1
|
Han Y, Kong Y, Peng S, Wang X. Effect of attribution training on early postoperative depression of kidney transplant recipients. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
2
|
Rometsch C, Denkinger JK, Engelhardt M, Windthorst P, Graf J, Gibbons N, Pham P, Zipfel S, Junne F. Pain, somatic complaints, and subjective concepts of illness in traumatized female refugees who experienced extreme violence by the "Islamic State" (IS). J Psychosom Res 2020; 130:109931. [PMID: 31981895 DOI: 10.1016/j.jpsychores.2020.109931] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/21/2019] [Accepted: 01/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Refugees with a history of war or sexual violence often experience somatic symptoms along with mental disorders. After being held in captivity by the so-called "Islamic State" (IS), 1100 especially vulnerable Yazidi women and children (around 400 women) received special medical and psychological support. We report on their (psycho-) somatic complaints and concepts of illness. METHODS Female refugees (N = 116) were surveyed regarding their somatic complaints and concepts of illness. The Impact of Event Scale-Revised (IES-R) and self-developed questionnaire items with ratings on a five-point Likert scale from 0 ("not at all") to 4 ("extremely") were used. Subgroup analyses and a multiple linear regression model were computed. RESULTS Pain (M = 2.43, SD = 1.70) is the main somatic complaint with a moderate rated severity, followed by feelings of suffocation (M = 2.37, SD = 1.53), and movement disorders (M = 1.62, SD = 1.70). In a linear regression model, pain explains variance (R2 = 0.325) in the refugees' self-reported health-related wellbeing. Somatic symptoms are mainly attributed to psychological causes, followed by physical (e.g., physical origin of symptoms), religious, and supernatural causes. Women with pain symptoms attributed their symptoms more to physical causes (M = 1.90, SD = 1.78) than did women without pain symptoms (M = 1.07, SD = 1.59). CONCLUSION Female Yazidi refugees being kept in IS captivity mainly suffer from pain, which is attributed to an explanatory psychological model. The study results show the specific psychosomatic and psychotherapeutic needs and demands for specifically tailored psychotherapy.
Collapse
Affiliation(s)
- Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Niamh Gibbons
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | - Phuong Pham
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA; Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| |
Collapse
|
3
|
von dem Knesebeck O, Lehmann M, Löwe B, Lüdecke D. Causal attributions for somatic symptom disorder. J Psychosom Res 2020; 129:109910. [PMID: 31887458 DOI: 10.1016/j.jpsychores.2019.109910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Two research questions will be addressed: (1) What does the German public think about possible causes of somatic symptom disorder (SSD) and are there differences in causal attributions according to symptom and course of SSD? (2) Are causal attributions associated with beliefs about treatment and stigmatizing attitudes? METHODS Two vignettes with symptoms of SSD were used in a national telephone survey in Germany (N = 1004). Vignettes differed regarding main type of symptom (pain vs. fatigue) and existence of an earlier somatic disease (yes vs. no). Respondents were asked about their agreement with five causal beliefs (broken home, heredity, lack of willpower, work stress, and misinterpretation of body signals). RESULTS About 90% of the respondents agreed that work stress is a possible cause of the SSD symptoms. Agreement was significantly more pronounced in case of a person with fatigue and an earlier severe somatic disease. A quarter endorsed lack of willpower as a possible cause. Lack of willpower was associated with a significant increase of desire for social distance in both vignettes. Work stress was associated with a significantly increased likelihood of positively evaluating the effectiveness of psychotherapy in both cases of SSD. CONCLUSIONS Public beliefs about causes of SSD are associated with stigma and treatment beliefs. Emphasising work stress as a cause may promote the belief that psychotherapy is effective for treatment of SSD.
