Katon W, Kleinman A, Rosen G
Am J Med. 1982 Feb;72(2):241-7. doi: 10.1016/0002-9343(82)90816-6.
In Part I, the authors described the relationship between somatization and depression and the extent and rate of misdiagnosis of the problem of depression in primary care. A conceptual model was developed to explain the patient's selective perception and focus on the somatic manifestation of depression and the resulting misdiagnosis. In the first section, the sociocultural and childhood experience were reviewed as two major factors influencing the ability of the patient to perceive affective changes. In this second part, the authors review the influence of the developmental stage of the patient's cognitive mechanisms and the effect of the environmental systems in which the patient dwells, i.e., medical care, family and social network, work/disability and the sociopolitical institutions, on the recognition of affective, cognitive and somatic symptoms.
在第一部分中，作者描述了躯体化与抑郁症之间的关系，以及初级保健中抑郁症问题的误诊程度和发生率。作者构建了一个概念模型，以解释患者对抑郁症躯体表现的选择性认知和关注以及由此导致的误诊。在第一部分，作者回顾了社会文化和童年经历这两个影响患者感知情感变化能力的主要因素。在第二部分，作者回顾了患者认知机制发展阶段的影响，以及患者所处环境系统，即医疗保健、家庭和社会网络、工作/残疾状况以及社会政治机构，对情感、认知和躯体症状识别的影响。
