title: Association of somatoform disorders with anxiety and depression in women in low and middle income countries: a systematic review.
abstract: BACKGROUND
  Across cultures, women are more likely than men to report somatoform disorders (SD), depression and anxiety. The aim of this article is to describe the co-morbidity of SD with depression/anxiety and to investigate the possible mechanisms of this relationship in women in low and middle income countries (LMIC).
  
  
  METHODS
  We reviewed two databases: MEDLINE and PsycINFO from 1994 to 2012 for studies which assessed the association between any SD and depression/ anxiety in women from LMIC. Our focus was on community and primary healthcare based studies. Both quantitative and qualitative studies were included.
  
  
  RESULTS
  A total of 21 studies covering eight LMICs were included in our analysis. Our findings suggest a strong association between SD and depression/anxiety (with odds ratios ranging from 2.5-3.5), though we also observed that the majority of women with SD did not have depression/anxiety. The likely mechanisms for this association are multidimensional, and may include shared aetiologies, that both conditions are in fact variants of the same primary mental disorder, and that one disorder is a risk factor for the other. Anthropological research offers a number of frameworks through which we can view these mechanisms.
  
  
  CONCLUSIONS
  The current evidence indicates that service providers at the primary care level should be sensitized to consider SD in women as variants of CMD (Common Mental Disorders) and address both groups of disorders concurrently. Further research should explicitly seek to unpack the mechanisms of the relationship between SD and CMD.
authors: Indian Institute of Public Health, Hyderabad, Andhra Pradesh, India.
authors: Rahul
authors: R
authors: Shidhaye
authors: Emily
authors: E
authors: Mendenhall
authors: Kethakie
authors: K
authors: Sumathipala
authors: Athula
authors: A
authors: Sumathipala
authors: Vikram
authors: V
authors: Patel
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D003156:Community Mental Health Services / Q000706:statistics & numerical data; D015897:Comorbidity; D003469:Culture; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D003906:Developing Countries; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005008:Ethnopsychology; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D011320:Primary Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D016387:Women's Health
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