Somatic symptom disorders and utilization of health services among Palestinian primary health care attendees: a cross-sectional study

Zaher Nazzal, Beesan Maraqa, Marah Abu Zant, Layali Qaddoumi, Rana Abdallah

Keywords: Somatic symptom disorder; Primary Care clients; Risk factor; Palestine

Background:
Somatization is the expression of psychological or emotional distress through physical symptoms that are otherwise unexplained. Many primary health care (PHC) clients come in with medically unexplained complaints, leading to frequent consultations and high usage of services and healthcare costs.

Research questions:
The research questions are
1- What is the prevalence of somatic symptom disorder (SSD) among PHC attendees
2- Is somatic symptom disorder associated with utilization of health services and other mental conditions

Method:
A cross-sectional design was used to interview 400 attendees. Men and women aged over 18 years old without a psychiatric diagnosis were invited to participate. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in a PHC setting. We used the Chi-square test and multivariable logistic regression to explore determinant variables.

Results:
The study included 400 PHC; 71.8% of them were female, and 52.3% were over 50 years of age. The majority were married (77.5%), unemployed (66.2%), and have chronic diseases (64%). The prevalence of SSD was 32.5% (95%CI= 27.9%-37.1%). The most common symptoms were painful muscles (61.5%) followed by back pain (52.3%).
Female gender [adjusted OR = 2.1 (95% CI= 1.2-3.7)], chronic diseases [adjusted OR = 2.4 (95%CI=1.3-4.5)], depression [adjusted OR = 3.3 (95%CI= 2.0-5.5)], and anxiety [adjusted OR = 2.1 (95%CI= 1.2-3.6)] were all associated with SSD. In addition, frequent primary health care attendance was found to be associated with SSD [adjusted OR = 2.4 (95%CI= 1.4-4.1)]

Conclusions:
SSD is prevalent among Palestinian PHC attendees. It is significantly higher among females, patients with chronic diseases, anxiety and depressive disorders, and patients with frequent doctors' visits. Painful muscles and back pain are the most prevalent symptoms reported by patients, and this might be used as an early screening signal by PHC physicians.

Points for discussion: