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Journal ArticleDOI

Somatic Symptom Reporting in Women and Men

01 Apr 2001-Journal of General Internal Medicine (Springer)-Vol. 16, Iss: 4, pp 266-275
TL;DR: Women report more intense, more numerous, and more frequent bodily symptoms than men, and general internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief.
Abstract: Women report more intense, more numerous, and more frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those which are medically unexplained are examined. More limited, but suggestive, literature on experimental pain, symptom reporting in childhood, and pain thresholds in animals are compatible with these findings in adults. A number of contributory factors have been implicated, supported by varying degrees of evidence. These include innate differences in somatic and visceral perception; differences in symptom labeling, description, and reporting; the socialization process, which leads to differences in the readiness to acknowledge and disclose discomfort; a sex differential in the incidence of abuse and violence; sex differences in the prevalence of anxiety and depressive disorders; and gender bias in research and in clinical practice. General internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief.

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Citations
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Journal ArticleDOI
TL;DR: The PHQ-15 is a brief, self-administered questionnaire that may be useful in screening for somatization and in monitoring somatic symptom severity in clinical practice and research.
Abstract: OBJECTIVE Somatization is prevalent in primary care and is associated with substantial functional impairment and healthcare utilization. However, instruments for identifying and monitoring somatic symptoms are few in number and not widely used. Therefore, we examined the validity of a brief measure of the severity of somatic symptoms. METHODS The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-15 comprises 15 somatic symptoms from the PHQ, each symptom scored from 0 ("not bothered at all") to 2 ("bothered a lot"). The PHQ-15 was administered to 6000 patients in eight general internal medicine and family practice clinics and seven obstetrics-gynecology clinics. Outcomes included functional status as assessed by the 20-item Short-Form General Health Survey (SF-20), self-reported sick days and clinic visits, and symptom-related difficulty. RESULTS As PHQ-15 somatic symptom severity increased, there was a substantial stepwise decrement in functional status on all six SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. PHQ-15 scores of 5, 10, 15, represented cutoff points for low, medium, and high somatic symptom severity, respectively. Somatic and depressive symptom severity had differential effects on outcomes. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSIONS The PHQ-15 is a brief, self-administered questionnaire that may be useful in screening for somatization and in monitoring somatic symptom severity in clinical practice and research.

2,451 citations

Journal ArticleDOI
TL;DR: In this article, the authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar non-caregivers, and found that caregivers exhibited a slightly greater risk for health problems than did non caregivers, however, sex and the health category assessed moderated this relationship.
Abstract: Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

1,551 citations

Journal ArticleDOI
01 Jan 2006-Sleep
TL;DR: A meta-analysis confirmed a female predisposition of insomnia, which was consistent and progressive across age, with more significance in the elderly, and there was a relatively lower female excess in East Asia.
Abstract: Study objective Most but not all epidemiologic evidence suggests a female predisposition of insomnia. We applied meta-analytic methods to investigate sex differences in the risk of insomnia among the published epidemiologic studies. Design Meta-analysis with Comprehensive Meta-Analysis (Englewood, NJ); 9 different analyses were performed to investigate the sex difference of insomnia among different conditions. Setting A comprehensive search of the medical literature databases was performed to identify epidemiologic studies of insomnia. A rolling snowball method was also used. Participants General population. Interventions N/A. Result Thirty-one related papers were found, but 2 studies only reported the subtype prevalence of insomnia. All other studies (1,265,015 participants, female/male: 718,828/546,187) were included in the overall analysis of insomnia. A risk ratio of 1.41 [95% confidence interval: 1.28-1.55] for female versus male was found. The female excess in the risk of insomnia in large and quality studies was much higher than that of small and nonquality studies. The trend of female predisposition was consistent and progressive across age, with more significance in the elderly. The use of various criteria and frequency and duration of insomnia did not influence the predisposition of female in the risk of developing insomnia. Although obvious female excess in the risk of insomnia exists among different regions, there was a relatively lower female excess in East Asia. Conclusion This meta-analysis confirmed a female predisposition of insomnia. Further studies will be needed to examine the roles of different factors in leading to the sex difference of insomnia.

