1
|
Kuanar Baboo AG, Ranjan P, Kaur T, Rawat N, Sarkar S, Kaloiya G, Singh A, Babu N, Baitha U, Prakash B. Evaluation of Tools to Assess Symptoms and Symptom Severity in Patients With Medically Unexplained Physical Symptoms: A Systematic Review and Narrative Synthesis. Cureus 2024; 16:e56204. [PMID: 38618386 PMCID: PMC11016182 DOI: 10.7759/cureus.56204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
A substantial portion of patients presenting to healthcare settings exhibit physical symptoms lacking clear, demonstrable organic causes. Accurate assessment of symptom severity is crucial for documenting outcomes and establishing treatment efficacy. This systematic review and narrative synthesis aims to provide researchers with insights into available and validated tools for assessing medically unexplained physical symptoms (MUPS). It involved comprehensive searches across electronic databases, including PubMed, Wiley, and Cochrane, adhering to PRISMA and COSMIN guidelines. The study comprised two phases: Phase 1 systematically reviewed tools for assessing MUPS symptoms and severity, while Phase 2 conducted a narrative synthesis of their measurement properties, focusing on validity and reliability. Out of 14,459 records, 191 articles were identified, leading to the recognition of 16 validated tools for assessing MUPS symptoms and severity. Most tools demonstrated excellent internal consistency and structural validity. However, the majority lacked cross-cultural validity. The choice of tools for the assessment of MUPS will assist clinicians and researchers in determining the severity of MUPS and developing a tailored treatment plan to improve the physical and psychological functioning of these patients.
Collapse
Affiliation(s)
| | - Piyush Ranjan
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Tanveer Kaur
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Nandini Rawat
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Siddharth Sarkar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Amandeep Singh
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Natesh Babu
- Yoga, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, IND
| | - Upendra Baitha
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Bindu Prakash
- Medicine, All India Institute of Medical Sciences, New Delhi, IND
| |
Collapse
|
2
|
Guo Z, Wang J, Liu D, Tian E, Chen J, Kong W, Zhang S. Early detection and monitoring of hearing loss in vestibular migraine: Extended high-frequency hearing. Front Aging Neurosci 2023; 14:1090322. [PMID: 36704499 PMCID: PMC9871761 DOI: 10.3389/fnagi.2022.1090322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background Vestibular migraine (VM) presents mainly with recurrent vestibular symptoms and migraine. A great number of patients with VM have cochlea symptoms such as tinnitus, hearing loss. Methods A cross-sectional study was conducted on patients with definite VM (dVM) and probable VM (pVM) who met the diagnostic criteria. Auditory-vestibular tests and psychological assessments were performed. Logistic regression was used to evaluate the predictive effect of EHF pure tone audiometry (PTA) for standard frequency (SF) hearing loss. Results Fifteen patients with pVM and 22 patients with dVM were recruited. Overall, the two most vertigo types were vestibulo-visual symptoms (83.78%) and internal vertigo (54.05%). A vertigo attack persisted for <5 min in approximately 57% of patients, compared with 5 min to 72 h in 43%, and lasted longer than 72 h in 8%. Approximately 87% of patients had psychological disorders. Most patients with VM (92%) suffered from some degree of EHF hearing impairment, and 68% had SF hearing loss, which is substantially higher than their complaints (43%). Moreover, the mean EHF hearing threshold cutoff value (57 dB HL) worked well in predicting SF hearing loss (area under curve, AUC, 0.827), outperforming distortion product optoacoustic emission (AUC, 0.748). Conclusion VM has a wide range of clinical manifestations. Hearing loss had a considerably higher rate compared to actual complaints. Moreover, patients with VM tended to have bilateral EHF and high-frequency hearing loss. The effectiveness of the mean EHF hearing threshold cutoff value in predicting hearing loss supported its use in the early detection of hearing loss and monitoring disease progression.
