Psychological and behavioral variables associated with the somatic symptom severity of general hospital outpatients in China

Gen Hosp Psychiatry. 2013 May-Jun;35(3):297-303. doi: 10.1016/j.genhosppsych.2012.11.001. Epub 2012 Dec 6.


Objective: In high-income countries, the number and severity of somatic symptoms - irrespective of etiology--are associated with adverse psychobehavioral and functional characteristics. This study aimed to assess these key features among Chinese general hospital outpatients with high levels of somatic symptoms.

Methods: This multicenter, cross-sectional study evaluated four outpatient departments of internal medicine and Traditional Chinese Medicine in Beijing and Kunming and enrolled a total of 281 consecutive patients. The patients answered questionnaires concerning somatic symptom severity [Patient Health Questionnaire (PHQ-15)], illness perception (Brief Illness Perception Questionnaire), illness behavior (Scale for the Assessment of Illness Behavior), emotional distress (Hospital Anxiety and Depression Scale) and health-related quality of life (12-Item Short Form Health Survey). Subsamples reporting high scores of somatic symptom severity (PHQ-15 ≥10, SOM+) versus low scores (PHQ-15 <10, SOM-) were compared.

Results: Twenty-eight percent (79/281) of all outpatients showed high somatic symptom severity. The strongest correlations between high somatic symptom severity and psychobehavioral variables were found for high emotional distress, female gender, living alone, low physical quality of life and high dysfunctional illness behavior. The proportion of the explained variance was 36.1%.

Conclusion: In Chinese outpatients, high somatic symptom severity is frequent and associated with psychobehavioral characteristics. With the PHQ-15 cutoff of 10, SOM+ patients could be differentiated from SOM- patients using these characteristics.

Publication types

  • Multicenter Study

MeSH terms

  • Abdominal Pain / psychology*
  • Adult
  • Attitude to Health
  • China
  • Cross-Sectional Studies
  • Fatigue / psychology*
  • Female
  • Health Status
  • Hospitals, General
  • Humans
  • Illness Behavior
  • Male
  • Middle Aged
  • Musculoskeletal Pain / psychology*
  • Outpatient Clinics, Hospital
  • Quality of Life / psychology
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / psychology*
  • Somatoform Disorders / psychology*
  • Stress, Psychological / psychology