Psychological and somatic distress in Chinese outpatients at general hospitals: a cross-sectional study

Common mental disorders and associated factors among adult patients admitted in non-psychiatric wards of public hospitals in Harari regional State, Eastern Ethiopia

INTRODUCTION

Common mental disorders represent psychiatric co-morbidity in medical illness, which leads to poor adherence to treatment, increased exposure to diagnostic procedures and the cost of treatment, longer hospital stay, and increasing the risk of complications that result in morbidity and mortality among patients admitted to non-psychiatric wards. There is a dearth of evidence related to the prevalence of common mental disorders and associated factors among adult patients admitted to non-psychiatric wards, particularly in the study area. This study aimed to assess the prevalence of common mental disorders and associated factors among adult patients admitted to non-psychiatric wards of public hospitals in the Harari region, eastern Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted among 640 randomly selected patients admitted to non-psychiatric wards from November 15 to December 15, 2022. A systematic random sampling technique was employed to select the study participants. Data were collected by interviewer-administered structured and semi-structured questionnaires. Self-report questionnaire (SRQ-20) was used to assess the presence of common mental disorders. The collected data were entered into Epi-data version 3.1 and exported to STATA version 14 for analysis. Bivariable and multivariable logistic regression were used to evaluate the association between independent and the outcome variable. Variables with a p-value < 0.05 were taken as statistically significant with an adjusted odds ratio and 95% confidence interval.

RESULTS

The prevalence of common mental disorders among adult patients admitted to non-psychiatric wards was found to be 45.3%, with a 95% CI: of 41.3-49.2. Age 41-51 years (AOR = 1.732, 95% CI: 1.030, 2.913), age 51 and above (AOR = 2.429, 95% CI: 1.515, 3.894), staying at hospital for 1-2 weeks (AOR = 1.743, 95% CI: 1.065, 2.853), staying at hospital for more than 4 weeks (AOR = 2.12, 95% CI: 1.77, 3.29), history of mental illness (AOR = 5.841, 95% CI: 2.274, 15.004), stressful life events (AOR = 1.876, 95% CI: 1.206, 2.9196), current substance use (AOR = 1.688, 95% CI: 1.75, 2.650), and poor social support (AOR = 2.562, 95% CI:1.166, 5.629) were factors significantly associated with common mental disorders.

CONCLUSION

The prevalence of common mental disorders among patients admitted to non-psychiatric wards was high. It appears to be significantly associated with age, length of hospital stay, history of mental illness, stressful life events, current substance use, and social support. The study suggested that patients who are admitted to non-psychiatric wards should be screened for common mental disorders and its associated factors as part of routine inpatient care.

Psychological Distress Among Ethnically Diverse Participants From Eastern and Southern Africa

Importance

Psychological distress is characterized by anxiety and depressive symptoms. Although prior research has investigated the occurrence and factors associated with psychological distress in low- and middle-income countries, including those in Africa, these studies' findings are not very generalizable and have focused on different kinds of population groups.

Objective

To investigate the prevalence and characteristics (sociodemographic, psychosocial, and clinical) associated with psychological distress among African participants.

Design, setting, and participants

This case-control study analyzed data of participants in the Neuropsychiatric Genetics in African Populations-Psychosis (NeuroGAP-Psychosis) study, which recruited from general outpatient clinics in Eastern (Uganda, Kenya, and Ethiopia) and Southern (South Africa) Africa. Individuals who participated in the control group of NeuroGAP-Psychosis from 2018 to 2023 were analyzed as part of this study. Data were analyzed from May 2023 to January 2024.

Main outcomes and measures

The prevalence of psychological distress was determined using the Kessler Psychological Distress Scale (K10), which measures distress on a scale of 10 to 50, with higher scores indicating more distress. Participants from the NeuroGAP-Psychosis study were categorized into cases as mild (score of 20-24), moderate (score of 25-29), and severe (score of 30-50), and participants with scores less than 20 were considered controls. Factors that were associated with psychological distress were examined using binomial logistic regression.

Results

From the data on 21 308 participants, the mean (SD) age was 36.5 (11.8) years, and 12 096 participants (56.8%) were male. The majority of the participants were married or cohabiting (10 279 participants [48.2%]), most had attained secondary education as their highest form of learning (9133 participants [42.9%]), and most lived with their families (17 231 participants [80.9%]). The prevalence of mild, moderate, and severe psychological distress was 4.2% (869 participants), 1.5% (308 participants), and 0.8% (170 participants), respectively. There were 19 961 participants (93.7%) who served as controls. Binomial logistic regression analyses indicated that the independent associations of psychological distress were experience of traumatic events, substance use (alcohol, tobacco, or cannabis), the physical comorbidity of arthritis, chronic neck or back pain, and frequent or severe headaches.

