Training in psychosomatic medicine and psychotherapy for medical doctors in China: A field report.

Background: The high prevalence rates of mental disorders in China contrast a comparatively low care capacity from qualified trained medical doctors in the mental health field. The main objective of our cooperation project was to develop and implement advanced postgraduate training for medical doctors for their acquisition of knowledge, skills, and attitudes in the field of psychosomatic medicine and psychotherapy in China. Methods: Monitoring and evaluation as part of the advanced training in Beijing were conducted following the Kirkpatrick training approach using four levels of evaluation: reaction, learning, behavior and results. We performed a continuous course evaluation, assessed the respective learning goal attainment, conducted a pre-post evaluation of reasons and goals for participation in the training, and measured the treatment effects on the patient side. Results: The implementation of training standards in the field of psychosomatic medicine and psychotherapy for medical doctors and the transfer of didactic knowledge and skills for Chinese lecturers were achieved. A total of 142 mainly medical doctors attended the 2-year training. Ten medical doctors were trained as future teachers. All learning goals were reached. The content and didactics of the curriculum were rated with an overall grade of 1.23 (1 = very good to 5 = very bad). The highest rated elements were patient life interviews, orientation on clinical practice and communication skills training. The achievement of learning objectives for each block (depression, anxiety disorders, somatic symptom disorder, coping with physical diseases) was rated between 1 and 2 (1 = very well achieved to 5 = not achieved) for all items from participants' perspectives. On the patient side (n = 415), emotional distress decreased and quality of life and the doctor-patient alliance improved significantly. Discussion: Advanced training in psychosomatic medicine and psychotherapy was successfully implemented. The results of the evaluation show high participant satisfaction and the successful achievement of all learning objectives. A more detailed and extensive evaluation of the data, such as an analysis of the development of the participants as psychotherapists, is in preparation. The continuation of the training under Chinese guidance is guaranteed.

Validation of the Chinese version bodily distress syndrome checklist in Chinese out-patients of general hospitals.

OBJECTIVE: The 25-item Bodily Distress Syndromes (BDS) checklist was developed to assess BDS symptoms with high validity and reliability. The aim of this study was to reveal the psychometric properties of the Chinese version of the BDS checklist in Chinese outpatients of general hospitals. METHOD: A cross-sectional study was carried out in nine Chinese general hospitals, consisting of three different medicine settings: biomedicine, traditional medicine, and psychosomatic medicine. The 25-item BDS checklist was translated into the Chinese version and conducted on outpatients from all nine centers. We performed validity and reliability analyses, including test-retest reliability, construct validity, and internal consistency reliability, on the collected checklist data. The convergent validity of the BDS checklist was analyzed with Pearson's Coefficient vs. Patient Health Questionnaire-15 (PHQ-15). The discriminant validity of the BDS checklist was analyzed with Pearson's Coefficient vs. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Whiteley-8 (WI-8). RESULTS: A total of 699 patients were included in this study. The test-retest reliability, construct validity, and internal consistency reliability of the Chinese version of the BDS were satisfactory in our study. Factor analyses identified five distinct determining factors: cardiopulmonary, gastric, intestinal, musculoskeletal, and general symptoms. Pearson's coefficients were found to be high in both discriminant validity and convergent validity analyses. CONCLUSION: The results provide empirical support for the Chinese version of the BDS checklist in patients in general hospitals. The Chinese version of the BDS checklist is potentially valuable for case finding in both clinical practice and research in Chinese.

Patient satisfaction & use of health care: a cross-sectional study of asylum seekers in the Freiburg initial reception centre.

BACKGROUND: In response to a high number of incoming asylum seekers and refugees (AS&R) in Germany, initial reception centres were established to provide immediate shelter, food and health support. This study evaluates the satisfaction with and use of the health care available at the Freiburg initial reception centre (FIRC) where an integrated health care facility (ICF) was set up in 2015. METHODS: We assessed use and satisfaction with health services available to resident AS&R within and outside the FIRC in a cross-sectional design. Data were collected in 2017 using a questionnaire with both open and closed ended items. RESULTS: The majority of 102 included participants were young (mean age 24.2; 95%CI 22.9-25.5, range 18-43) males (93%), from Sub-Saharan Africa (92%). High use frequencies were reported from returning patients of the ICF; with 56% fortnightly use and 19% daily use reported. The summary of satisfaction scores indicated that 84% (CI95 76-89%) of respondents were satisfied with the ICF. Multivariate analysis showed female gender and non-English speaking as risk factors for low satisfaction. Outside the FIRC, the satisfaction scores indicated that 60% of participants (95%CI 50-69%) were satisfied with the health care received. CONCLUSION: Our study shows that AS&R residing in the FIRC are generally satisfied with the services at the ICF, though strategies to enhance care for females and non-English speakers should be implemented. Satisfaction with health care outside of the FIRC was not as high, indicating the need to improve quality of care and linkage to regular health care services.

Prevalence of DSM-5 somatic symptom disorder in Chinese outpatients from general hospital care.

OBJECTIVE: We aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. METHODS: This multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. RESULTS: SSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (χ2 = 34.049, df = 2, p ≤0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = 0.45. CONCLUSION: There is a high prevalence of SSD in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients.