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Palagini L, Zerbinati L, Balestrieri M, Belvederi Murri M, Caruso R, D'Agostino A, Ferrara M, Ferrari S, Minervino A, Massa L, Milia P, Miniati M, Maria Giulia N, Petrucci A, Pini S, Politi P, Porcellana M, Rocchetti M, Taddei I, Toffanin T, Grassi L. Poor sleep quality may contribute to dysfunctional illness perception, physical and emotional distress in hospitalised patients: results of a national survey of the Italian Society of Consultation-Liaison Psychiatry. J Sleep Res 2023; 32:e13617. [PMID: 35460144 DOI: 10.1111/jsr.13617] [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: 03/25/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/03/2023]
Abstract
Distress associated with physical illness is a well-known risk factor for adverse illness course in general hospitals. Understanding the factors contributing to it should be a priority and among them dysfunctional illness perception and poor sleep quality may contribute to it. As poor sleep quality is recognised as a major risk factor for health problems, we aimed to study its association with illness perception and levels of distress during hospitalisation. This cross-sectional study included a consecutive series of 409 individuals who were hospitalised in medical and surgical units of different hospitals located throughout the Italian national territory and required an assessment for psychopathological conditions. Sleep quality was assessed with the Pittsburgh (Sleep Quality Index), emotional and physical distress with the Edmonton Symptom Assessment System (ESAS), and illness perception with the Brief Illness Perception Questionnaire (BIPQ). Differences between groups, correlations and mediations analyses were computed. Patients with poor sleep quality were more frequently females, with psychiatric comorbidity, with higher scores in the ESAS and BIPQ. Poor sleep quality was related to dysfunctional illness perception, and to both emotional and physical distress. In particular, by affecting cognitive components of illness perception, poor sleep quality may, directly and indirectly, predict high levels of distress during hospitalisation. Poor sleep quality may affect >70% of hospitalised patients and may favour dysfunctional illness perception and emotional/physical distress.Assessing and treating sleep problems in hospitalised patients should be included in the routine of hospitalised patients.
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Affiliation(s)
- Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy.,Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Matteo Balestrieri
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Armando D'Agostino
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Silvia Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Lucia Massa
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Paolo Milia
- Psychiatric Clinic and Medical Clinic, University of Sassari, Sassari, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Nanni Maria Giulia
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Alessandra Petrucci
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Matteo Porcellana
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Ines Taddei
- Department of Psychiatric Sciences and Psychological Medicine, University La Sapienza, 3rd Psychiatric Clinic, Rome, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
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Balestrieri M, Rucci P, Murri MB, Caruso R, D'Agostino A, Ferrari S, Nanni MG, Palagini L, Pini S, Politi P, Rocchetti M, Zerbinati L, Grassi L. Suicide risk in medically ill inpatients referred to consultation-liaison psychiatric services: A multicenter study. J Affect Disord 2022; 319:329-335. [PMID: 36057291 DOI: 10.1016/j.jad.2022.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/23/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this multicenter study was to investigate the suicide risk in medically ill patients admitted to six Italian hospitals for whom a consultation-liaison intervention was requested. METHODS Participants completed socio-demographic and clinical report forms and the Brief Illness Perception Questionnaire. Suicidality was assessed using the P4 screener that investigates the presence of Past suicide attempts, Plans to commit a suicide, Probability of completing suicide, and Preventive factors. Participants were categorized as being at no, low or high suicide risk. Univariate and multivariable associations of categorical and continuous variables with suicide risk were investigated using multinomial logistic regression. RESULTS Of the 641 inpatients, with mean age 60 years (SD = 16.9) and 49.2 % male, 13.2 % were at high suicidal risk (HR), 7.6 % low risk (LR) and 79.2 % no risk. Contacts with psychiatrists in the previous six months were associated with LR and HR (OR = 2.159 and 2.634, respectively), ongoing benzodiazepine use was associated with a threefold likelihood of LR (OR = 3.005), and the experienced intensity of illness symptoms was associated with LR and HR (OR = 1.257 and OR = 1.248, respectively). CL psychiatrists prescribed appropriate psychotropic drugs and activated liaison interventions and psychological support for the level of suicidal risk. LIMITATIONS The use of self-report measures bears the risk of recall bias. CONCLUSIONS Our findings based on psychiatric consultations in the general hospital underscore the need to include suicide risk in the routine assessment of inpatients referred to CL psychiatric services and to plan an appropriate management of suicidal risk after discharge.