Conclusions and relevance

In this case-control study among ethnically diverse African participants, psychological distress was associated with traumatic stress, substance use, and physical symptoms. These findings were observed to be consistent with previous research that emphasizes the importance of traumatic events as a factor associated with risk for psychopathology and notes the frequent co-occurrence of conditions such as physical symptoms, depression, and anxiety.

Characteristics and economic burden of patients with somatoform disorders in Chinese general hospitals: a multicenter cross-sectional study

BACKGROUND

In China, patients with somatoform disorders (SFD) often seek medical treatment repeatedly in outpatient clinics of general hospitals, which increases unreasonable medical expenses. It is imperative to provide early screening to these patients and specialized treatment to reduce the unnecessary cost. This study aimed to screen patients with SFD in general hospitals using a new Chinese questionnaire and explore the characteristics and economic burden of these patients.

METHODS

Patients (n = 1497) from the outpatient department of neurology, cardiology and gastroenterology of three large general hospitals were included. Participants were screened using a newly developed questionnaire, the Self-screening Questionnaire for Somatic Symptoms (SQSS), to identify the patients with SFD (total SQSS score ≥ 29 points). We compared the demographics and clinical information of patients with and without SFD. Logistic regression was used to explore potential factors related to medical expenses, visits to doctors and sick leave days taken.

RESULTS

The frequency of detection of patients with SFD was 17.03%. There were significant differences in employment, doctor visits, symptom duration, medical expenses, sick leave days, PHQ-15 scores, and PHQ-9 scores between patients with SFD and without SFD. General nonspecific somatic symptoms were frequently present in patients with SFD. Several potential factors were associated with higher medical expenses, repeated doctor visits, and sick leave days taken in the regression analysis.

CONCLUSION

The findings indicate that patients with SFD are common in general hospitals, and their direct and indirect economic burden is higher than that of non-SFD patients, which indicates that more screening effort should be made to this group to early identify their problems. Certain characteristics were identified among patients with SFD and several factors were associated with negative consequences of SFD, all of which might be prevented by developing a preventive intervention program to reduce the economic burden of the patients.

Clinical and psychobehavioral features of outpatients with somatic symptom disorder in otorhinolaryngology clinics

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.

Factors related with COVID-19 vaccination willingness among outpatients in China

BACKGROUND

COVID-19 vaccination has been accepted widely. However, there are only a few reports on patients' willingness to be vaccinated. This study investigated the willingness of Chinese outpatients to accept COVID-19 vaccination as well as influencing factors.

METHODS

A cross-sectional survey was conducted in Jiangsu province, China in December 2020. Self-administered questionnaires, which were distributed to 625 outpatients among secondary hospitals, addressed demographic characteristics, sociological characteristics, and subjective reasons. There were 522 (83.5%) participants who gave completely valid responses. Logistic regression analysis was performed to explore the risk factors for willingness of COVID-19 vaccination.

RESULTS

71.5% of participants were willing to receive the COVID-19 vaccine. "worried about contracting COVID-19" (49.6%) and "vaccines have just been introduced and need time to consider" (38.9%) were the main reasons for being willing and unwilling to receive COVID-19 vaccine, respectively. The logistic regression analysis showed that "vaccines are an effective way to prevent diseases" (OR = 5.07, 95%CI: 3.32-7.75), "the price you are willing to pay for non-free vaccines (yuan) (101-500 vs ≤100)″ (OR = 1.87, 95%CI: 1.16-3.02), "per capital monthly income(yuan) (>6000 vs ≤3000)"(OR = 2.13, 95%CI: 1.03-4.41), and "self- assessed health status (Good vs Bad)″ (OR = 1.71, 95%CI: 1.01-2.90) were the main risk factors for outpatients to be willing to receive the COVID-19 vaccine.

CONCLUSIONS

The willingness of Chinese outpatients to receive COVID-19 vaccine was not high. The government should do more to increase publicity of knowledge about COVID-19 vaccine thus increasing willingness to vaccinate, and provide free vaccine to eliminate the cost impact.

The Value of Chinese Version GAD-7 and PHQ-9 to Screen Anxiety and Depression in Chinese Outpatients with Atypical Chest Pain

Background

Atypical chest pain in some outpatients could derive from mental disorders. It is necessary for them to have a preliminary emotional assessment in the outpatient department of Cardiology before psychiatric outpatient visits.

