title: Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China.
abstract: OBJECTIVE
  In primary care populations in Western countries, high somatic symptom severity (SSS) and low quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients.
  
  
  METHODS
  This multicentre cross-sectional study enrolled 404 patients from 10 outpatient departments, including Neurology, Gastroenterology, Traditional Chinese Medicine [TCM] and Psychosomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15<10, n=203, SOM-) were compared to patients who reported high SSS (PHQ-15≥10, n=201, SOM+).
  
  
  RESULTS
  As compared to SOM- patients, SOM+ patients showed significantly more frequently adverse psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS was significantly associated with "catastrophising" and "illness vulnerability"; low physical QoL was associated with "avoidance of physical activities" and "disuse of body parts"; low mental QoL was associated with "need for immediate medical help."
  
  
  CONCLUSIONS
  In accordance with the results from Western countries, high SSS was associated with negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.
authors.affiliation: Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
authors.forename: Yaoyin
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Germany. Electronic address: kurt.fritzsche@uniklinik-freiburg.de.
authors.forename: Kurt
authors.initials: K
authors.lastname: Fritzsche
authors.affiliation: Institute of Psychology, University of Freiburg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Leonhart
authors.affiliation: Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, P.R. China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
authors.forename: Lan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Psychosomatic Medicine, Peking Union Hospital, P.R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Psychosomatic Medicine, Red Cross Hospital, Kunming, P.R. China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wirsching
authors.affiliation: Department of Psychology, University of Marburg, Germany.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Nater-Mewes
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University, Giessen, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Larisch
authors.affiliation: Department of General Internal Medicine and Psychosomatics, University Medical Centre Heidelberg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schaefert
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006769:Hospitals, General; D006801:Humans; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data*; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D012803:Sick Role; D012938:Social Perception; D011795:Surveys and Questionnaires
keywords: China; Depression; Illness behaviour; Illness perception; Quality of life; Somatic symptom severity