Collapse
Affiliation(s)
- Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146 Hamburg, Germany.
| | - Marco Lehmann
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, Martinistr. 52, 20146 Hamburg, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, Martinistr. 52, 20146 Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20146 Hamburg, Germany
| |
Collapse
|
4
|
Zhang L, Schwarz J, Kleinstäuber M, Fritzsche K, Hannig W, Wei J, Yang J, Zhang L. Confirmatory factor analysis of the causal illness attribution scale in Chinese patients with multiple somatic symptoms. PSYCHOL HEALTH MED 2018; 23:1056-1070. [PMID: 29770714 DOI: 10.1080/13548506.2018.1455983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Causal illness attributions influence how individuals cope with somatic symptoms and illnesses. Dimensions of causal symptom attributions have been examined in Western cultures with the subscale 'causes' of the revised Illness Perception Questionnaire (IPQ-R). Some previous studies have identified a stronger somatic attribution style in Asian patients. In this study it was examined if the factorial structure of causal attributions identified in Western populations can be identified in a large Chinese sample of patients presenting with somatic symptoms. We recruited 665 patients aged at least 18 who were visiting the hospital for reasons of treatment from departments of traditional Chinese medicine (TCM), neurology (Biomedicine), and psychosomatic medicine in six hospitals across China. All subjects completed the Patient Health Questionnaire (PHQ) and the causes subscale of the IPQ-R. We split the data-set by chance in two parts. On the first subsample, we conducted a confirmatory factor analysis (CFA) to check the fit of the originally proposed 4-factor structure and an exploratory factor analysis (EFA). The factor structure indentified in the EFA was rechecked with a CFA in the second subsample. The originally proposed 4-factor-model of the IPQ-R subscale causes showed no adequate fit in the first subsample. The EFA revealed two factors, psychological attributions and risk factors. The CFA in the second sample showed mediocre fit indices (RMSEA = .098, CFI = .923). For the Chinese sample we propose a two-factor structure for IPQ-R causes scale. As in other studies, we identified the relatively stable factor psychological attributions, indicating no fundamental differences in illness attributions between Western and Chinese samples.
Collapse
Affiliation(s)
- Ling Zhang
- Mental Health Centre , West China Hospital, Sichuan University , Chengdu , China.,Suzhou Psychiatric Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jeanine Schwarz
- Division of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Marburg , Germany
| | - Maria Kleinstäuber
- Division of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Marburg , Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy , University Medical Centre Freiburg , Freiburg , Germany
| | - Wiebke Hannig
- Division of Clinical Psychology and Psychotherapy , Philipps University of Marburg , Marburg , Germany
| | - Jing Wei
- Department of Psychological Medicine , Peking Union Medical College Hospital , Peking , China
| | | | - Lan Zhang
- Mental Health Centre , West China Hospital, Sichuan University , Chengdu , China
| |
Collapse
|
5
|
Miglioretti M, Meroni C, Baiardo G, Savioli G, Velasco V. The perceptions of the causes of cardiac diseases: a taxonomy. Psychol Health 2017; 33:537-554. [DOI: 10.1080/08870446.2017.1380810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Claudia Meroni
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Baiardo
- Psychological Unit, Cardiovascular Institute of Camogli, Ruta di Camogli (GE), Italy
| | - Gaia Savioli
- Psychological Unit, Cardiovascular Institute of Camogli, Ruta di Camogli (GE), Italy
| | - Veronica Velasco
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
6
|
Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy. Behav Cogn Psychother 2016; 44:601-14. [PMID: 27126076 DOI: 10.1017/s1352465816000163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive-behavioural therapy can change dysfunctional symptom attributions in patients with hypochondriasis. Past research has used forced-choice answer formats, such as questionnaires, to assess these misattributions; however, with this approach, idiosyncratic attributions cannot be assessed. Free associations are an important complement to existing approaches that assess symptom attributions. AIMS With this study, we contribute to the current literature by using an open-response instrument to investigate changes in freely associated attributions after exposure therapy (ET) and cognitive therapy (CT) compared with a wait list (WL). METHOD The current study is a re-examination of a formerly published randomized controlled trial (Weck, Neng, Richtberg, Jakob and Stangier, 2015) that investigated the effectiveness of CT and ET. Seventy-three patients with hypochondriasis were randomly assigned to CT, ET or a WL, and completed a 12-week treatment (or waiting period). Before and after the treatment or waiting period, patients completed an Attribution task in which they had to spontaneously attribute nine common bodily sensations to possible causes in an open-response format. RESULTS Compared with the WL, both CT and ET reduced the frequency of somatic attributions regarding severe diseases (CT: Hedges's g = 1.12; ET: Hedges's g = 1.03) and increased the frequency of normalizing attributions (CT: Hedges's g = 1.17; ET: Hedges's g = 1.24). Only CT changed the attributions regarding moderate diseases (Hedges's g = 0.69). Changes in somatic attributions regarding mild diseases and psychological attributions were not observed. CONCLUSIONS Both CT and ET are effective for treating freely associated misattributions in patients with hypochondriasis. This study supplements research that used a forced-choice assessment.
