On somatic symptoms measurement: the scale for assessment of somatic symptoms revisited

Development and Validation of a Symptom Scale for Indian Patients With Medically Unexplained Physical Symptoms

Introduction Patients with medically unexplained physical symptoms (MUPS) account for a substantial proportion of patients visiting the outpatient department. Diagnosis of MUPS is a challenge for most physicians. An accurate diagnosis relies on obtaining a detailed history from patients regarding the nature of their symptoms, their onset, and any associated aggravating or relieving factors. This study aims to develop a symptom scale for Indian patients with MUPS. Methods The study had a mixed-method study design. Phase 1 involved designing the questionnaire using qualitative techniques, such as literature reviews, focus-group discussions, expert evaluation, and pre-testing of a Hindi and English language Likert-rated interviewer-administered scale. In phase 2, the construct validity of the questionnaire was established using quantitative approaches among 116 patients diagnosed with MUPS. Results The final questionnaire consists of 38 items, with good internal consistency (Cronbach 𝛂 = 0.916). Confirmation sampling adequacy for factor analysis was done using the Kaiser-Meyer-Olkin test (KMO value = 0.792) and Bartlett's test of sphericity (p < 0.001). The newly developed scale showed a Pearson correlation coefficient of 0.568 (p < 0.001) with Patient Health Questionnaire (PHQ)-15 scores. Conclusion A reliable and valid tool has been developed to assess patients' symptoms with MUPS in English and Hindi languages. This questionnaire can be used for assessment, screening, and diagnostic purposes as well as to chart longitudinal changes in patients with MUPS.

Association between the telecommuting environment and somatic symptoms among teleworkers in Japan

OBJECTIVES

This study aimed to clarify the association between telecommuting environments and somatic symptoms among teleworkers in Japan.

METHODS

This cross-sectional study, conducted from September 27 to October 29, 2021, used data from the Japan COVID-19 and Society Internet Survey (JACSIS study) in Japan. Of the 31 000 male and female respondents, who were Japanese residents aged 15-79 years and were randomly selected from the panel members of an internet survey company, 4569 home-based teleworkers were finally included in the analysis; 26 431 respondents who met the exclusion criteria were excluded. The analysis included 4 cut-offs (≥4, 8, 12, and 16 points) for somatic symptoms on the Somatic Symptom Scale-8 as objective variables, and the telecommuting environment, such as having adequate desk light and a quiet environment, as explanatory variables. Adjusted Poisson regression analysis was conducted using demographic variables as covariates.

RESULTS

The prevalence ratio (PR) for somatic symptoms increased significantly as the number of poor telecommuting conditions increased, regardless of the cut-off value for somatic symptoms or the frequency of teleworking. In the telecommuting environment, the PR for somatic symptoms was significantly higher for the following 6 items: poor teleworking space to concentrate, inadequate foot space, poor communication environment, poor space for relaxation, noise, and inappropriate temperature and humidity.

CONCLUSIONS

These results suggest that for home-based teleworkers, the more inadequate the telecommuting environment, especially in the aforementioned 6 areas, the higher the likelihood of somatic symptoms. Improving these environments may be useful in preventing various somatic symptoms.

Prevalence of Somatic Symptoms and Quality of Life Among Married Women Having a Distant Relationship With Their Spouses in Mangalore, India

Background: Married women having a distant relationship with their husbands are prone to mental disorders like somatic symptoms, eventually reducing their quality of life (QoL).

Objective: To assess the somatic symptoms and quality of life among married women having a distant relationship with their spouses.

Methodology: A descriptive cross-sectional study was conducted in 2018. Women having a distant relationship were selected using snowball sampling from selected urban areas of Mangalore, Karnataka. The Scale for Assessment of Somatic Symptoms (SASS) and the World Health Organization Quality of Life Scale (WHOQOL)-BREF questionnaire were used to assess somatic symptoms and quality of life, respectively. Multiple linear regression was used to identify the predictors of somatic symptoms and QoL.

Results: Out of 100 married women with a distant relationship, 83% experienced at least one symptom at a moderate/severe level, whereas the prevalence of somatic symptoms was 30% (at least one symptom at a severe level). Among these 30 women, the majority were in the age groups of 25-30 (32%) and 31-35 (30%). The somatic symptoms had a negative association with Christians (p<0.05), whereas they were positively associated with women living in nuclear families (p<0.05) and marriages of less than 3 years (p<0.05). Among the four domains of WHOQOL-BREF, the highest QoL was seen in the social domain (61.06 ± 18.58), the lowest was seen in the psychological domain (54.78 ± 13.05).

Conclusion: Women who have a distant relationship with their husbands manifest somatic symptoms which decrease their quality of life. This emphasizes the need to use different approaches during hospital visits and community-oriented programs to identify and improve mental health among married women and wellbeing in the family.

Perinatal mental health in India: protocol for a validation and cohort study

BACKGROUND

Common mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh).

METHODS

The study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women's knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively.

CONCLUSION

Improving understanding, detection and management of CMD among women is key to improving women's health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.

