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J Psychosom Res. 2014 Sep;77(3):187-95. doi: 10.1016/j.jpsychores.2014.06.005. Epub 2014 Jun 22.

Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China.

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Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Germany. Electronic address:
Institute of Psychology, University of Freiburg, Germany.
Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, P.R. China.
Department of Psychosomatic Medicine, Peking Union Hospital, P.R. China.
Department of Psychosomatic Medicine, Red Cross Hospital, Kunming, P.R. China.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Germany.
Department of Psychology, University of Marburg, Germany.
Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University, Giessen, Germany.
Department of General Internal Medicine and Psychosomatics, University Medical Centre Heidelberg, Germany.



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.


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+).


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."


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.


China; Depression; Illness behaviour; Illness perception; Quality of life; Somatic symptom severity

[Indexed for MEDLINE]

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