912 citations

Journal ArticleDOI
TL;DR: Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption, and Gender was not found to be a consistent predictor as traditionally believed.
Abstract: Pain is a subjective and multidimensional experience that is often inadequately managed in clinical practice. Effective control of postoperative pain is important after anesthesia and surgery. A systematic review was conducted to identify the independent predictive factors for postoperative pain and analgesic consumption. The authors identified 48 eligible studies with 23,037 patients included in the final analysis. Preoperative pain, anxiety, age, and type of surgery were four significant predictors for postoperative pain. Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption. Gender was not found to be a consistent predictor as traditionally believed. Early identification of the predictors in patients at risk of postoperative pain will allow more effective intervention and better management. The coefficient of determination of the predictive models was less than 54%. More vigorous studies with robust statistics and validated designs are needed to investigate this field of interest. PAIN is a multifaceted and highly personal experience, as McCaffery described “pain is whatever the experiencing person says it is and exists whenever he/she says it does”. 1 It causes significant distress to patients and has adverse effects on the endocrine and immune function, 2 which can affect wound healing 3 and cardiopulmonary and thromboembolic diseases. 4–6 Given that postoperative pain is one of the most frequently reported postoperative symptoms, 7 identification of the predictive factors for postoperative pain would facilitate early intervention and better pain management if the predictive factors for postoperative pain can be identified. To date, a review of the published literature indicates that there is no systematic review in this area. The purpose of this systematic review was to identify preoperative predictive factors for acute postoperative pain and analgesic consumption.

895 citations


Cites background from "Somatic Symptom Reporting in Women ..."

  • ...It can also be attributed to a different socialization processes for men and women that influence bodily experience and the willingness to communicate distress.(110) Hormone variations,(111) neurotransmitters that can influence patient perception of pain, and pharmacokinetic variations may also occur....

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Journal ArticleDOI
TL;DR: The rate of musculoskeletal pain in adolescent and adult populations is examined, with a focus on three commonly reported pain disorders: shoulder pain, low back pain and fibromyalgia/chronic widespread pain.
Abstract: The rate of musculoskeletal pain in adolescent and adult populations is examined, with a focus on three commonly reported pain disorders: shoulder pain, low back pain and fibromyalgia/chronic widespread pain. There is a paucity of data on musculoskeletal pain in adolescent populations. Those studies available suggest that pain is common, although the actual rates are unclear. This is probably due to differences in study methodologies and populations. Pain is commonly reported among adult populations, with almost one fifth reporting widespread pain, one third shoulder pain, and up to one half reporting low back pain in a 1-month period. The prevalence of pain varies within specific population subgroups; group factors (including socioeconomic status, ethnicity and race) and individual factors (smoking, diet, and psychological status) are all associated with the reporting of musculoskeletal pain. However, the precise nature of these relationships, and particularly the mechanisms of association, are unclear and require further investigation.

661 citations

References
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Journal ArticleDOI
TL;DR: The adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization was assessed, the factors that influenced whether analgesia was adequate were studied, and the effects of inadequate analgesia on the patients' perception of pain relief and functional status were determined.
Abstract: Background and Methods Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status. Results Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percen...

2,002 citations

Journal ArticleDOI
TL;DR: The evidence for differing rates of depression between the sexes in the United States and elsewhere during the last 40 years is reviewed, and the various explanations offered are critically analyzed.
Abstract: • This article reviews the evidence for differing rates of depression between the sexes in the United States and elsewhere during the last 40 years, and then critically analyzes the various explanations offered. These explanations include the possibility that the trends are spurious because of artifacts produced by methods of reporting symptoms, or that they are real because of biological susceptibility (possibly genetic or female endocrine), psychosocial factors such as social discrimination, or female-learned helplessness.