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Affiliation(s)
- Matteo Balestrieri
- Psychiatric Unit, Department of Medicine, University of Udine, Udine, Italy.
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Armando D'Agostino
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Silvia Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Laura Palagini
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy.
| | - Pierluigi Politi
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy.
| | - Matteo Rocchetti
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy.
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
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Li J, Fritzsche K, Glinka M, Pang Y, Song L, Wang Y, Li Z, He Y, Zhang Y, He S, Leonhart R, Toussaint AK, Tang L. Prevalence of DSM-5 somatic symptom disorder in Chinese patients with breast cancer. Psychooncology 2022; 31:1302-1312. [PMID: 35353396 DOI: 10.1002/pon.5932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/09/2022] [Accepted: 03/19/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aims of this study were to explore the frequency of somatic symptom disorder (SSD) and the relationship between SSD and somatic, psychological, and social factors in Chinese patients with breast cancer. METHODS This multicenter cross-sectional study enrolled 264 patients with breast cancer from 3 different departments in Beijing. The structured clinical interview for DSM-5 (SCID-5) for SSD. Standardized questionnaires and clinical data were used to compare patients with and without SSD. RESULTS SSD was diagnosed in 21.6% (57/264) of all enrolled patients. No differences were found between SSD patients and non-SSD patients in terms of sociodemographic characteristics and tumor-specific variables, except radiotherapy.However, patients with SSD reported higher levels of depression, anxiety and cancer-related worry. They also showed a longer duration of symptoms, greater impairment in daily life, more concern over their physical complaints and more doctor visits. In a stepwise binary logistic regression analysis, among others, higher health anxiety (WI-8, Exp(B) = 0.107, p = 0.009) and more doctor visits (OR = -1.841, p < 0.001) showed a significant association with SSD; the model explained 53.7% of the variance. CONCLUSIONS Similar to other physical diseases, there is a high prevalence of SSD in patients with breast cancer. SSD patients differ from non-SSD patients by exhibiting higher cancer-related emotional distress and dysfunctional illness perception and behavior. There remain substantial challenges in the diagnosis of SSD in patients with cancer and other medical conditions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jinjiang Li
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China.,Department of Outpatient, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Germany
| | - Mark Glinka
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Germany
| | - Ying Pang
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Lili Song
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Wang
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Zimeng Li
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yi He
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yening Zhang
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuangzhi He
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | | | - Anne-Kristin Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Lili Tang
- Department of Psycho-oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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Marcelo Castro e Silva I, Lúcia Penteado Lancellotti C. Health-Related Quality of Life in Women with Breast Cancer Undergoing Chemotherapy in Brazil. Int J Gen Med 2021; 14:10265-10270. [PMID: 34992441 PMCID: PMC8711561 DOI: 10.2147/ijgm.s343804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Breast cancer (BC) is an austere public health problem, representing the most incident and prevalent malignancy among women worldwide. OBJECTIVE To evaluate the health-related quality of life of women with breast cancer undergoing initial and final stages of chemotherapy treatment. METHODS It was descriptive, correlational, analytical, prospective cross-sectional study that included 80 women diagnosed with breast cancer undergoing chemotherapy treatment. Health-related quality of life was assessed in two phases. The first one was on the initial day of the treatment and the second, 120 days after started the chemotherapy. RESULTS Eighty adult women were part of the study, whose average age was 52.54. Overall quality of life decreased due to chemotherapy. It was noted the negative impact that the emotional role, the sexual function and the concern about hair loss on health-related quality of life. It was observed that fatigue, nausea and vomiting, appetite loss, diarrhea were frequent symptoms in comparison between the phases. Sexual function and satisfaction were dissatisfying and worsened during chemotherapy. CONCLUSION The quality of life related to the health of patients is negatively influenced during chemotherapy treatment, hence, requiring interventions in oncology and research in this sphere.