Collapse
|
7
|
McLawhorn AS, Bjerke-Kroll BT, Blevins JL, Sculco PK, Lee YY, Jerabek SA. Patient-Reported Allergies Are Associated With Poorer Patient Satisfaction and Outcomes After Lower Extremity Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2015; 30:1132-6. [PMID: 25702595 DOI: 10.1016/j.arth.2015.01.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 02/01/2023] Open
Abstract
Anecdotal evidence suggests that patient-reported allergies (PRAs) may exhibit prognostic value for patient-reported outcomes after lower extremity arthroplasty. This study's purpose was to investigate associations between PRAs, patient satisfaction and outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA). PRAs in 274 patients undergoing primary THA and 257 patients receiving primary TKA were reviewed retrospectively. Satisfaction scores, baseline Western Ontario and McMaster Universities Arthritis Index (WOMAC), 2-year postoperative WOMAC and length-of-stay (LOS) were analyzed with PRAs. Increasing number of PRAs was significantly associated with worse satisfaction scores and worse WOMAC scores for TKA and THA, and it was significantly associated with increased LOS for TKA. These results may have implications for patient counseling and risk-adjusted outcome models.
Collapse
Affiliation(s)
| | | | - Jason L Blevins
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Yuo-yu Lee
- Department of Biostatistics, Hospital for Special Surgery, New York, New York
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
8
|
Taycan O, Ozdemir A, Erdogan-Taycan S, Jurcik T. Associations of somatic symptom attribution in Turkish patients with major depression. Nord J Psychiatry 2015; 69:167-73. [PMID: 25174430 DOI: 10.3109/08039488.2014.950328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There are differences across ethno-cultural groups in the degree of somatization among patients with major depressive disorder (MDD). Studies showed that the attribution style of somatic symptoms is an important predictor of health outcome in depressed patients. AIMS The aims of this study were to investigate associations of psychologizing, normalizing and somatizing attribution styles as measured by the Symptom Interpretation Questionnaire (SIQ) in Turkish patients with MDD. METHODS Ninety patients who were diagnosed with a major depressive episode using a semi-structured interview were administered the SIQ to assess attribution styles, each of which was regressed on age, gender, educational level, depressive symptom severity, tendency for somatosensory amplification, current somatic symptoms and alexithymia. RESULTS Scores on somatizing, psychologizing and normalizing attribution subscales of the SIQ were strongly correlated with each other. Somatosensory amplification and alexithymia were independent correlates of somatizing attributions. Higher levels of psychologizing and normalizing attributions were both related to more severe symptoms of depression and to somatosensory amplification. CONCLUSIONS These results suggested that patients with higher levels of depressive symptoms were more likely to engage in a greater diversity of attribution styles as measured by the SIQ in our sample. Independent correlates of somatic symptom attribution in patients with MDD were found to be different from Western countries, suggestive of disparate cultural characteristics and help-seeking pathways and behaviour in Turkey.
Collapse
Affiliation(s)
- Okan Taycan
- Okan Taycan, M.D., Psychiatrist, Department of Psychiatry, Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
| | | | | | | |
Collapse
|
9
|
Frostholm L, Ørnbøl E, Fink PK. Physical symptom attributions: a defining characteristic of somatoform disorders? Gen Hosp Psychiatry 2015; 37:147-52. [PMID: 25677210 DOI: 10.1016/j.genhosppsych.2015.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/04/2014] [Accepted: 01/08/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We examined whether primary care patients were more likely to perceive a current health problem as 'physical illness only' as opposed to entailing psychological difficulties if they had a comorbid somatoform disorder compared to patients who had (a) both comorbid somatoform disorder and anxiety/depression or (b) comorbid anxiety and/or depression, and a reference group of (c) patients with well-defined physical disease. We examined whether attributions predicted future health expenditures. METHODS A total of 1209 of 1785 patients completed questions on patient-perceived illness. The physicians diagnosed the current health problem. A stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Health expenditure was obtained from registers for a 2-year period. RESULTS The belief that the current health problem was only physical was endorsed by 86% of patients presenting physical disease, 58% of patients with somatoform disorders, 29% of patients with both somatoform disorders and anxiety/depression and 24% of patients with anxiety or depressive disorders (χ2=269.2, df=3, P<.0001). In a multiple regression model, a 'physical illness only' perception predicted lower health expenditures [β = -0.31, 95% confidence interval (-0.55; -0.07), P=.013]. CONCLUSIONS The prevalent assumption that physical symptom attributions are a central aspect in somatoform disorders is not supported by the current study.
Collapse
Affiliation(s)
- Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark.
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
| | - Per K Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark
| |
Collapse
|
10
|
Guevara JDR, Vásquez R. [Critical Approach to Somatomorphic Disorders in Children]. ACTA ACUST UNITED AC 2014; 41:900-9. [PMID: 26572273 DOI: 10.1016/s0034-7450(14)60054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/14/2012] [Indexed: 11/17/2022]
Abstract
Somatomorphic disorders have common somatic manifestations without medical explanation, that can affect daily life. There are evaluation difficulties regarding symptom report or observation in children due to their age, parental influence and associated factors. The aim of this work is to acknowledge diagnosis difficulties and clinic tools to approach somatomorphic disorders in children. A systematic search in the information published for the last ten years was carried out. Historical evolution of the concept of somatization has generated difficulties to approach this issue. Some signs could indicate a somatomorphic disorder; however, there are very little evaluating tools for children. Currently, said tools are only based on lists of symptoms without fully answering to all questions. Somatomorphic disorders or somatic symptoms in children are still a gap to be closed.
Collapse
Affiliation(s)
| | - Rafael Vásquez
- Psiquiatra Infantil, Universidad Nacional de Colombia, Bogotá, Colombia
| |
Collapse
|
11
|
Neng JMB, Weck F. Attribution of somatic symptoms in hypochondriasis. Clin Psychol Psychother 2013; 22:116-24. [PMID: 24123559 DOI: 10.1002/cpp.1871] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 08/22/2013] [Accepted: 09/11/2013] [Indexed: 11/11/2022]
Abstract
The misinterpretation of bodily symptoms as an indicator of a serious illness is a key feature of the criteria and the cognitive-behavioural models of hypochondriasis. Previous research suggests that individuals suffering from health anxiety endorse attributions of physical disease, whereas persons with elevated general anxiety have the tendency to attribute psychological causes to their symptoms. However, whether a somatic attribution style is specific to patients with hypochondriasis, as opposed to those with anxiety disorders, has not yet been investigated and is therefore part of the present study. Fifty patients with hypochondriasis, 50 patients with a primary anxiety disorder and 50 healthy participants were presented with nine common bodily sensations and had to spontaneously attribute possible causes to the symptoms. Patients with hypochondriasis differed from patients with anxiety disorders and healthy controls in giving significantly fewer normalizing explanations, but attributing more often in terms of moderate or serious diseases. Patients with anxiety disorders also made significantly fewer normalizing attributions and more somatic attributions to a severe illness than healthy controls. There were no differences between the groups in the frequency of psychological attributions and somatic attributions concerning mild diseases. The present study demonstrates that hypochondriasis is associated with a disorder-specific attribution style connecting somatic symptoms primarily with moderate and serious diseases. By contrast, normalizing attributions are largely omitted from consideration by patients with hypochondriasis. The findings conform with the cognitive conception of hypochondriasis and support the strategy of modifying symptom attributions, as practiced in cognitive-behavioural therapy.