Methods

This study included 122 Chinese outpatients with atypical chest pain in the department of Cardiology. They accepted routine examinations, including treadmill test, and were judged by the three-question method as highly likely to have emotional disorders. Then, a standard questionnaire package containing the Chinese version of the seven-item scale for General Anxiety Disorder (GAD-7), Self-rating Anxiety Scale (SAS), the nine-item Patient Health Questionnaire (PHQ-9) and Self-rating Depression Scale (SDS) was administered to evaluate anxiety and depression.

Results

The percentages of anxiety evaluated by GAD-7 and SAS were 62.3% and 26.2%, respectively. Analogously, the assessment by PHQ-9 showed a significantly higher percentage of depression than that by SDS (61.5% vs 29.5%) (P < 0.05). Kappa analysis showed that the consistency between GAD-7 and SAS, or that between PHQ-9 and SDS was not very good. About 73% outpatients suffered from emotional disorders, presenting as anxiety/depression evaluated by GAD-7 and PHQ-9. Furthermore, sleep disorders accounted for more than 80% of patients with mental disorders. Finally, the suicidal tendency of depression patients was about 17% that should not be ignored.

Conclusion

Compared with SAS and SDS, GAD-7 and PHQ-9 detected more participants with emotional disorders in the Chinese outpatients with atypical chest pain, indicating that GAD-7 and PHQ-9 could be briefly well-validated tools to screen emotional disorders in the outpatient department of Cardiology before psychiatric visits.

Prevalence and Influencing Factors of Medical Dissatisfaction Experiences in Chinese Hospitals: A Cross-Sectional Study

PURPOSE

To explore the influencing factors of medical dissatisfaction experiences from the perspectives of patients, and provide corresponding strategies for its prevention.

PATIENTS AND METHODS

Using multistage random sampling, 43 hospitals in three provinces of China were surveyed using a self-designed questionnaire. There were 2065 valid questionnaires analyzed in our study.

RESULTS

46.9% (n = 934) of participants had experienced medical dissatisfaction in the past year, mainly due to poor service quality, cumbersome procedures and high medical costs. There were statistically significant differences in the medical dissatisfaction experiences for these patients with different ages, marital status and levels of education (P<0.05). According to structural equation modelling, health education and media reports had a positive and indirect influence (standardized coefficient = 0.046) on medical dissatisfaction experiences, while there was a negative correlation (standardized coefficient = -0.399) between patients' social recognition and medical dissatisfaction experiences. Also, our results also found that social relationships had a negative and indirect impact (standardized coefficient = -0.166) on medical dissatisfaction experiences. Besides, health education and media reports had a negative impact (standardized coefficient = -0.115) on patients' social recognition, while social relationships have a positive effect (standardized coefficient = 0.416) on patients' social recognition.

CONCLUSION

Health education and media reports and social relationships, as antecedent variables, have an indirect effect on inducing the medical dissatisfaction experiences of patients. In addition, patients' social recognition was an intermediate variable in inducing the medical dissatisfaction of patients.

How does patient provider communication affect patients' risk perception? A scenario experiment and an exploratory investigation

AIM

The aim of the study was to examine whether patient-provider communication interacts with treatment outcomes to influence patients' risk perception.

BACKGROUND

Medical uncertainties and risks are among the most serious problems faced by patients. This is exacerbated by communication failure in patient-provider relationships and poor treatment outcomes. However, we do not know how communication and treatment outcomes shape patients' risk perception and concern about uncertainty.

DESIGN

The study is a two-by-two between-subjects design.

METHODS

Two studies were conducted and data were collected in 2019. Each study used a different research design and different samples: Study 1 used a scenario experiment with 120 undergraduate students; and Study 2 surveyed 200 inpatients in clinical settings.

RESULTS

The convergent results found a significant interaction between patient-provider communication and treatment outcome on the perception of medical risks among the participants.

CONCLUSION

Patient-provider communication interacts with treatment outcome to influence patients' perceived risk about uncertainties for healthcare. Clinicians and nurses should be aware of the effects of patient-provider communication on patients' risk perception in their concerns about the uncertainties of treatment and pay much more attention to good healthcare relationship building in addition to the improvement of objective treatment outcome.

Linguistic and Psychometric Validation of the Chinese Version of the Control Attitudes Scale-Revised in Patients With Chronic Heart Failure

BACKGROUND

The concept of perceived control reflects the belief that one has resources needed to cope with negative events and the ability to positively influence consequences of those negative events. In patients with heart failure, perceived control is associated with a variety of health outcomes. Perceived control is commonly measured using the Control Attitudes Scale-Revised (CASR). There is no Chinese version of the CAS-R (CCAS-R).

OBJECTIVE

The purpose of this article was to perform linguistic validation and psychometric evaluation of the CCAS-R.

METHODS

The CAS-R was translated into Chinese according to Brislin's model. Then, a multicenter observational study was performed. Floor and ceiling effects, internal consistency, structural validity, and hypothesis testing were all assessed for psychometric validation of the CCAS-R.

RESULTS

A total of 227 patients with chronic heart failure were included. There were no ceiling or floor effects detected. Cronbach α was 0.94, indicating a high reliability. The results of the confirmatory factor analysis showed that the 1-factor structure as proposed by the original CAS-R fits the data well. The results of the principal component analysis suggested that the 1-factor structure was optimal as well, accounting for 71.6% of the total variance. The a priori hypothesis was supported by a statistically significant correlation between the CCAS-R and 3 theoretically related variables.

CONCLUSION

We developed a semantically equivalent version of the CAS-R in Chinese. The evaluation of the instruments' psychometric properties demonstrated that the CCAS-R has good reliability and validity for use in Chinese patients with chronic heart failure.

Validation of the Chinese Version of the Somatic Symptom Disorder-B Criteria Scale for Detecting DSM-5 Somatic Symptom Disorders: A Multicenter Study

OBJECTIVE

This study aimed to validate the Chinese version of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in an outpatient sample from Chinese general hospitals and to determine the diagnostic performance of the SSD-12 as a screening tool for somatic symptom disorder (SSD).

METHODS

The Chinese version of the SSD-12 was completed by 699 outpatients from nine general hospitals during a 16-month period (2016-2018). The SSD section of the Structured Clinical Interview for DSM Disorders, Fifth Edition, Research Version, was used to determine diagnostic accuracy (criterion validity). The construct validity of the SSD-12 was evaluated by examining correlations with the Whiteley Index-7, Patient Health Questionnaire-15, Patient Health Questionnaire-9, General Anxiety Disorder-7, World Health Organization Disability Assessment Schedule, and Medical Outcome Study 12-item Short Form Health Survey (SF-12).

RESULTS

The SSD-12 had excellent internal consistency in this sample (Cronbach α = .95). Confirmatory factor analyses replicated a three-factor structure that reflects the cognitive, affective, and behavioral aspects (Comparative Fit Index = 0.963, Tucker-Lewis Index = 0.952, root mean square error of approximation = 0.08, 90% confidence interval = 0.08-0.09), but was also consistent with a general one-factor model of the SSD-12 (Comparative Fit Index = 0.957, Tucker-Lewis Index = 0.948, root mean square error of approximation = 0.09, 90% confidence interval = 0.08-0.10). The optimal cutoff point for the Structured Clinical Interview for DSM Disorders-based diagnosis of SSD was 16 (sensitivity = 0.76, specificity = 0.80). The SSD-12 sum score was significantly associated with somatic symptom burden (Patient Health Questionnaire-15: r = 0.52, p < .001), health anxiety (Whiteley Index-7: r = 0.82, p < .001), depressive symptoms (Patient Health Questionnaire-9: r = 0.63, p < .001), general anxiety (General Anxiety Disorder-7: r = 0.64, p < .001), health-related quality of life (physical component score of SF-12: r = -0.49, p < .001; mental component score of SF-12: r = -0.61, p < .001), and health-related disabilities (World Health Organization Disability Assessment Schedule: r = 0.56, p < .001).

CONCLUSIONS

Initial assessment indicates that the Chinese version of the SSD-12 has sufficient reliability and validity to warrant further testing in both research and clinical settings.

The mediating effect of trust on the relationship between doctor-patient communication and patients' risk perception during treatment

Doctor-patient communication interacts with patients' satisfaction to influence patients' risk perception. Current theories to explain this relationship have assumed particular psychological processes to explain observations of risk-sensitive behavior in an economic setting, but as of yet, they have not addressed whether it is adaptive for a decision-maker in a health-care situation. In addition, little is known about the role of interpersonal trust between doctor and patient. We surveyed 602 patients to examine the way in which trust, communication, and patients' satisfaction are related to patients' risk perception about uncertainties in medical treatment. The results showed that patients held a relatively low level of risk perception, which means that they had insufficient preparation for the possibility of uncertainties about the treatment. The association between doctor-patient communication and patients' perceived risk was mediated by doctor-patient trust. These results suggest that there is a relationship among good doctor-patient communication, patients' trust in medical staff, and perceived risk during medical treatment. Finally, theoretical and practical implications are discussed.

Correction to: Psychological and somatic distress in Chinese outpatients at general hospitals: a cross-sectional study

[This corrects the article DOI: 10.1186/s12991-017-0158-y.].

Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study

Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China. Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed. Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples. Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.