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Affiliation(s)
- Igor Marcelo Castro e Silva
- Doctoral Program in Health Sciences, College of Medical Sciences, Santa Casa of São Paulo, Brazil
- Department of Pathology, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Tian P, Ma Y, Hu J, Zhou C, Liu X, Chen Q, Dang H, Zou H. Clinical and psychobehavioral features of outpatients with somatic symptom disorder in otorhinolaryngology clinics. J Psychosom Res 2021; 148:110550. [PMID: 34175726 DOI: 10.1016/j.jpsychores.2021.110550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In the Otorhinolaryngology Department, patients exhibiting somatic symptoms without a medical cause are frequently neglected and left untreated. The aim of this study was to characterize the psychosomatic features of outpatients with somatic symptom disorder (SSD) to better identify patients needing treatment. METHODS This cross-sectional study enrolled 883 consecutive patients with medically unexplained symptoms. A semistructured clinical interview was employed to confirm the diagnosis of SSD. Data, including sociodemographic and clinical measures, were collected. The Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Scale-China (SSS-CN) were used to assess the severity of somatic symptoms; the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression; the General Anxiety Disorder-7 (GAD-7) was used to assess anxiety; and the 12-item Short-form Health Survey (SF-12) was used to assess quality of life (QoL). RESULTS Based on the DSM-5 criteria, 641 patients were placed in the SSD group, and 212 were placed in the normal group. Compared with the normal group, the SSD group had significantly more doctor visits, longer symptom durations, higher GAD-7 and PHQ-9 scores, and lower physical composite scores (PCSs) and mental composite scores (MCSs). Spearman's correlation analysis and multiple linear regression analyses showed that the SSS-CN score, PHQ-15 score and the patient's subjective feeling that his or her daily life was affected by the disorder were significant risk factors for low PCSs; the SSS-CN, PHQ-15, PHQ-9, and GAD-7 scores were independent risk factors for low MCSs. CONCLUSION Our findings demonstrated that SSD patients are not rare in otorhinolaryngology clinics in China and that their QoL is significantly affected by SSD. Otolaryngologists should thoroughly evaluate these patients from the perspective of psychosomatic medicine.
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Affiliation(s)
- Peng Tian
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Yun Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Junwu Hu
- Department of Psychology, School of Public Health, Southern Medical University, No. 1023. South Shatai Road, Baiyun District, Guangzhou, Guangdong 510515, People's Republic of China
| | - Chao Zhou
- Guangzhou Psychiatric Hospital, No. 36, Ming Xin Road, Fangcun, Liwan District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Xiang Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Qiujian Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China
| | - Hua Dang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China.
| | - Hua Zou
- Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yan Jiang Xi Road, Haizhu District, Guangzhou, Guangdong 510120, People's Republic of China.
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Binotto M, Reinert T, Werutsky G, Zaffaroni F, Schwartsmann G. Health-related quality of life before and during chemotherapy in patients with early-stage breast cancer. Ecancermedicalscience 2020; 14:1007. [PMID: 32104209 PMCID: PMC7039692 DOI: 10.3332/ecancer.2020.1007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives Identify the main changes in the health-related quality of life (HRQoL) of women diagnosed with breast cancer (BC) undergoing chemotherapy. Methods Prospective cohort study that included 33 women diagnosed with clinical stages I–III BC and who underwent adjuvant chemotherapy. HRQoL was assessed using the EORTC QLQ-C30 and EORTC QLQ-BR23 instruments 1 week before the start of chemotherapy and during the third month of chemotherapy. Results There was a decline in the HRQoL scores of patients during treatment. Therefore, chemotherapy alters the patient’s perceptions of their HRQoL since there is a decrease in global health status/quality of life (QoL) and functional scales such as physical functioning, role functioning, emotional functioning, social functioning, body image, sexual function and sexual enjoyment. We also observed an increase in side effects related to the systemic therapy, fatigue, nausea and vomiting, insomnia, appetite loss and diarrhoea, despite a decrease in breast symptoms and arm symptoms. Conclusions HRQoL was negatively affected during chemotherapy. Even though HRQoL assessment is a useful method for optimising patients’ care, its implementation into clinical practice remains a challenge. Since side effects are very often underestimated, we consider that the evaluation of HRQoL parameters should be done for BC patients treated with chemotherapy.