Collapse
Affiliation(s)
- Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - E. Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jingyu Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Union Hospital, Institute of Otorhinolaryngology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Union Hospital, Institute of Otorhinolaryngology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Sulin Zhang ✉
| |
Collapse
|
3
|
Fu Y, Lin Q, Xiang Q, Wen X, Liu L. Comparison of SSS-CN and PHQ-15 in the evaluation of patients with suspected psychological disorders in cardiovascular medicine. Front Psychol 2023; 14:1027253. [PMID: 36936003 PMCID: PMC10019093 DOI: 10.3389/fpsyg.2023.1027253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Aims Somatic Symptom Scale-China (SSS-CN) has been applied to assess the presence and severity of somatization symptom disorders (SSD) in Chinese patients. However, there was no study comparing SSS-CN with Patient Health Questionnaire-15 (PHQ-15). The aim of this study was to compare the consistency of the SSS-CN with the PHQ-15 in evaluating SSD in patients with suspected psychological disorders in cardiovascular medicine and to explore the relationship between scores on the two SSD self-rating scales and scores on self-rating scales for anxiety or depression. Methods In this study, 1,324 subjects were enrolled by using a "three-question method." Then, they completed four self-assessment scales, i.e., SSS-CN, PHQ-15, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7 (GAD-7), in turn. The ability of SSS-CN to diagnose SSD was analyzed by the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) value, sensitivity, and specificity were calculated. Reliability analysis was performed with the Kappa statistic to determine consistency between SSS-CN and PHQ-15. The relationship between two qualitative variables was analyzed by Spearman correlation analysis. Results The proportions of SSD evaluated by SSS-CN and PHQ-15 were 83.2 and 87.0%, respectively. SSS-CN score was significantly correlated with PHQ-15 one (r = 0.709, p < 0.001). The AUC of the SSS-CN for the diagnosis of SSD was 0.891, with a high sensitivity and acceptable specificity. There was a moderate agreement between SSS-CN and PHQ-15 in assessing SSD, with a Kappa value of 0.512. Anxiety and/or depression were detected in about 70% of patients with SSD. There was significant correlation between the score of each SSD scale and that of GAD-7 or PHQ-9 (SSS-CN: r = 0.614 or 0.674; PHQ-15: r = 0.444 or 0.582, all p < 0.001). In addition, the SSS-CN score was more closely correlated with the GAD-7 or PHQ-9 score than the PHQ-15 score, and a higher proportion of patients with anxiety or depression was detected in those with moderate and severe SSD evaluated by SSS-CN. Conclusion The SSS-CN could be one of the ideal scales for the rapid screening of patients with suspected psychological disorders in cardiovascular medicine.
Collapse
Affiliation(s)
- Yan Fu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qunyan Xiang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingyu Wen
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Ling Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Ling Liu,
| |
Collapse
|
4
|
Wu Y, Tao Z, Qiao Y, Chai Y, Liu Q, Lu Q, Zhou H, Li S, Mao J, Jiang M, Pu J. Prevalence and characteristics of somatic symptom disorder in the elderly in a community-based population: a large-scale cross-sectional study in China. BMC Psychiatry 2022; 22:257. [PMID: 35413865 PMCID: PMC9004132 DOI: 10.1186/s12888-022-03907-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/01/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The aging population is expected to reach 2 billion by 2050, but the impact of somatic symptom disorder (SSD) on the elderly has been insufficiently addressed. We aimed to clarify the prevalence of SSD in China and to identify physical and psychological differences between the elderly and non-elderly. METHODS In this prospective multi-center study, 9020 participants aged (2206 non-elderly adults and 6814 elderly adults) from 105 communities of Shanghai were included (Assessment of Somatic Symptom in Chinese Community-Dwelling People, clinical trial number NCT04815863, registered on 06/12/2020). The Somatic Symptom Scale-China (SSS-CN) questionnaire was used to measure SSD. Depressive and anxiety disorders were assessed by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. RESULTS The prevalence of SSD in the elderly was higher than that in the non-elderly (63.2% vs. 45.3%). The elderly suffered more severe SSD (20.4% moderate and severe in elderly vs. 12.0% in non-elderly) and are 1.560 times more likely to have the disorder (95%CI: 1.399-1.739; p < .001) than the non-elderly. Comorbidity of depressive or anxiety disorders was 3.7 times higher than would be expected in the general population. Additionally, the results of adjusted multivariate analyses identified older age, female sex, and comorbid physical diseases as predictive risk factors of SSD in the elderly group. CONCLUSIONS With higher prevalence of common physical problems (including hypertension, diabetes mellitus and cardio/cerebrovascular disease), the elderly in Shanghai are more vulnerable to have SSD and are more likely to suffer from comorbid depressive and anxiety disorders. SSD screening should be given more attention in the elderly, especially among older females with several comorbid physical diseases.
