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Objective To explore the characteristics of illness attribution of outpatients with multiple somatic symptoms in Peking Union Medical College Hospital. Methods It was a cross-sectional study conducted from March to October,2012. A total of 150 outpatients were recruited from the departments of Gastroenterology,Traditional Chinese Medicine and Psychological Medicine by convenience sampling. Somatic symptom scale of the Patient Health Questionnaire (PHQ-15) was used to screening each patient in the waiting list. With the cut-off value of 10,patients were divided into the somatic symptom positive (SOM+) group and somatic symptom negative (SOM-) group. Sociodemographic characteristics were compared between these two groups. All the subjects completed interviews including questions about illness attribution. All the answers of illness attribution were concluded into three major groups as physical factors,situational factors and psychological factors. Results The proportion of female was significantly higher in SOM+ group than in SOM-group (69.3% vs. 53.3%;χ=4.048,P=0.044). In SOM+ group,significantly more patients contributed their illness to psychological factors (64.0% vs. 45.0%;χ=5.273,P=0.022). There was no significantly difference between SOM+ group and SOM-group on the phenomenon of multiple illness attribution (41.0% vs. 32.0%;χ=1.407,P=0.236). However,in the Department of Gastroenterology,there were significantly more outpatients in SOM+ group with multiple illness attribution (60.0% vs. 32.0%;χ=3.945,P=0.047).Conclusions The outpatients in general hospital with multiple somatic symptoms are more likely to contribute their illness to psychological factors. The phenomenon of multiple illness attribution is common among patients. Clinicians should increase their awareness and knowledge of illness attribution,so as to provide better holistic health services.
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Objective To investigate the co-morbid state of mental disorder in patients with functional dyspepsia (FD) in a tertiary general hospital in China and explore the risk factors of the co-morbidity of FD and major depressive disorder(MDD).Methods This study was designed as a bilateral evaluation and structural psychiatric interview.Patients with FD and newly diagnosed outpatients with MDD in gastrointestinal and psychological departments were enrolled.FD was defined by Rome Ⅲ criteria.The questionnaires including symptoms of FGIDs Roma Ⅲ,the composite international diagnostic interview (CIDI 3.0) Chinese version,the Hamilton depression/anxiety rating scale (HAMD/HAMA),Montgomery-Asberg depression scale (MADRS) were involved in this study.All patients were administered by well trained physicians and investigators in face to face interview.Results A total of 69 patients have completed the valid questionnaires and interview,among whom 42 met FD criteria (FD group) and 27 with FD co-morbid MDD (co-morbid group).Male to female ratios were 17∶25 and 10∶ 17,the mean age (42.1 ± 13.3) and (43.1 ± 15.3)years respectively.The life-long co-morbidity of FD and MDD was 39.1％ (27/69),while 31.9％ (22/69) patients with FD were accompanied with other mental disorders rather than MDD.Patients in FD co-morbid MDD group had significantly more severe depression than those in FD group with HAMD-17 score 21.6 ± 8.0 and 14.5 ± 7.6,HAMA score 21.2 ± 9.0 and 14.9 ± 7.5 respectively (all P ＜ 0.01).Logistic regression analysis showed that high score of MADRS and complication with functional anorectal disorder may be the risk factors of FD co-morbid MDD [OR (95％ CI) 1.12 (1.06-1.19) and 7.07(1.12-44.53)].Conclusions The co-morbidity rate of FD with MDD in our hospital is high.In addition to MDD,other mental disorders also need to be paid attention in FD patients.FD co-morbid MDD patients suffered more severe depression and anxiety.The high score of MADRS and complication with functional anorectal disorder seem to be the risk factors of co-morbidity of FD and MDD.
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Objective:To evaluate the validity and reliability of the Problem Area in Diabetes Scale (PAID) for assessing diabetes-related distress in patients with type 2 diabetes. Methods:Totally 203 outpatients with type 2 diabetes from a tertiary hospital in Beijing were selected. They were assessed with PAID,Hamilton Depression Scale (HAMD-17),Patient Health Questionaire-9(PHQ-9),World Health Organization Five item Well-Being Index (WHO-5 ),Mini-International Neuropsychiatric Interview (MINI)and HbA1 C. Item analysis and exploratory factoranalysis were conducted to test constructive validity. Concurrent validity was evaluated by the correlation coeffi-cients with the other instruments mentioned above. Totally 3 1 subjects were retested 4 weeks later to obtain the test-retest reliability. Results:Exploratory factor analysis produced 4 factors,including emotional,therapeutic,diet and perceived society support problems specific to diabetics. The total variance contribution ratio was 64. 33%. Except i-tem 7 and 20,no item was across two factors. The correlation coefficients of each item with relevant subscale score ranged from 0. 67 to 0. 86. The PAID scores were positively correlated with the scores of HAMD-17,PHQ-9 and HbA1C (r=0. 48,0. 43,0. 21,P<0. 001 or 0. 01),and negatively correlated with WHO-5 scores (r=-0. 46,P<0. 001). The Cronbach's αcoefficients were 0. 94 for the total scale and 0. 81 -0. 88 for the 4 subscales. The test-retest reliability coefficient was 0. 65 for the total scale and 0. 53-0. 73 for the 4 subscales. Conclusion:The validi-ty and reliability of the Problem Area in Diabetes Scale are acceptable in Chinese mainland,and can be available to assess the stress related to diabetics.