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Affiliation(s)
- Monique Binotto
- Postgraduate Program in Clinical Research, Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, RS 90035-007, Brazil.,Centro de Pesquisa da Serra Gaúcha, CEPESG, Caxias do Sul, RS 95020-450, Brazil.,https://orcid.org/0000-0002-5799-5390
| | - Tomás Reinert
- Centro de Pesquisa da Serra Gaúcha, CEPESG, Caxias do Sul, RS 95020-450, Brazil.,https://orcid.org/0000-0003-4715-1415
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group, LACOG, Porto Alegre, RS 90619-900, Brazil.,https://orcid.org/0000-0001-6271-105X
| | - Facundo Zaffaroni
- Latin American Cooperative Oncology Group, LACOG, Porto Alegre, RS 90619-900, Brazil
| | - Gilberto Schwartsmann
- Postgraduate Program in Clinical Research, Hospital de Clínicas de Porto Alegre, HCPA, Porto Alegre, RS 90035-007, Brazil.,https://orcid.org/0000-0002-7850-1644
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Schmalbach B, Tibubos AN, Hinz A, Zenger M, Brähler E. Measuring Illness Behavior in One Minute. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2019. [DOI: 10.1027/2512-8442/a000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The present study addresses shortcomings in previous psychometric research into the Scale for the Assessment of Illness Behavior (SAIB) and develops a short form, the SAIB-10. We used ant-colony optimization to construct a subset of items in an exploratory sample ( n = 1,187) and affirmed it in factor analysis in a confirmatory sample ( n = 1,208). We find excellent model fit and evidence for strict invariance across sex and age. As expected, there were associations with distressed personality, perceived social support, and mental health. Finally, we report normative values for usage by researchers and clinicians. In sum, the SAIB-10 is an economical measure of illness behavior and recommended as a screening tool or for large-scale surveys.
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Affiliation(s)
- Bjarne Schmalbach
- Department of Psychology, University of Münster, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Ana Nanette Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Markus Zenger
- Faculty of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases – Behavioral Medicine, Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
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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.
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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
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Tang L, Fritzsche K, Leonhart R, Pang Y, Li J, Song L, Fischer I, Koch M, Wuensch A, Mewes R, Schaefert R. Emotional distress and dysfunctional illness perception are associated with low mental and physical quality of life in Chinese breast cancer patients. Health Qual Life Outcomes 2017; 15:231. [PMID: 29191208 PMCID: PMC5709963 DOI: 10.1186/s12955-017-0803-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/17/2017] [Indexed: 12/29/2022] Open
Abstract
Background To evaluate the relationship between quality of life (QOL) and physical as well as psychological variables in Chinese breast cancer patients. Methods This multicenter cross-sectional study enrolled 254 Chinese breast cancer patients in different stages and treatment phases. They answered standard instruments assessing QOL (EORTC), somatic symptom severity (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health-related anxiety (WI-7), illness perception (BIPQ), and sense of coherence (SOC-9). Canonical correlation was applied to identify the strongest correlates between the physical, emotional and social QOL scales and the physical and psychological variables. Results In our sample, a low global QOL was significantly associated with the following physical and psychological variables: symptom-related disability (Karnofsky Index) (r = .211, p < .01), somatic symptom severity (r = −.391, p < .001), depression (r = −.488, p < .001), anxiety (r = −.439, p < .001), health-related anxiety (r = −.398, p < .001), dysfunctional illness perception (r = −.411, p < .001), and sense of coherence (r = .371, p < .001). In the canonical correlation analysis, high somatic symptom severity, depression, anxiety, dysfunctional illness perception, and low sense of coherence showed the strongest correlations with low physical, emotional and social functioning. The first three significant canonical correlations between these two sets of variables were .78, .56, and .45. Conclusions QOL in Chinese breast cancer patients is strongly associated with psychological factors. Our results suggest that Chinese physicians and nurses should incorporate these factors into their care for women with breast cancer to improve patients’ QOL.