Collapse
Affiliation(s)
- Julia M B Neng
- Department of Clinical Psychology and Psychotherapy, University of Frankfurt, Frankfurt, Germany
| | | |
Collapse
|
12
|
Douzenis A, Seretis D. Descriptive and predictive validity of somatic attributions in patients with somatoform disorders: a systematic review of quantitative research. J Psychosom Res 2013; 75:199-210. [PMID: 23972408 DOI: 10.1016/j.jpsychores.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/07/2013] [Accepted: 05/12/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Research on hypochondriasis and other somatoform disorders (SFD) has provided evidence that patients with SFD tend to attribute their symptoms to organic dysfunctions or disease. However, recent studies appear to discredit this. There is no systematic evidence on whether patients with SFD predominantly rely on somatic attributions, despite calls to include somatic attributions as a positive criterion of somatic symptom disorder (SSD) in the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS This study is a systematic review of quantitative studies which assess the descriptive and predictive validity of somatic attribution in SFD. The literature search was restricted to studies with patients who met the DSM-IV criteria for SFD. RESULTS Somatic attribution style in SFD has acceptable descriptive but insufficient predictive validity. This confirms that the overlap between somatic and psychological attributions is often substantial. Attribution style can discriminate between SFD patients with and without comorbidity. CONCLUSION A somatic attribution style does not qualify as a positive criterion in SSD. However, there is an urgent need for further research on causal illness perceptions in the full spectrum of medically unexplained symptoms in order to confirm this result. Given its high prevalence, research on psychological attribution style is warranted. Re-attribution does not provide a framework sophisticated enough to address the needs of patients in primary care.
Collapse
Affiliation(s)
- Athanassios Douzenis
- Second Psychiatry Department, Athens University Medical School, Attikon General Hospital, 1 Rimini St., Athens, 12462, Greece.
| | | |
Collapse
|
13
|
Haas L, Stargardt T, Schreyoegg J, Schlösser R, Klapp BF, Danzer G. The trade-off between costs and quality of care in the treatment of psychosomatic patients with somatoform pain disorder. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:359-368. [PMID: 23852985 DOI: 10.1007/s40258-013-0042-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The introduction of efficiency-oriented provider payment systems in inpatient mental healthcare in various Western countries may lead to the use of less healthcare resources in the treatment of patients. To avoid unintended effects on quality of care that may result from reductions in resource utilization, it is essential for decision and policy makers to know whether there is a trade-off between costs and quality of care. AIM OF THE STUDY The aim of this study was to investigate and quantify the relationship between costs and outcomes in psychosomatic inpatients with somatoform pain disorder. METHODS The inclusion criteria for patient selection (n = 101) were (i) a main diagnosis of somatoform pain disorder according to International Classification of Diseases-10 (ICD-10) [F45.4, F45.40, F45.41]; (ii) complete data on the mental component summary reflecting overall functioning of mental health (MCS-8) measured with the Short Form-8 Health Survey (SF-8) within 3 days of the admission and discharge dates; and (iii) treatment at Charité Universitaetsmedizin (Berlin, Germany) during the period January 2006-June 2010. The change in the MCS-8 score incurred over the treatment period was used as an indicator of quality of care. Treatment costs were calculated from the provider's perspective, mainly using bottom-up micro-costing. The year of valuation for cost calculation was 2008 (with no inflation adjustment); for costs provided by the accounting department for services consumed by the patient, the valuation year was based on the year of service provision. We hypothesized that the outcome 'change in MCS-8 score' was a function of the independent variable costs, patient characteristics, socio-demographic variables, pain-related variables, co-morbidities and subjective illness attribution, i.e. whether patients attributed the origin of pain mainly to a somatic cause or not. An interaction term between costs and illness attribution was included to control for the hypothesized differing effects of resource input or costs on the outcome variable conditional on patients' illness attribution. Hausman tests indicated that endogeneity was not present, thus, ordinary least squares regression (OLS) was conducted. We assessed whether the change in the MCS-8 score was clinically meaningful and perceptible by the patient, using the minimal clinical important difference (MCID). For Short Form Health Surveys, the MCID for changes in the mental component summary is typically around 3 points. RESULTS We found a trade-off between costs and outcome for patients without or with only minor somatic illness attribution (77 % of the sample). This patient group improved 0.4 points in outcome after every 100 <euro> increase in total costs per case (F 1,77 = 13.836, t(77) = 3.72, p = 0.0004). For patients with mainly somatic illness beliefs (23 % of the sample), we did not find a trade-off between costs and outcome. CONCLUSION For the majority of patients, we found a trade-off between costs and health outcome, thus, it seems advisable to carefully monitor outcome parameters when applying cost containment measures.
