination of somatic symptoms and symptom-related psychological features is predictive of worsened self-reported physical and mental health status, and increased health care utilization.
A range of 3 to 4 hours per day spent on dealing with physical complaints seems indicative of excessiveness. If, during a clinical consultation, a patient reports such a large amount of time, a more comprehensive clinical examination of SSD should follow.
躯体症状障碍（SSD）的诊断标准强调，躯体症状一旦伴有过度的思想、情感或行为，就会被赋予疾病价值。本研究的主要目的是检验对躯体主诉的心理反应中何为过度，以及过度的与症状相关的行为如何影响自我报告的健康状况和卫生保健利用度。
2016 年 1 月至 3 月期间，在德国开展了一项全国性的、具有代表性的一般人群调查，纳入了 2395 名年龄大于 13 岁的个体。使用自我报告问卷（躯体症状量表-8、躯体症状障碍-B 标准量表）来操作 SSD 标准。分析 SSD 患者与非 SSD 患者之间，个体躯体主诉的每日时间投入量存在何种差异。采用逐步线性回归分析预测一般心理健康和身体健康状况，以及卫生保健利用度。
在控制年龄、性别、抑郁和焦虑因素后，组间（SSD 是/否）在症状每日时间投入上存在显著差异（F(1,2336) = 447.53，p <.001）。SSD 组（n = 213）报告的平均时间为 4 小时，而无 SSD 组报告的平均时间为 30 分钟。回归分析结果显示，躯体症状与症状相关心理特征的组合，可预测自我报告的身心健康状况恶化和卫生保健利用度增加。
每天花 3 到 4 个小时来处理躯体主诉，似乎表明存在过度。如果在临床就诊中，患者报告了如此大量的时间，那么应进行更全面的 SSD 临床检查。
