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Am J Psychiatry 1997; 154:989-995
Copyright © 1997 by American Psychiatric Association
Somatization in cross-cultural perspective: a World Health Organization study in primary care
O Gureje, GE Simon, TB Ustun and DP Goldberg
Department of Psychiatry, University College Hospital, Ibadan, Nigeria. ogureje@papyrus.mhri.edu.au
OBJECTIVE: The purpose of this study was to examine the phenomenon of
somatization in different cultures by determining its frequency and
correlates in primary care settings in 14 countries. METHOD: Consecutive
primary care patients (N = 25,916) were screened with the 12-item General
Health questionnaire, and a stratified sample (N = 5,438) was interviewed
with the Composite International Diagnostic Interview. Interviewed patients
were also assessed for physical disease burden, self-rated overall health,
physician-rated physical health status, number of disability days, and
interviewer-rated occupational role functioning. The authors determined
center-specific associations with the use of logistic regression analyses
in which confounding variables were controlled. RESULTS: ICD-10 defined
somatization disorder was relatively uncommon in most primary care
settings. A less restrictively defined form was more common. Symptom rates
were much higher in South American sites. There was a modest association
with low education. Otherwise, frequency of unexplained somatic symptoms
did not clearly vary according to geography or level of economic
development. Somatizing patients were at elevated risk for self-reported
disease burden, negative perception of their health, and comorbid
depression and generalized anxiety disorder. Somatization was also commonly
associated with disability. Cultures did not differ markedly in the pattern
of these associated features. CONCLUSION: Somatization is a common problem
in primary care across cultures and is associated with significant problems
and disability.
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