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Affiliation(s)
- Lili Tang
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Kurt Fritzsche
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Ying Pang
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Jinjiang Li
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Lili Song
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Irmela Fischer
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Maike Koch
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | | | - Ricarda Mewes
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Rainer Schaefert
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, 4031, Basel, Switzerland
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Xiong N, Zhang Y, Wei J, Leonhart R, Fritzsche K, Mewes R, Hong X, Cao J, Li T, Jiang J, Zhao X, Zhang L, Schaefert R. Operationalization of diagnostic criteria of DSM-5 somatic symptom disorders. BMC Psychiatry 2017; 17:361. [PMID: 29115965 PMCID: PMC5678573 DOI: 10.1186/s12888-017-1526-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/31/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to test the operationalization of DSM-5 somatic symptom disorder (SSD) psychological criteria among Chinese general hospital outpatients. METHODS This multicenter, cross-sectional study enrolled 491 patients from 10 general hospital outpatient departments. The structured clinical "interview about cognitive, affective, and behavioral features associated with somatic complaints" was used to operationalize the SSD criteria B. For comparison, DSM-IV somatoform disorders were assessed with the Mini International Neuropsychiatric Interview plus. Cohen's к scores were given to illustrate the agreement of the diagnoses. RESULTS A three-structure model of the interview, within which items were classified as respectively assessing the cognitive (B1), affective (B2), and behavioral (B3) features, was examined. According to percentages of screening-positive persons and the receiver operator characteristic (ROC) analysis, a cut-off point of 2 was recommended for each subscale of the interview. With the operationalization, the frequency of DSM-5 SSD was estimated as 36.5% in our sample, and that of DSM-IV somatoform disorders was 8.2%. The agreement between them was small (Cohen's к = 0.152). Comparisons of sociodemographic features of SSD patients with different severity levels (mild, moderate, severe) showed that mild SSD patients were better-off in terms of financial and employment status, and that the severity subtypes were congruent with the level of depression, anxiety, quality of life impairment, and the frequency of doctor visits. CONCLUSIONS The operationalization of the diagnosis and severity specifications of SSD was valid, but the diagnostic agreement between DSM-5 SSD and DSM-IV somatoform disorders was small. The interpretation the SSD criteria should be made cautiously, so that the diagnosis would not became over-inclusive.
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Affiliation(s)
- Nana Xiong
- 0000 0000 9889 6335grid.413106.1Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 China
| | - Yaoyin Zhang
- 0000 0004 1808 0950grid.410646.1Department of Psychosomatic, Sichuan Provincial People’s Hospital, Chengdu, Sichuan People’s Republic of China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Rainer Leonhart
- grid.5963.9Institute of Psychology, University of Freiburg, 79085 Freiburg, Germany
| | - Kurt Fritzsche
- 0000 0000 9428 7911grid.7708.8Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany
| | - Ricarda Mewes
- 0000 0004 1936 9756grid.10253.35Department of Psychology, Philipps University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Xia Hong
- 0000 0000 9889 6335grid.413106.1Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 China
| | - Jinya Cao
- 0000 0000 9889 6335grid.413106.1Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 China
| | - Tao Li
- 0000 0000 9889 6335grid.413106.1Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 China
| | - Jing Jiang
- 0000 0000 9889 6335grid.413106.1Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 China
| | - Xudong Zhao
- 0000000123704535grid.24516.34Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, 200120 China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan People’s Republic of China
| | - Rainer Schaefert
- grid.410567.1Department of Psychosomatics, Medical Division, University Hospital Basel, Basel, Switzerland
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Wang J, Wu X, Lai W, Long E, Zhang X, Li W, Zhu Y, Chen C, Zhong X, Liu Z, Wang D, Lin H. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open 2017; 7:e017173. [PMID: 28838903 PMCID: PMC5640125 DOI: 10.1136/bmjopen-2017-017173] [Citation(s) in RCA: 236] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Depression and depressive symptoms are common mental disorders that have a considerable effect on patients' health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties. DESIGN Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY CRITERIA The PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2 tests and the I2 statistic. The study protocol has been registered with PROSPERO under number CRD42017054738. RESULTS Eighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ 2 =25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%). CONCLUSION Our study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.
