AccScience Publishing / JCBP / Volume 1 / Issue 2 / DOI: 10.36922/jcbp.0636
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Clinical characteristics of somatization symptoms of Chinese outpatients in the Department of Cardiology

Yali Ou1† Yanan Zhang1† Chao Jin1 Liang Ning1 Yi Xiao1 Guolong Yu1*
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1 Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
Submitted: 19 April 2023 | Accepted: 23 August 2023 | Published: 25 September 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( )

Somatization symptoms are common in patients with cardiovascular disease (CVD). However, it is challenging to improve these symptoms as the cardiologists in general hospitals, whom these patients sought medical attention from, are imperceptible to signs of psychological disorders, thereby leading to unnecessarily high medical costs and failure of improving the symptoms. Therefore, this study aimed to explore the clinical characteristics and factors that affect somatization symptoms in Chinese outpatients with CVD, providing results that could benefit the improvement of diagnosis and intervention of psychological disorders in the future. We conducted a cross-sectional and observational study in a tertiary general hospital in Hunan, China, from August 2020 to July 2021. Patient health questionnaire-15 (PHQ-15), general anxiety disorder-7 (GAD-7), PHQ-9, and a general demographic data questionnaire were used to screen outpatients for suspected psychiatric disorders. Of the 808 patients in this study, somatization symptoms occurred in 93.1% (752/808) of the sample. In patients with somatization symptoms, the mean total score on the PHQ-15 was 8.54 ± 2.67, and the prevalence of anxiety or depression was 78.7%. The PHQ-15 symptom items with a positive rate of >50% were sleep disorders, chest pain, headache, dyspnea, palpitation, and dizziness. The severity of somatization symptoms differed based on gender (P = 0.0341) and past hospitalization history (P = 0.023). In addition, there was a correlation between somatization symptoms and scores on the GAD-7 (P = 0.0282) and PHQ-9 scales (P = 0.0011). Linear correlation analysis found that PHQ-15 scores were significantly linked to GAD-7 (r = 0.4787, P < 0.001) and PHQ-9 scores (r = 0.5141, P < 0.001) in patients with somatization symptoms. Stepwise logistic regression analysis indicated that female gender, PHQ-9, and GAD-7 scores could positively predict somatization symptoms. In conclusion, somatization symptoms are prevalence in Chinese outpatients treated in the cardiology department. Anxiety, depression, and gender are the main factors affecting somatization symptoms.

General hospitals
Somatic symptoms
  1. Pedersen SS, Von Känel R, Tully PJ, et al., 2017, Psychosocial perspectives in cardiovascular disease. Eur J Prev Cardiol, 24 3 Suppl: 108–115.


  1. Chauvet-Gelinier JC, Bonin B, 2017, Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilitation. Ann Phys Rehabil Med, 60: 6–12.


  1. Reavell J, Hopkinson M, Clarkesmith D, et al., 2018, Effectiveness of cognitive behavioral therapy for depression and anxiety in patients with cardiovascular disease: A systematic review and meta-analysis. Psychosom Med, 80: 742–753.


  1. Zhao M, Yu GL, Yang TL, 2012, Investigate the incidence of anxiety and depression in outpatients from cardiovascular department in a general hospital. Chin J Clin Psychol, 20: 188–189.(in chinese)


  1. Yin H, Geng Q, 2017, Advances in discovering the interrelationship between mental disorders and heart diseases. Heart Mind, 1: 71–77.


  1. Liu M, 2021, Spotlight on the relationship between heart disease and mental stress. Heart Mind, 5: 1–3.


  1. Celano CM, Villegas AC, Albanese AM, et al., 2018, Depression and anxiety in heart failure: A review. Harv Rev Psychiatry, 26: 175–184.


  1. Koh DJ, Kim NY, Kim Y, et al., 2016, Predictors of depressive mood in patients with isolated cerebellar stroke: A retrospective study. Ann Rehabil Med, 40: 412–419.


  1. Kohlmann S1, Gierk B, Hümmelgen M, et al., 2013, Somatic symptoms in patients with coronary heart disease: Prevalence, risk factors, and quality of life. JAMA Intern Med, 173: 1469–1471, discussion 1471.


  1. Wu H, Zhao X, Fritzsche K, et al., 2014, Negative illness perceptions associated with low mental and physical health status in general hospital outpatients in China. Psychol Health Med, 19: 273–285.


  1. Haftgoli N, Favrat B, Verdon F, et al., 2010, Patients presenting with somatic complaints in general practice: Depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors. BMC Fam Pract, 11: 67.