Collapse
Affiliation(s)
- Yani Wu
- grid.16821.3c0000 0004 0368 8293School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025 China
| | - Zhengyu Tao
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Yongxia Qiao
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
| | - Yezi Chai
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Qiming Liu
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Qifan Lu
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Hongmei Zhou
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Shiguang Li
- grid.411634.50000 0004 0632 4559Division of Cardiology, Anhui No. 2 Provincial People’s Hospital, Anhui, 230011 China
| | - Jialiang Mao
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Meng Jiang
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Jun Pu
- Division of Cardiology, Key Laboratory of Coronary Heart Disease, School of Medicine, Shanghai Municipal Education Commission, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China.
| |
Collapse
|
5
|
Zolotareva A. Factor Structure of the Russian Version of the Somatic Symptom Scale-8 (SSS-8). КОНСУЛЬТАТИВНАЯ ПСИХОЛОГИЯ И ПСИХОТЕРАПИЯ 2022. [DOI: 10.17759/cpp.2022300302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Somatic Symptom Scale-8 (SSS-8) is one of the most common and psychometrically sound instruments for self-reporting somatization and eight specific somatic symptoms [7]. Objective. This study was aimed to adapt and examine the factor structure of the Russian SSS-8. Methods. A total sample of 167 care home residents completed the Russian version of the SSS-8 and questionnaire covering socio-demographic information. Results. Exploratory and confirmatory factor analyses showed that the adapted scale demonstrated a single-factor structure evaluating the somatization total score via medically unexplained symptoms (stomach or bowel problems; back pain; pain in arms, legs, or joints; headaches; chest pain or shortness of breath; dizziness; feeling tired or having low energy; trouble sleeping). The Cronbach’s α coefficient for the SSS-8 total score was 0,76, indicating the good internal consistency. Conclusions. The Russian version of the SSS-8 is a reliable and valid measure assessing somatic symptoms in care home residents.
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Jiang Y, Wei J, Fritzsche K, Toussaint AC, Li T, Cao J, Zhang L, Zhang Y, Chen H, Wu H, Ma X, Li W, Ren J, Lu W, Leonhart R. Assessment of the structured clinical interview (SCID) for DSM-5 for somatic symptom disorder in general hospital outpatient clinics in China. BMC Psychiatry 2021; 21:144. [PMID: 33691663 PMCID: PMC7944631 DOI: 10.1186/s12888-021-03126-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is still unknown whether the "Somatic symptom disorders (SSD) and related disorders" module of the Structured Clinical Interview for DSM-5, research version (SCID-5-RV), is valid in China. This study aimed to assess the SCID-5-RV for SSD in general hospital outpatient clinics in China. METHODS This multicentre cross-sectional study was conducted in the outpatient clinics of nine tertiary hospitals in Beijing, Jincheng, Shanghai, Wuhan, and Chengdu between May 2016 and March 2017. The "SSD and related disorders" module of the SCID-5-RV was translated, reversed-translated, revised, and used by trained clinical researchers to make a diagnosis of SSD. Several standardized questionnaires measuring somatic symptom severity, emotional distress, and quality of life were compared with the SCID-5-RV. RESULTS A total of 699 patients were recruited, and 236 were diagnosed with SSD. Of these patients, 46 had mild SSD, 78 had moderate SSD, 100 had severe SSD, and 12 were excluded due to incomplete data. The SCID-5-RV for SSD was highly correlated with somatic symptom severity, emotional distress, and quality of life (all P < 0.001) and could distinguish nonsevere forms of SSD from severe ones. CONCLUSIONS This study suggests that SCID-5-RV for SSD can distinguish SSD from non-SSD patients and severe cases from nonsevere cases. It has good discriminative validity and reflects the DSM-5 diagnostic approach that emphasizes excessive emotional, thinking, and behavioural responses related to symptoms.
Collapse
Affiliation(s)
- Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany
| | - Anne Christin Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoyin Zhang
- Department of Psychosomatic Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Chen
- Department of Psychological Medicine, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiquan Ma
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wentian Li
- Department of Clinic Psychology, Wuhan Mental Health Center, Wuhan, China
| | - Jie Ren
- Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co. Ltd, Jincheng, China
| | - Wei Lu
- Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University, Beijing, China
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| |
Collapse
|