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Affiliation(s)
- Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Erping Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiaojian Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Wei J, Zhang L, Zhao X, Fritzsche K. Current Trends of Psychosomatic Medicine in China. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:388-390. [PMID: 27744441 DOI: 10.1159/000447780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/19/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Peking, China
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Xiong N, Wei J, Fritzsche K, Leonhart R, Hong X, Li T, Jiang J, Zhu L, Tian G, Zhao X, Zhang L, Schaefert R. Psychological and somatic distress in Chinese outpatients at general hospitals: a cross-sectional study. Ann Gen Psychiatry 2017; 16:35. [PMID: 29075308 PMCID: PMC5644179 DOI: 10.1186/s12991-017-0158-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/05/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Our study aimed (1) to describe the proportion of psychological distress among Chinese outpatients at general hospitals, (2) to compare cognitive and behavioral characteristics of patients with different distress patterns, and (3) to investigate the discriminant function of the analyzed variables in indicating the affinity towards the different distress patterns. METHODS This multicenter cross-sectional study was conducted at ten outpatient departments at Chinese general hospitals. The somatic symptom severity scale (PHQ-15), the nine-item depression scale (PHQ-9), and the seven-item anxiety scale (GAD-7) were employed to classify patients in terms of four distress patterns. RESULTS A total of 491 patients were enrolled. Among them, the proportion of patients with high psychological distress was significantly higher within those with high somatic distress (74.5% vs. 25.5%, p < .001). Patients with psychological distress alone and mixed distress were significantly younger and with lower monthly family income, while the proportion of female patients (80.9%) was highest in the somatic distress group. Patients with mixed distress had the most negative cognitive and behavioral characteristics [highest health anxiety (5.0 ± 1.9), lowest sense of coherence (35.5 ± 10.0), the worst doctor-patient relationship from both patients' (36.0 ± 7.3) and doctors' perspectives (23.3 ± 7.0)], as well as most impaired quality of life (41.6 ± 7.4 and 31.9 ± 10.3). In addition, compared with patients with somatic distress alone, those with psychological distress alone had lower sense of coherence, worse doctor-patient relationship, and more impaired mental quality of life, but less doctor visits. Discriminant analysis showed that gender, mental quality of life, health anxiety, sense of coherence, and frequent doctor visits were significant indicators in identifying patients with different distress patterns. CONCLUSIONS Our study found that (1) psychological distress was not rare in the Chinese general hospital outpatients, especially in those with high somatic distress; (2) patients with psychological distress alone sought less help from doctors, despite their severe psychosocial impairment; and (3) gender, health anxiety, sense of coherence, mental quality of life, and frequent doctor visits could help to identify different distress patterns.
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Affiliation(s)
- Nana Xiong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Jing Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730 People's Republic of China
| | - Liming Zhu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guoqing Tian
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xudong Zhao
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan China
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Leonhart R, Tang L, Pang Y, Li J, Song L, Fischer I, Koch M, Wuensch A, Fritzsche K, Schaefert R. Physical and psychological correlates of high somatic symptom severity in Chinese breast cancer patients. Psychooncology 2016; 26:656-663. [PMID: 27350559 DOI: 10.1002/pon.4203] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/02/2016] [Accepted: 06/24/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We researched associations between somatic symptom severity (SSS), and physical and psychological factors in Chinese breast cancer patients. METHODS This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (Patient Health Questionnaire [PHQ]-15), depression (PHQ-9), anxiety (General Anxiety Disorder [GAD]-7), health anxiety (Whiteley-7 [WI-7]), illness perception (Brief-Illness Perception Questionnaire [IPQ]), illness attribution (Illness Perception Questionnaire-Revised [IPQ-R]), and sense of coherence (Sense of Coherence [SOC]-9). Logistic regression was applied to identify the strongest correlates with SSS. RESULTS Our sample of high (PHQ-15 ≥ 10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r = 0.339, P < .001), symptom-related disability (Karnofsky Index) (r = 0.182, P < .001), depression (r = 0.556, P < .001), anxiety (r = 0.433, P < .001), health anxiety (r = 0.400, P < .001), illness perception (r = 0.349, P < .001), psychological illness attributions (r = 0.217, P < .01), and sense of coherence (r = -0.254, P < .001). In an adjusted stepwise multiple binary logistic regression analysis, higher health anxiety (WI-7, B = 0.388, P = .002), higher depression (PHQ-9, B = 0.158, P < .001), younger age (B = -0.042, P = .048), higher impairment in daily life (B = 1.098, P = .010), and longer symptom duration (Wald = 18.487, P = .001) showed a significant association with high SSS; the model explained 55.1% of the variance. CONCLUSIONS High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, SSD concept in cancer patients and to better operationalize psychobehavioral factors in this patient group.
