Page 62 - JCBP-1-2

Journal of Clinical and
Basic Psychosomatics Somatization symptoms of outpatient

Table 3. Comparison of anxiety and depression scores among patients with different degrees of somatization symptoms
Mild symptom (n=254) Moderate symptom (n=399) Severe symptom (n=99) F P
GAD-7 score 6.61±2.32 8.42±2.16 12.81±3.31 9.781 0.023
PHQ-9 score 8.62±2.17 10.12±2.31 13.91±3.21 14.552 0.001
Abbreviations: GAD-7: General anxiety disorder-7; PHQ-9: Patient health questionnaire-9.

Table 4. Logistic regression analysis of predictive factors of somatization symptoms

Variable Regression coefficient Standard error Wals’s value Odds ratio 95% confidence interval
Lower limit Upper limit
GAD-7 score 1.943 0.550 13.197 6.526 2.903 13.045
PHQ-9 score 2.105 0.571 15.148 8.020 3.470 18.930
Female 1.540 0.416 8.451 4.440 1.059 9.073
Constant 1.463 0.947 2.385 0.232
Abbreviations: GAD-7: General anxiety disorder-7; PHQ-9: Patient health questionnaire-9.

do not have a clear understanding of psychological PHQ-15 scale. The PHQ-15 symptoms with a high positive
problems and consider that somatic diseases cause rate include CVD-related symptoms, such as chest pain,
somatization symptoms, so they often seek medical palpitation, and dyspnea. The nervous system is also
help from cardiologists, instead of psychologists, in a affected by symptoms such as headache and dizziness,
tertiary hospital. Anxiety and depression are common while the digestive system is affected by gastralgia and
psychological disorders in outpatients of the cardiology abdominal distention. The incidence of sleep disorder
department , which are often manifested by various surveyed using PHQ-15 questionnaire was as high as
[4]
prominent symptoms of cardiovascular somatization, such 77.38%, indicating that sleep disorder is an important
as “heart distress” or “racing heart.” A report by Ye et al. clinical feature of somatization symptoms in patients with
[22]
found that the incidence of somatization symptoms in psychological disorders. Item 4 (menstrual problems)
cardiology outpatients was as high as 64.2%. and item 8 (sexual problems) displayed extreme floor
effects. These floor effects were also reported in previous
Unlike other published studies, this study enrolled [24-26]
cardiology outpatients who were not only suspected of Chinese and Western studies , which may be related to
the impact of Chinese cultural tradition and the patients’
psychological disorders, but also screened using the “three
questions” method . Furthermore, this study used the unwillingness to discuss about these private matters.
[15]
three DSM-5-recommended questionnaires, namely, The present study found that anxiety and depression in
GAD-7, PHQ-9, and PHQ-15, in Chinese versions as patients with mild-to-moderate somatization symptoms could
research tools. Several previous studies [18,23-25] confirmed not be detected using only the GAD-7 and PHQ-9 scales.
that these three scales could screen anxiety, depression, Despite the overall positive detection rate of 78.7%, anxiety or
and somatization symptoms and assess the severity with depression in patients with somatization symptoms might not
good validity and reliability in general hospitals in China. be detected for several reasons [27,28] . First, the scale, which was
compiled by psychologists, focuses on psychological moods
The results of this study showed that the total detection
rate of anxiety or depression and somatization symptoms and symptoms that patients are not familiar with. Second,
patients tend to emphasize their somatization symptoms and
was 81.1% and 93.1%, respectively, among the participants. may only have mild or moderate psychological disorders.
The finding further confirmed that the “three questions” Third, due to stigma and cultural traditions, patients
[15]
method has a high validity for the initial screening of often deny having psychological and emotional problems.
psychological disorders. The results also suggested that the Greden’s study found that 69% of patients with depression
incidence of somatization symptoms in the patients with only complained of somatization symptoms, and 11%
psychological disorders screened by the “three questions” denied having any psychological symptoms of depression
method was much higher than that in the general when inquired directly . Several recent reports focusing
[15]
[29]
cardiology outpatients (64.2%) . on the incidence of and factors that affect somatization
[22]
The present study found that patients with somatization symptoms among patients of general hospitals confirmed that
symptoms scored an average of more than 8 on the somatization symptoms were closely related to anxiety and

Volume 1 Issue 2 (2023) 5 https://doi.org/10.36922/jcbp.0636