[Determinants of quality of life in patients with somatoform disorders with pain as main symptom - the case for differentiating subgroups].
OBJECTIVE
What impact do the degree of somatization and the presence of a comorbid psychological disorder have on health-related quality of life in patients with pain-dominated somatoform disorders?


METHODS
282 consecutive patients (57.6 %) from a total population of N=490 patients fulfilling the criteria of somatoform pain disorders were included in the study following a thorough interdisciplinary diagnostic process at a German university hospital. Structured interviews (SKIDI and SKID-II) to assess comorbid psychological disorders as well as a structured biographical interview to assess chronification factors were conducted. We employed the Screening for Somatoform Disorders form (SOMS) to discover the extent and distribution of somatic symptoms and the SF-36 to determine the health-related quality of life.


RESULTS
The patients exhibited a multiplicity of further somatic complaints apart from pain. 69 % had a comorbid psychological disorder. The health-related physical and psychological quality of life was clearly impaired in patients with "small", "substantial" and "pronounced" somatization. Regression analysis explained 48 % of the variance of the body-related and 35 % of the variance of the psychological quality of life: Besides the extent of somatization, older age, duration of pain-associated hospitalizations and the subjective amount of occupational impairment proved to be important. With regard to the psychological (but not the somatic) health-related quality of life, the presence of a current comorbid psychological disorder was also relevant.


CONCLUSIONS
Patients with pain-dominated somatoform disorders are substantially impaired in their quality of life. Because 31 % of the patients with such disorders have no additional comorbid psychic disorder and the existence of a comorbid psychic disorder impacts only the psychological domain of their health-related quality of life, the results appear to strongly support maintaining the diagnostic category of somatoform disorders in ICD-11 and DSM-V. They also support the grading of the severity of the somatization similar to the grading of depressive disorders.
HSK, Klinik für Psychosomatische Medizin und Psychotherapie, Dr. Horst Schmidt Klinik Wiesbaden, 65388 Schlangenbad. ralf.nickel@hsk-wiesbaden.de
Ralf
R
Nickel
Jochen
J
Hardt
Bernd
B
Kappis
Rainer
R
Schwab
Ulrich T
UT
Egle
D000328:Adult; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D002908:Chronic Disease; D015897:Comorbidity; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D010552:Personality Assessment / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012803:Sick Role; D012959:Socioeconomic Factors; D013001:Somatoform Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology*
Determinanten der Lebensqualität bei somatoformen Störungen mit Leitsymptom Schmerz - Plädoyer für eine Subgruppen-Differenzierung im ICD-11.