Piccinelli M, Simon G
Servizio di Psicologia Medica, Università di Verona, Italy.
Psychol Med. 1997 Mar;27(2):433-44. doi: 10.1017/s0033291796004539.
Gender and cross-cultural differences in the association between somatic symptoms and emotional distress were investigated, using data from the World Health Organization Collaborative Project on Psychological Problems in General Health Care.
Data were collected at 15 centres in 14 countries around the world. At each centre, a stratified random sample of primary care attenders aged 15-65 years was assessed using, among other instruments, the 28-item General Health Questionnaire and the Composite International Diagnostic Interview-Primary Health Care Version.
Females reported higher levels of somatic symptoms and emotional distress than males. A strong correlation between somatic symptoms and emotional distress was found in both sexes, with females reporting more somatic symptoms at each level of emotional distress. However, linear regression analysis showed that gender had no significant effect on level of somatic symptoms, when the effects of centre and emotional distress were controlled for. In both sexes, no specific pattern of association emerged between somatic symptom clusters and either anxiety or depression. Primary care attenders from less developed centres reported more somatic symptoms and showed greater gender differences than individuals from more developed centres, but inter-centre differences were small. Finally, gender was not a significant predictor of reason for consultation (somatic versus mental/behavioural symptoms), after controlling for levels of somatic symptoms and emotional distress as well as for centre effect.
These data do not support the common belief that females somatize more than males or the traditional view that somatization is a basic orientation prevailing in developing countries. Instead, somatic symptoms and emotional distress are strongly associated in primary care attenders, with few differences between the two sexes and across cultures.
利用世界卫生组织普通医疗保健心理问题合作项目的数据，对躯体症状与情绪困扰之间关联的性别及跨文化差异进行了调查。
在全球14个国家的15个中心收集数据。在每个中心，使用28项一般健康问卷和综合国际诊断访谈-初级保健版等工具，对年龄在15至65岁的初级保健就诊者分层随机样本进行评估。
女性报告的躯体症状和情绪困扰水平高于男性。在两性中均发现躯体症状与情绪困扰之间存在强相关性，在每个情绪困扰水平上，女性报告的躯体症状更多。然而，线性回归分析表明，在控制了中心和情绪困扰的影响后，性别对躯体症状水平没有显著影响。在两性中，躯体症状群与焦虑或抑郁之间均未出现特定的关联模式。来自欠发达中心的初级保健就诊者报告的躯体症状更多，且性别差异比来自较发达中心的个体更大，但中心间差异较小。最后，在控制了躯体症状和情绪困扰水平以及中心效应后，性别不是咨询原因（躯体症状与精神/行为症状）的显著预测因素。
这些数据不支持女性比男性更多地出现躯体化的普遍观点，也不支持躯体化是发展中国家普遍存在的一种基本倾向的传统观点。相反，在初级保健就诊者中，躯体症状与情绪困扰密切相关，两性之间和不同文化之间差异不大。