1,811 citations

Journal ArticleDOI
TL;DR: One-month prevalence results were determined from 18571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemilogic Catchment Area Program as mentioned in this paper.
Abstract: • One-month prevalence results were determined from 18571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemilogic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (

1,663 citations

Book
01 Jan 1982
TL;DR: In this paper, the authors discuss the relationship between symptoms and emotions and propose a Schema-directed search for the Symptom-Emotion link to understand the emotional-symptom link.
Abstract: 1 Introduction and Overview.- Boundary Conditions Surrounding Symptom Reporting.- Demographic and Cultural Comparisons.- Experimental and Theoretical Approaches.- Plan of This Book.- 2 Perceptual Processes I: Competition of Cues.- The Perceptual Process.- Orienting and Competition of Cues.- Concluding Remarks.- 3 Perceptual Processes II: Schemas, Selective Search, and Inference.- Selective Monitoring of Specific Sensations.- Selective Monitoring of Categorical or Higher Order Body States.- Inference of Physical Symptoms.- Generality of Schema-Directed Search.- Implications and Conclusions.- 4 Accuracy of Perception Relative to Physiological State.- Measurement of Accuracy: Between-Subjects Versus Within-Subject Approaches.- Situational and Dispositional Factors and Accuracy.- Is Accuracy Unidimensional?.- Conclusions and Future Directions Concerning Accuracy.- 5 Cognitive Organization I: Emotions.- Symptoms and Emotions: Perceptual Specificity.- Causal and Temporal Relationships Between Symptoms and Emotions.- Physiological Search for the Symptom-Emotion Link.- Toward an Understanding of the Emotion-Symptom Link.- Summary.- 6 Cognitive Organization II: Blood Pressure and Blood Glucose.- Blood Pressure and Blood Glucose Research Projects.- Bases of Cognitive Organization: Through the Looking Glass.- Conclusions and Implications.- 7 Personality and Developmental Correlates.- Measurement and Construct Validity of Symptom Reporting.- Personality Correlates of Symptom Reporting.- Habits and Daily Behaviors of the Symptom Reporter.- Developmental Issues in Symptom Reporting.- Composite Picture of the Symptom Reporter.- 8 Summary and Conclusions.- Adaptive and Functional Bases of Symptoms.- Applications of Symptom Research.- Current Problems and Future Directions.- Appendix A Symptom/Emotion Checklist: A State Measure.- Sample Symptom-Emotion Checklist.- Measurement Parameters of Checklist.- Appendix B The PILL: A Trait Measure.- The Pennebaker Inventory of Limbic Languidness.- Measurement Parameters of the PILL.- References.- Author Index.

1,639 citations


"Somatic Symptom Reporting in Women ..." refers background in this paper

  • ...Thus, Pennebaker(66) found that female college students recalled more somatic symptoms in the past month and past year than male students, but there were no differences when respondents were asked about current symptoms.(66) This sort of recall bias is also suggested by a study of chronic pain patients who kept daily ratings of pain intensity and also provided a weeklong summary rating of pain at the end of the week....

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  • ...He points out that under controlled laboratory conditions, men seem to be more accurate perceivers of heart rate, stomach contractions,(73) systolic blood pressure,(74) blood glucose level,(75) and finger temperature.(66) However, in naturalistic studies conducted during daily life, no sex differences are evident in the accuracy of estimates of blood pressure, blood glucose, heart rhythm, and heart rate....

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Journal ArticleDOI
01 May 1996-Pain
TL;DR: Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.
Abstract: This review is a critical summary of research examining gender variations in clinical pain experience. Gender-comparative pain research was identified through Medline and Psychlit searches and references obtained from bibliographies of pertinent papers and books. Review of this research demonstrates that women are more likely than men to experience a variety of recurrent pains. In addition, many women have moderate or severe pains from menstruation, pregnancy and childbirth. In most studies, women report more severe levels of pain, more frequent pain and pain of longer duration than do men. Women may be at greater risk for pain-related disability than men but women also respond more aggressively to pain through health related activities. Women may be more vulnerable than men to unwarranted psychogenic attributions by health care providers for pain. Underlying biological mechanisms of pain and the contribution of psychological and social factors as they contribute to the meaning of pain for women and men warrant greater attention in pain research.

1,462 citations


"Somatic Symptom Reporting in Women ..." refers background in this paper

  • ...In laboratory studies of pain, the sex of the experimenter may influence the subjects' pain response: Men may report less pain to a female than to a male experimenter,(140) though this effect is not found consistently.(2) Additionally, since positive findings are more likely to find their way into the literature than negative findings, gender differences are more likely to be emphasized and published than the absence of such differences....

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  • ...Additionally, since positive findings are more likely to find their way into the literature than negative findings, gender differences are more likely to be emphasized and published than the absence of such differences.(2) Gender bias in clinical practice may also contribute to reported differences in symptoms....

    [...]