Simon G, Gater R, Kisely S, Piccinelli M
Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA.
Psychosom Med. 1996 Sep-Oct;58(5):481-8. doi: 10.1097/00006842-199609000-00010.
The objective of this study was to examine cross-national differences in somatic symptoms associated with psychological distress. Data from the World Health Organization (WHO) collaborative study of psychological problems in general health care (5438 patients at 15 sites) were used to examine somatic symptoms associated with psychological distress. At each site, a stratified random sample of consecutive primary care patients completed the 28-item General Health Questionnaire (GHQ) and the Composite International Diagnostic Interview (CIDI). At all sites, the number of current CIDI somatic symptoms (whether medically explained or not) was strongly associated with current psychological distress (measured by selected GHQ-28 items). Pearson correlation of somatic symptom count with psychological distress score was .42 for all sites and ranged from .20 to .58 (p < .0001 at all sites). Across all sites, anxiety and depressive symptoms showed roughly the same association with somatic symptom counts, and specific somatic symptoms or symptom clusters did not show differential association with anxiety or depression. Although somatic symptoms did cluster into meaningful groups (gastrointestinal, neurological/conversion, autonomic, and musculoskeletal), these symptom groups did not show differential association with psychological distress. Examination of individual somatic symptoms and symptom clusters across sites did not reveal clear patterns of association according to geography or level of economic development. These data show a strong association between somatic symptoms and psychological distress, which did not vary across disparate cultures and levels of economic development. Cultural factors, however, may influence the meaning attached to symptoms or the likelihood of presentation for health care.
本研究的目的是检验与心理困扰相关的躯体症状的跨国差异。来自世界卫生组织（WHO）普通医疗保健中心理问题合作研究（15个地点的5438名患者）的数据被用于检验与心理困扰相关的躯体症状。在每个地点，连续的初级保健患者的分层随机样本完成了28项一般健康问卷（GHQ）和复合国际诊断访谈（CIDI）。在所有地点，当前CIDI躯体症状的数量（无论是否有医学解释）与当前心理困扰（通过选定的GHQ - 28项目测量）密切相关。所有地点躯体症状计数与心理困扰评分的Pearson相关性为0.42，范围从0.20到0.58（所有地点p < 0.0001）。在所有地点，焦虑和抑郁症状与躯体症状计数的关联大致相同，特定的躯体症状或症状群与焦虑或抑郁没有显示出差异关联。尽管躯体症状确实聚集成有意义的组（胃肠道、神经/转换、自主神经和肌肉骨骼），但这些症状组与心理困扰没有显示出差异关联。对各地点个体躯体症状和症状群的检查未发现根据地理或经济发展水平的明确关联模式。这些数据表明躯体症状与心理困扰之间存在很强的关联，这种关联在不同文化和经济发展水平中没有差异。然而，文化因素可能会影响对症状的理解或寻求医疗保健的可能性。
