Standardization of a screening instrument (PHQ-15) for somatization syndromes in the general population

BMC Psychiatry

Elmar Brähler²  Andreas Hinz²  Rüya-Daniela Kocalevent¹ 

[1]Institute and Policlinic for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, Hamburg, 20246, Germany

[2]Department of Medical Psychology and Medical Sociology, University of Leipzig, Ph.-Rosenthal-Str. 55, Leipzig, 04103, Germany

关键词: General population;    PHQ-15;    Standardized data;    Somatization;   

Others  :  1124103
DOI  :  10.1186/1471-244X-13-91

 received in 2012-08-07, accepted in 2013-03-12,  发布年份 2013

【 摘 要 】

Background

The PHQ-15 is widely used as an open access screening instrument for somatization syndromes in different health care settings, thus far, normative data from the general population are not available. The objectives of the study were to generate normative data and to further investigate the construct validity of the PHQ-15 in the general population.

Methods

Nationally representative face-to face household surveys were conducted in Germany between 2003 and 2008 (n=5,031). The survey questionnaires included, the 15-item somatization module from the Patient Health Questionnaire (PHQ-15), the 9-item depression module (PHQ-9), the Satisfaction With Life Scale (SWLS), the SF-12 for the measurement of health related quality of life, and demographic characteristics.

Results

Normative data for the PHQ-15 were generated for both genders and different age levels including 5031 subjects (53.6% female) with a mean age (SD) of 48.9 (18.1) years. Somatization syndromes occured in 9.3% of the general population. Women had significantly higher mean (SD) scores compared with men [4.3 (4.1) vs. 3.4 (4.0)]. Intercorrelations with somatization were highest with depression, followed by the physical component summary scale of health related quality of life.

Conclusions

The normative data provide a framework for the interpretation and comparisons of somatization syndromes with other populations. Evidence supports reliability and validity of the PHQ-15 as a measure of somatization syndromes in the general population.