Collapse
Affiliation(s)
- Laura Haas
- Department of Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charité Universitaetsmedizin, Luisenstr. 13a, 10117, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
14
|
Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem. J Psychosom Res 2013; 74:265-9. [PMID: 23438720 DOI: 10.1016/j.jpsychores.2012.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/17/2012] [Accepted: 12/27/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) is a chronic musculoskeletal pain disorder characterized by widespread pain. This study focuses on patients' attributions of illness and of symptom onset. METHODS Semi-structured interviews were conducted with 56 women to elicit patients' views on what triggered their FM. The transcripts of the interviews were analyzed using a classical indexing technique to identify key themes. Content analysis was performed by two independent coders. RESULTS Primary causal attributions fell into five categories: psychological problems (28 respondents); somatic concerns (N=12); violence/abuse during childhood (N=7), gynaecological/obstetrical problems (N=6), and fatigue (N=3). Patients' attributions were internal and external in the same proportions, more frequently unstable than stable, and more often described uncontrollable than controllable. Participants expressed decrements in self-esteem and feelings such as self-blame or despair; global perceptions of persistent pain and long-lasting problems, evoking chronicity and hopelessness; and low perceived control over their lives as well as beliefs that nothing can be done, thus increasing a feeling of guilt and vulnerability. Patients' narratives emphasized disruptive circumstances surrounding symptom onset. CONCLUSION Attributions often referred to the psychological dimension of the events surrounding FM onset, even though some of them also had a clear somatic dimension. Many narratives mentioned successive disruptive events and suggested an increasing loss of control. Addressing these illness representations may contribute to tailor the treatment and to help patients gain self-coherency by providing means to understand pain onset but also to guide future behaviours, particularly in terms of adjustment and help-seeking.
Collapse
|
15
|
Wollburg E, Voigt K, Braukhaus C, Herzog A, Löwe B. Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5. J Psychosom Res 2013; 74:18-24. [PMID: 23272984 DOI: 10.1016/j.jpsychores.2012.09.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/18/2012] [Accepted: 09/20/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Current diagnostic criteria for somatoform disorders demand revisions due to their insufficient clinical as well as scientific usability. Various psychological and behavioral characteristics have been considered for the proposed new category Somatic Symptom Disorder (SSD). With this study, we were able to jointly assess the validity of these variables in an inpatient sample. METHODS Using a cross-sectional design, we investigated N=456 patients suffering from somatoform disorder, anxiety, or depression. Within one week after admission to the hospital, informed consent was obtained and afterwards, a diagnostic interview and a battery of self-report questionnaires were administered. Logistic regression analyses were performed to determine which variables significantly add to construct and descriptive validity. RESULTS Several features, such as somatic symptom severity, health worries, health habits, a self-concept of being weak, and symptom attribution, predicted physical health status in somatization. Overall, our model explained about 50% of the total variance. Furthermore, in comparison with anxious and depressed patients, health anxiety, body scanning, and a self-concept of bodily weakness were specific for DSM-IV somatoform disorders and the proposed SSD. CONCLUSIONS The present study supports the inclusion of psychological and behavioral characteristics in the DSM-5 diagnostic criteria for somatoform disorders. Based on our results, we make suggestions for a slight modification of criterion B to enhance construct validity of the Somatic Symptom Disorder.
Collapse
|
16
|
Lee BO. Ambivalence over emotional expression and symptom attribution are associated with self-reported somatic symptoms in Singaporean school adolescents. ASIAN JOURNAL OF SOCIAL PSYCHOLOGY 2012. [DOI: 10.1111/ajsp.12005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Martin A, Rief W. Relevance of cognitive and behavioral factors in medically unexplained syndromes and somatoform disorders. Psychiatr Clin North Am 2011; 34:565-78. [PMID: 21889679 DOI: 10.1016/j.psc.2011.05.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandra Martin
- Department of Psychosomatic Medicine and Psychotherapy, University of Erlangen-Nürnberg, University Hospital Erlangen, Schwabachanlage 6, D-91054 Erlangen, Germany.
| | | |
Collapse
|