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Affiliation(s)
- Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lili Tang
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Ying Pang
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Jinjiang Li
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Lili Song
- Psycho-Oncology Department, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Psycho-Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
| | - Irmela Fischer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Maike Koch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Alexander Wuensch
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, TUM MEC, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Centre, Heidelberg, Germany
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Zhang L, Fritzsche K, Liu Y, Wang J, Huang M, Wang Y, Chen L, Luo S, Yu J, Dong Z, Mo L, Leonhart R. Validation of the Chinese version of the PHQ-15 in a tertiary hospital. BMC Psychiatry 2016; 16:89. [PMID: 27044309 PMCID: PMC4820992 DOI: 10.1186/s12888-016-0798-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 03/31/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to investigate the reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-15) in a tertiary hospital. METHODS Using a cross-sectional study design, the Chinese version of the PHQ-15 was administered to a total of 1329 inpatients. To examine the discriminant validity of this questionnaire, we investigated the correlation of the PHQ-15 score with sociodemographic data and the PHQ-9 and GAD-7 scale scores. Exploratory factor analysis was performed to assess the internal consistency of the PHQ-15. To evaluate the consistency of this questionnaire with item response theory (IRT), IRT analysis was performed. RESULTS The Chinese version of the PHQ-15 showed good reliability (Cronbach's alpha = 0.83). The correlations of the PHQ-15 scores with the PHQ-9 depression scale scores (r = 0.565) and the GAD-7 anxiety scale scores (r = 0.512) were moderate; these results suggested that the PHQ-15 had discriminant validity. We identified three factors, referred to as "cardiopulmonary," "gastrointestinal," and "pain/neurological," which explained 56 % of the total variance. A second-order factor analysis including these three factors produced an acceptable model. Several items (4, 8 and 11) displayed extreme floor effects. Additionally, item 4 displayed a very small variance of 0.35 and showed very small differences in its thresholds based on IRT analysis. CONCLUSIONS The PHQ-15 scale had good reliability and high validity to detect patients with high somatic symptom severity in a Chinese tertiary hospital. Several of the current findings were consistent with previous research on the PHQ-15 in Western countries and in China. To improve the diagnostic quality of this questionnaire, items 4, 8 and 11 can be omitted.
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Affiliation(s)
- Lan Zhang
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Hauptstr. 8, D-79104, Freiburg, Germany.
