ما چه کاری می توانیم از یک مطالعه ملی پریشانی جسمی یاد بگیریم؟

Objective To examine the extent of cross-national variations in the rates and correlates of somatic distress and determine whether this can be ascribed to cultural differences. Methods A two-stage survey in primary care across 15 sites in 14 countries. Screening with the 12-item General Health Questionnaire (GHQ-12) was followed with detailed diagnostic assessment with the Composite International Diagnostic Interview. Self-rating of overall health and evaluation of disability days were also conducted (N=5438). Twelve months later, 3204 of the patients completed follow-up interviews. Results Somatic distress (different definitions of somatization and of hypochondriasis as well as persistent pain disorder) varied in its occurrence across sites. However, other than elevated rates in Latin America, variation tends to be complex and does not lend itself to a neat cultural explanation. The nature of patient–doctor relationship is related to this variation. Conclusion Cross-national differences occur in somatic distress. The pattern of these differences does not follow clear cultural lines even though the role of culture cannot be excluded.

Even though the literature is replete with reports describing association of culture with various aspects of somatization [1], [2], [3] and [4], there is little empirical evidence that observed variations in, for example, the occurrence of the disorders across countries lend themselves to obvious cultural explanations [5] and [6]. To draw reliable inferences in regard to cross-national variations in somatoform disorders, studies need to meet a set of conditions. One, it is important that cross-national comparisons be drawn from data that utilize identical ascertainment procedure in the countries of interest. Two, the assessment tools should be developed in such a way that they allow for the inclusion of symptoms that may be peculiar to study sites. Third, the assessment should be comprehensive, allowing not just for examination of the frequency of somatic distress but also its correlates in regard to demographic attributes and impact. When differences are obtained in these areas, attempts could thereafter be made to examine whether such differences bear associations with study sites in a manner that may suggest plausible cultural explanation. The study Psychological Problems in General Health Care (PPGHC), a World Health Organization collaborative project that was conducted in 15 centers in 14 countries located in four continents [7], provides an opportunity to address the following questions: To what extent do differences in the experience of somatic distress across countries lend themselves to cultural interpretations? Are there factors related to the nature of patient–doctor interaction that may be associated with the reporting of somatization symptoms?