Prevalence and clinical correlates of intimate partner violence (IPV) in women with severe mental illness (SMI)

Women with severe mental illness (SMI) are a vulnerable population in whom varying rates of Intimate Partner Violence (IPV) have been reported with impact on their illness. The current study aimed to assess the prevalence and clinical correlates of IPV among women with SMI admitted to a tertiary care psychiatric hospital. The study was a cross sectional assessment of IPV among women with severe mental illness receiving inpatient care. The assessments included Indian Family Violence and Control Scale (IFVCS) for IPV, Brief Psychiatric Rating Scale (BPRS version 4) for psychopathology, The Suicide Behaviours Questionnaire Revised (SBQ-R) for suicidality, Physical Health Questionnaire (PHQ) for physical health, Scale for Assessment of Somatic Symptoms (SASS) for somatic symptoms and also semi structured schedule for their sociodemographic profile. A total of 100 women diagnosed with SMI with a cohabiting partner were assessed. The lifetime prevalence of IPV in the women with SMI was 22 %. Last 1-year prevalence of IPV in them was 20 %. Control and emotional violence were the most commonly reported form of violence, followed by physical violence, and sexual violence was the least reported. Significant association of IPV with suicidal behaviour, depression scores, physical health and somatic symptoms were found. IPV is prevalent in women with SMI and needs to be addressed. It is important to assess all types of IPV as it can impact the illness and the lives of these women, overall.

Deficits in Theory of Mind and Emotional Awareness in Somatoform Disorders

INTRODUCTION

Emotions develop from a less differentiated to a highly differentiated level, and their arrest at a lower level is hypothesized to result in somatization. The present study aimed at investigating the Theory of Mind and emotional awareness in patients with somatoform disorders.

MATERIALS AND METHODS

Twenty patients with somatoform disorders, along with 20 healthy controls matched for age, sex, and education, were recruited after obtaining informed consent. Assessments included semi-structured proforma for sociodemographic and clinical details; Scale for Assessment of Somatic Symptoms (SASS) for somatic symptoms; and Patients Health Questionnaire (PHQ) to assess somatic symptoms, depression, and anxiety. Emotional awareness was measured using the Levels of Emotional Awareness Scale (LEAS), in which the participants had to provide descriptions of feelings of self and the other person in 20 imaginary situations. The responses were scored using a standardized manual. The Theory of Mind was measured using the Social Cognition Rating Tool in Indian Settings (SOCRATIS).

RESULTS

The two groups did not differ on any demographic parameters. Patients with somatoform disorders scored significantly lower on emotional awareness (t = -3.74; P < 0.001) and the Theory of Mind (t = -3.56; P < 0.001). The above differences remained significant even after controlling for comorbid depressive and anxiety symptoms.

CONCLUSION

Patients with somatoform disorders are likely to have Theory of Mind and emotional awareness deficits independent of mood states. Future studies are needed to assess whether these deficits are trait- or state-dependent and whether they are cause or effect.

Health-related life events in patients with somatic symptom disorders: A case control study

BACKGROUND

The positive association between adverse life events and somatoform disorders is a consistent observation. But no systematic studies have evaluated the relationship between health-related life events (HLEs) in patients with somatic symptom disorder (SSD)/somatoform disorders.

AIM

To examine the nature and relationship of HLE in patients with SSD and to assess the correlates of HLE.

METHODS

A total of 50 adult patients with SSD and 50 matched healthy controls from a Neuropsychiatric hospital were recruited. Sociodemographic interview, scale for assessment of somatic symptoms (SASS), Patient Health Questionnaire-15 (PHQ-15) and a semi-structured interview schedule to gather information on HLE were used.

RESULTS

Patients in the SSD group had a significantly higher number of total HLE in general (4.72 ± 2.63, 3.36 ± 1.92; p = .004), major HLE (1.48 ± 1.45, 0.68 ± 0.94; p = .006), during their lifetime in comparison to controls. Infections, trauma, non-communicable diseases and reproductive system-related diseases were the more common types of HLE in SSD group.

CONCLUSION

Our findings may implicate a role of major HLE of patients and HLE of their family members in the pathophysiology of SSD.

Development of a Japanese version of the Somatic Symptom Scale-8: Psychometric validity and internal consistency

OBJECTIVE

We aimed to psychometrically validate the Japanese version of the Somatic Symptom Scale-8 (SSS-8) in Japanese individuals.

METHOD

Data were collected from Japanese individuals aged 20-64years, who were recruited online, in February 2015. The scale reliability and validity were analyzed.

RESULTS

Data from 52,353 individuals were analyzed. Cronbach's alpha for the assessment of internal consistency reliability was 0.86 for the total score. The concurrent validity results showed strong correlations with three domains of the Profile of Mood States-Brief form (ρ=0.51-0.61) and the EuroQol 5 Dimension (ρ=-0.54). The known-group validity results indicated a linear trend in the severity of depression stratified using the Patient Health Questionnaire-2 (Jonckheere-Terpstra test, p<0.001). Regarding convergent and discriminant validities, all items correlated most strongly with their own domains (coefficients≥0.5), except for one item (headaches). Scores on perceived stress, pain, and general health differed across five SSS-8 severity groups (Steel-Dwass test, p<0.001), expect for one group pair in health.

CONCLUSION

The Japanese version of the SSS-8 was valid with good internal consistency. This questionnaire could help detect somatic symptom burdens of chronic and severe musculoskeletal pain for primary prevention.

Somatization in the dermatology patient: Some sociocultural perspectives

Somatization in dermatology patients is a challenge to diagnose and manage. Somatization presents as medically unexplained dermatologic symptoms, which are commonly encountered in dermatology and psychiatry practices. These cutaneous symptoms are often intriguing and do not fit into any particular known dermatologic condition. Sometimes, they may evoke negative feelings in the practicing dermatologist. The dermatologic somatic symptoms might be one way of communicating psychologic distress in a culturally acceptable method. These somatic symptoms may be masking another psychiatric disorder such as depression. They could also be an adaptive response to a difficult psychosocial situation and means of coping in a culturally meaningful way; therefore, the underlying conflicts need to be understood and managed in the sociocultural context of the symptoms. This chapter discusses the various unexplained physical symptoms in dermatology patients and the need for comprehensive evaluation.