| | - Yang Liu
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Jian Wang
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Mingjin Huang
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Yu Wang
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Liang Chen
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Shanxia Luo
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Jianying Yu
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Zaiquan Dong
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Liling Mo
- Mental Health Center, West China Hospital of Sichuan University, No. 28 Dianxin S. St., Chengdu, Sichuan 610041 P. R. China
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
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Illness perceptions of people with long-term conditions are associated with frequent use of the emergency department independent of mental illness and somatic symptom burden. J Psychosom Res 2016; 81:38-45. [PMID: 26800637 DOI: 10.1016/j.jpsychores.2016.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether illness perceptions of patients with long-term conditions (LTCs) are associated with urgent healthcare use and whether this association is independent from mental illness and somatic symptom burden. METHODS Illness perceptions (B-IPQ) and somatic symptom severity (PHQ-15) were assessed in 304 patients with diabetes, rheumatological disorders and COPD attending an Accident and Emergency Department (AED) in Greece over a one year period. The presence of mental illness was determined by the Mini International Neuropsychiatric Interview. A Generalized Linear Model (Negative Binomial) regression was used to determine the associations of illness perceptions with AED use after adjusting for mental illness, somatic symptom severity, disease parameters and demographics. RESULTS Eighty-six patients (28.3%) reported at least one visit to the AED during the previous year and 75 (24.7%) twice or more. 124 patients (40.8%) had some form of mental disorder with 85 (28.0%) meeting criteria for major depressive disorder. The degree to which the patients had an understanding of their illness (illness comprehensibility) (p<0.01) along with younger age (p<0.05), additional comorbidities (p<0.05) and greater somatic symptom burden (p<0.001) was strongly associated with AED use; AED visits were expected to be reduced by 9.1% for each unit increase in illness comprehensibility. CONCLUSIONS The way people perceive their illness influences urgent healthcare seeking behavior independent of somatic symptom burden. This finding indicates that information provision may prove effective in reducing urgent healthcare use and encourage the design of psycho-educational interventions targeting disease-related cognitions in an attempt to prevent unnecessary healthcare utilization.
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Inamura K, Shinagawa S, Nagata T, Tagai K, Nukariya K, Nakayama K. Cognitive Dysfunction in Patients With Late-Life Somatic Symptom Disorder: A Comparison According to Disease Severity. PSYCHOSOMATICS 2015; 56:486-94. [DOI: 10.1016/j.psym.2014.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/03/2014] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
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Xiong N, Fritzsche K, Wei J, Hong X, Leonhart R, Zhao X, Zhang L, Zhu L, Tian G, Nolte S, Fischer F. Validation of patient health questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: a multicenter cross-sectional study. J Affect Disord 2015; 174:636-43. [PMID: 25576931 DOI: 10.1016/j.jad.2014.12.042] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Despite the high co-morbidity of depressive symptoms in patients with multiple somatic symptoms, the validity of the 9-item Patient Health Questionnaire (PHQ-9) has not yet been investigated in Chinese patients with multiple somatic symptoms. METHODS The multicenter cross-sectional study was conducted in ten outpatient departments located in four cities in China. The psychometric properties of the PHQ-9 were examined by confirmative factor analysis (CFA). Criterion validation was undertaken by comparing results with depression diagnoses obtained from the Mini International Neuropsychiatric Interview (MINI) as the gold standard. RESULTS Overall, 491 patients were recruited of whom 237 had multiple somatic symptoms (SOM+ group, PHQ-15≥10). Cronbach׳s α of the PHQ-9 was 0.87, 0.87, and 0.90 for SOM+ patients, SOM- patients, and total sample respectively. All items and the total score were moderately correlated. The factor models of PHQ-9 tested by CFA yielded similar diagnostic performance when compared to sum score estimation. Multi-group confirmatory factor analysis based on unidimensional model showed similar psychometric properties over the groups with low and high somatic symptom burden. The optimal cut-off point to detect depression in Chinese outpatients was 10 for PHQ-9 (sensitivity=0.77, specificity=0.76) and 3 for PHQ-2 (sensitivity=0.77, specificity=0.74). LIMITATIONS Potential selection bias and nonresponse bias with applied sampling method. CONCLUSIONS PHQ-9 (cut-off point=10) and PHQ-2 (cut-off point=3) were reliable and valid to detect major depression in Chinese patients with multiple somatic symptoms.
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Affiliation(s)
- Nana Xiong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing 100730, PR China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Freiburg, Germany
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing 100730, PR China.
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan 1, Dongcheng District, Beijing 100730, PR China
| | | | - Xudong Zhao
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, PR China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liming Zhu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Guoqing Tian
- Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Sandra Nolte
- Medical Clinic for Internal Medicine, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Germany; Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Felix Fischer
- Medical Clinic for Internal Medicine, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Germany; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Germany
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