  1. Zhu C, Ou L, Geng Q, et al., 2012, Association of somatic symptoms with depression and anxiety in clinical patients of general hospitals in Guangzhou, China. Gen Hosp Psychiatry, 34: 113–120.


  1. Zhong BL, Chen HH, Zhang JF, et al., 2010, Prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China. Gen Hosp Psychiatry, 32: 268–275.


  1. Wang J, Wang Q, Wimalaratne I, et al., 2017, Chinese non-psychiatric hospital doctors’ attitudes toward management of psychological/psychiatric problems. BMC Health Serv Res, 22: 576–584.


  1. Chinese Society of Rehabilitation Cardiovascular Disease Professional Committee, China Geriatrics Society of Cardiovascular and Cerebrovascular Diseases Professional Committee. 2014, China expert consensus on the psychological prescription of cardiovascular patients. Chin J Cardiol, 42: 6–13.[in Chinese].


  1. Spitzer RL, Kroenke K, Williams JB, et al., 2006, A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med, 166: 1092–1097.


  1. Kroenke K, Spitzer RL, Williams JB, 2001, The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med, 16: 606–613.


  1. Zhang L, Fritzsche K, Liu Y, et al., 2016, Validation of the Chinese version of the PHQ-15 in a tertiary hospital. BMC Psychiatry, 16: 89.


  1. Ishikawa Y, Takeshima T, Mise J, et al., 2015, Physical symptoms in outpatients with psychiatric disorders consulting the general internal medicine division at a Japanese university hospital. Int J Gen Med, 13: 261–266.


  1. Zhang YN, Jin C, Ning L, et al., 2019, Clinical characteristics and related factors of somatization symptoms in outpatients with psychiatric disorders of the department of cardiology in general hospitals. Zhonghua Xin Xue Guan Bing Za Zhi, 47: 907–912. [in Chinese].


  1. Isaac ML, Paauw DS, 2014, Medically unexplained symptoms. Med Clin North Am, 98: 663–672.


  1. Ye RF, Geng QS, Qu LM, et al., 2013, Correlative analysis between anxiety, depression and somatic symptoms in outpatients in cardiology clinic. Lingnan J Cardiovas Dis, 19: 48–51.[in Chinese]


  1. Liao SC, Huang WL, Ma HM, et al., 2016, The relation between the patient health questionnaire-15 and DSM somatic diagnoses. BMC Psychiatry, 16: 351–359.


  1. Wang J, Guo WJ, Mo LL, et al., 2017, Prevalence and strong association of high somatic symptom severity with depression and anxiety in a Chinese inpatient population. Asia Pac Psychiatry, 9: e12282.


  1. Leonhart R, Vroege L, Zhang L, et al., 2018, Comparison of the factor structure of the patient health questionnaire for somatic symptoms (PHQ-15) in Germany, the Netherlands, and China. A transcultural structural equation modeling (SEM) study. Front Psychiatry, 26: 240–241.


  1. Körber S, Frieser D, Steinbrecher N, et al., 2011, Classification characteristics of the patient health questionnaire-15 for screening somatoform disorders in a primary care setting. J Psychosom Res, 71: 142–147.


  1. Löwe B1, Spitzer RL, Williams JB, et al., 2008, Depression, anxiety and somatization in primary care: Syndrome overlap and functional impairment. Gen Hosp Psychiatry, 30: 191–199.


  1. Lieb R, Meinlschmidt G, Araya R, 2007, Epidemiology of the association between somatoform disorders and anxiety and depressive disorders: An update. Psychosom Med, 69: 860–863.


  1. Greden JF, 2003, Physical symptoms of depression: Unmet need. J Clin Psychiatry, 64 Suppl 17: 5–11.


  1. Zhou X, Min S, Sun J, et al., 2015, Extending a structural model of somatization to South Koreans: Cultural values, somatization tendency, and the presentation of depressive symptoms. J Affect Disord, 176: 151–154.


  1. Aamland A, Malterud K, Werner EL, 2014, Patients with persistent medically unexplained physical symptoms: A descriptive study from Norwegian general practice. BMC Fam Pract, 15: 107–117.


  1. Shraim M, Mallen CD, Dunn KM, 2013, GP consultations for medically unexplained physical symptoms in parents and their children: A systematic review. Br J Gen Pract, 63: e318–e325.


  1. Xu W, Liu JS, Mao JL. 2016, Investigation and analysis of multiple somatic symptoms of Chinese expatriates in general and internal medicine outpatient departments of foreign-funded hospitals. Clin J Med Offic, 44: 304–308.[in Chinese].
Conflict of interest
The authors declare that they have no competing interests.
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Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Published by AccScience Publishing