Perceived family-related stressors and clinical manifestations of patients with psychosomatic morbidity attending general outpatient clinic university college hospital

Abstract

Background: Depression, anxiety and somatoform disorder account for psychosomatic morbidity (PSM), the most prevalent mental disorder encountered in primary care. Prominent clinical manifestations of PSM can result from perceived stress and are general and unspecified symptoms (GUS) which most times are unexplained. These symptoms vary in individuals, usually multiple and affect different body parts. Studies have shown that stress relating to health, work and financial problems is common among primary health care attendees, but association with pattern and extent of PSM has not been widely studied in Nigeria.

Objective: This study sought to explore the relationship between severity of patients' clinical manifestations and perceived family related stressors (PFRS).

Method: The study span for three months, during which 1402 patients ≥18 years who presented at the out-patient clinic for various complaints were encountered. The sample size was determined using the prevalence of 63.1%. for psychosomatic disorder from Ogunsemi et al's study. A sample of 360 patients with varying forms of PSM identified by ≥ 5 from symptoms in the primary evaluation of mental disorder- patient health questionnaire somatoform, anxiety and depression modules (PRIME-MD PHQ SADs) was recruited consecutively out of the patients encountered during the study period. The clinical manifestations of these patients were categorized using international classification for primary care second electronic version (ICPC-2E). The ICPC-2E was modified by the addition of somatic symptoms observed to be peculiar in people with PSM in the study area. The Social Readjustment Rating Scale (SRRS) was used to explore the PFRS. Data were analyzed using statistical package for Social Sciences soft ware version 17. Tables and diagrams in form of graphs, charts were used for relevant variables. Cross tabulations of some independent variables and dependent variable were analyzed using independent t-test and analysis of variance. Statistical significance level was set at p ≤ 0.05.

Results: The age of respondents ranged between 18 and 80 years with mean age of 42.2 years + 15.2. Two-thirds of them (67.8%) were females and majority had married once 76.4% [this comprised those that were living with their spouses (62.5%), separated/divorced (3.1%) and widowed (10.8%), while (23.6%) were never married. Commonest complaints observed were GUS (23.3%), cardiovascular system complaints (14.2%), gastrointestinal (11.9%), musculoskeletal complaints (11.4%), gynaecological symptoms (10.6%), neurological (8.6%) and symptoms from other body parts constituted 20%. GUS complaints in this study contained additional features (crawling body sensation, sensation of pain or heaviness in the head, peppery body sensation, migratory body pains and migratory body movement) included in the modified ICPC-2E classification. Almost all respondents screened in with PSM (95.6%) had somatoform disorder by the (PRIME MD) PHQ-SAD questionnaire used.

The second and third parts of PHQ-SADS diagnosed that only few have depressive disorder (40%) and anxiety disorder (44.4%). The mean scores for PFRS were higher in respondents with moderate to severe PSM. However, respondents with anxiety related symptoms are more likely to have greater PFRS (p = 0.03).

Conclusion: GUS were predominant complaints identified in patients with PSM in this study. Females tend to perceive more psychosocial stressors when compared with males and are more likely to report their symptoms. The study finding suggests that risk factor for a severe manifestation of patients with PSM is higher PFRS.