What can we learn from a cross-national study of somatic distress?

Abstract

Objective: To examine the extent of cross-national variations in the rates and correlates of somatic distress and determine whether this can be ascribed to cultural differences.

Methods: A two-stage survey in primary care across 15 sites in 14 countries. Screening with the 12-item General Health Questionnaire (GHQ-12) was followed with detailed diagnostic assessment with the Composite International Diagnostic Interview. Self-rating of overall health and evaluation of disability days were also conducted (N = 5438). Twelve months later, 3204 of the patients completed follow-up interviews.

Results: Somatic distress (different definitions of somatization and of hypochondriasis as well as persistent pain disorder) varied in its occurrence across sites. However, other than elevated rates in Latin America, variation tends to be complex and does not lend itself to a neat cultural explanation. The nature of patient-doctor relationship is related to this variation.

Conclusion: Cross-national differences occur in somatic distress. The pattern of these differences does not follow clear cultural lines even though the role of culture cannot be excluded.