【 授权许可】

   
2013 Kocalevent et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Steinbrecher N, Koerber S, Frieser D: The prevalence of medically unexplained symptoms in primary care. Psychosom 2011, 52:263-71.
• [2]De Vroege L, Hoedeman R, Nuyen J: Validation of the PHQ-15 for somatoform disorder in the occupational health care setting. J Occup Rehabil 2011, 22:51-58.
• [3]Korber S, Frieser D, Steinbrecher N: Classification characteristics of the Patient Health Questionnaire-15 for screening somatoform disorders in a primary care setting. J Psychosom Res 2011, 71:142-7.
• [4]Burton C, Weller D, Marsden W: A primary care symptoms clinic for patients with medically unexplained symptoms: pilot randomised trial. BMJ Open 2012, 2:e000513.
• [5]Hiller W, Fichter MM, Rief W: A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness. J Psychosom Res 2003, 54:369-80.
• [6]Hiller W, Fichter MM: High utilizers of medical care: a crucial subgroup among somatizing patients. J Psychosom Res 2004, 56:437-43.
• [7]Kroenke K, Spitzer RL, Williams JB: The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002, 64:258-66.
• [8]Hanel G, Henningsen P, Herzog W: Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res 2009, 67:189-97.
• [9]Hiller W, Rief W, Brahler E: Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol 2006, 41:704-12.
• [10]Jasper F, Hiller W, Rist F: Somatic symptom reporting has a dimensional latent structure: results from taxometric analyses. J Abnorm Psychol 2012, 121:725-38.
• [11]Kroenke K, Spitzer RL, Williams JB: The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010, 32:345-59.
• [12]Mergl R, Seidscheck I, Allgaier AK: Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition. Depress Anxiety 2007, 24:185-95.
• [13]Barkow K, Heun R, Ustun TB: Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care. Eur Psychiatry 2004, 19:250-7.
• [14]Rief W, Hessel A, Braehler E: Somatization symptoms and hypochondriacal features in the general population. Psychosom Med 2001, 63:595-602.
• [15]Wittchen HU, Jacobi F, Rehm J: The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011, 21:655-79.
• [16]Jacobi F, Wittchen HU, Holting C: Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health interview and examination Survey (GHS). Psychol Med 2004, 34:597-611.
• [17]Lowe B, Spitzer RL, Williams JB: Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry 2008, 30:191-9.
• [18]Kroenke K: Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am 2007, 30:593-619.
• [19]Schumacher S, Rief W, Brahler E: Disagreement in doctor's and patient's rating about medically unexplained symptoms and health care use. Int J Behav Med 2011, 2011:2011.
• [20]Kroenke K: Patients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res 2003, 12:34-43.
• [21]Hahn SR, Thompson KS, Wills TA: The difficult doctor-patient relationship: somatization, personality and psychopathology. J Clin Epidemiol 1994, 47:647-57.
• [22]Kroenke K, Rosmalen JG: Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am 2006, 90:603-26.
• [23]Stanley IM, Peters S, Salmon P: A primary care perspective on prevailing assumptions about persistent medically unexplained physical symptoms. Int J Psychiatry Med 2002, 32:125-40.
• [24]Spitzer RL, Kroenke K, Williams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999, 282:1737-44.
• [25]Mewes R, Rief W, Brahler E: Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population. Gen Hosp Psychiatry 2008, 30:349-55.
• [26]Härter M, Kentgens M, Brandes A, Bock T, Dirmaier J, Erzberger M, Fürstenberg W, Hillebrandt B, Karow A, Knesebeck O, König HH, Löwe B, Meyer HJ, Romer G, Rouhiainen T, Scherer M, Thomasius R, Watzke B, Wegscheider K, Lambert M: Rationale and content of psychenet: the Hamburg Network for Mental Health. Eur Arch Psychiatry Clin Neurosci 2012. published online 13 September 2012
• [27]Inc P: PHQ-Screeners. 2002. http://www.phqscreeners.com webcite. 19 March 2013
• [28]Löwe BSR, Zipfel S, Herzog W: Gesundheitsfragebogen für Patienten (PHQ D). Komplettversion und Kurzform. Testmappe mit Manual, Fragebögen, Schablonen. 2. Auflage. Karlsruhe: Pfizer; 2002.
• [29]APA: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (4th edition). Washington DC: American Psychiatric Press; 2000.
• [30]Lowe B, Kroenke K, Herzog W: Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 2004, 81:61-6.
• [31]Kroenke K, Spitzer RL, Williams JB: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001, 16:606-13.
• [32]Gandek B, Ware JE, Aaronson NK: Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998, 51:1171-8.
• [33]Schumacher J: SWLS - Satisfaction With Life Scale. In Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Edited by Schumacher J, Klaiberg A, Brähler E. Göttingen: Hogrefe; 2003:305-309.
• [34]Diener E, Emmons RA, Larsen RJ: The Satisfaction With Life Scale. J Pers Assess 1985, 49:71-5.
• [35]Pavot W, Diener E: Review of the Satisfaction With Life Scale. Psychol Assess 1993, 5:164-72.
• [36]Lowe B, Wahl I, Rose M: A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord 2010, 122:86-95.
• [37]Han C, Pae CU, Patkar AA: Psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) for measuring the somatic symptoms of psychiatric outpatients. Psychosom 2009, 50:580-5.
• [38]Rief W, Pilger F, Ihle D: Immunological differences between patients with major depression and somatization syndrome. Psychiatry Res 2001, 105:165-74.
• [39]Rief W, Auer C: Is somatization a habituation disorder? Physiological reactivity in somatization syndrome. Psychiatry Res 2001, 101:63-74.
• [40]Interian A, Allen LA, Gara MA: Somatic complaints in primary care: further examining the validity of the Patient Health Questionnaire (PHQ-15). Psychosom 2006, 47:392-8.
• [41]van Ravesteijn H, Wittkampf K, Lucassen P: Detecting somatoform disorders in primary care with the PHQ-15. Ann Fam Med 2009, 7:232-8.
• [42]Smith RC, Lein C, Collins C: Treating patients with medically unexplained symptoms in primary care. J Gen Intern Med 2003, 18:478-89.
• [43]Jackson JL, O'Malley PG, Kroenke K: Antidepressants and cognitive-behavioral therapy for symptom syndromes. CNS Spectr 2006, 11:212-22.
• [44]Kroenke K: Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007, 69:881-8.
• [45]Kleinstauber M, Witthoft M, Hiller W: Efficacy of short-term psychotherapy for multiple medically unexplained physical symptoms: a meta-analysis. Clin Psychol Rev 2011, 31:146-60.