SOMATIZATION DISORDER AMONG THE UPPER SOCIO-ECONOMIC CLASS ADULT PATIENTS ATTENDING THE GENERAL OUTPATIENT CLINIC AT THE NATIONAL HOSPITAL ABUJA

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SOMATIZATION DISORDER AMONG THE UPPER SOCIO-ECONOMIC CLASS ADULT PATIENTS ATTENDING THE GENERAL OUTPATIENT CLINIC AT THE NATIONAL HOSPITAL ABUJA

SUMMARY

Aim The aim was to assess the association of the manifestations of somatization disorder on the family functioning, workplace and social functioning in the upper socio-economic class adult patients attending outpatient clinic at the National Hospital Abuja

Methods Socioeconomic class tool modified by Ogunlesi et al to classify the subjects as well as the PHQ-15 scale instrument updated with the ICD-10 criteria for somatization disorder were used to assess the prevalence, development and manifestations of somatization disorder among upper socioeconomic class subjects. This study was conducted in primary care settings at the general outpatient department (GOPD) of the National Hospital Abuja-Nigeria from July through September 2010. For the study, patients selected from preceding screening exercises with a socioeconomic class in the upper range and who had 3 or more severe somatic symptoms based on the PHQ-15 criteria, were recruited thereafter to fill out a 2 part questionnaire that addressed the association between somatization disorder and the patient’s family functioning, his workplace and social functioning.

Results 195 adults belonging to the upper socioeconomic class were recruited. The mean age of the participants was 37±14 years (age range of 18-65 years) while 76.2% (138) of them were females. At a cut off level of 3 or more severe somatic symptoms during the past 2 years according to the PHQ-15 scale, 11 subjects (or 5.6%) had somatization disorder. It was commoner among the females as well as among young adults. Certain associated risk factors like alcohol use was also identified following a logistic regression

 

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Headache occurring in 122 of the subjects (62%) was the commonest manifestation among the subjects irrespective of the gender. There was also a significant association between somatization disorder in the individual and some parameters in his/her family like type of marriage; however family functioning strictly was not affected. Ability to work was also affected by the disorder in the workplace while the social life especially involvement in private leisure activities was also affected.

Conclusion The findings indicate that a minority of individuals belonging to the upper socioeconomic class were affected by somatization disorder.

TABLE OF CONTENTS                                                                                         PAGES

TITLE PAGE……………………………………………………………………………………………………………… …i

DECLARATION…………………………………………………………………………………………………………………….. ii

SUPERVISORS’ CERTIFICATION………………………………………………………………………………………. iii

DEDICATION……………………………………………………………………………………………………………………….. iv

PREFACE/ACKNOWLEDGEMENT……………………………………………………………………………………… v

TABLE OF CONTENTS………………………………………………………………………………………………………… vi

LIST OF TABLES…………………………………………………………………………………………………………………. vii

LIST OF FIGURES………………………………………………………………………………………………………………. viii

LIST OF APPENDICES…………………………………………………………………………………………………………. ix

LIST OF ABBREVIATIONS…………………………………………………………………………………………………… x

SUMMARY…………………………………………………………………………………………………………………………… xii

 

CHAPTER ONE- INTRODUCTION…….…………………………………………….………………….1

CHAPTER TWO- LITERATURE REVIEW….…………………………………………………………..8

CHAPTER THREE-MATERIALS AND METHODS…………………………………………………..22

CHAPTER FOUR-RESULTS…….……………………….………………………………………………..28

CHAPTER FIVE-DISCUSSION, LIMITATIONS, 

CONCLUSION AND RECOMMENDATIONS…………………………………………………………….54

 REFERENCES……………………………………………………………………………… …………..67

APPENDICES………………………………………………………………..………… ………………..78

GLOSSARY…………………………………………………………………………………………………………………98

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CHAPTER ONE

INTRODUCTION

1.0   Background

Stress has been variously defined as an environmental event, a process, and an outcome.1 It can represent the life events (called stressors) an individual is exposed to. Depending on the personality or coping mechanisms available to an individual, stress is able to cause a certain level of discomfort or disease to the person. These stressors could range from environmental hazards such as floods, famine to major life events (loss of a loved one) or chronic daily

hassling.1

On a global scale, mental health disorders including somatization disorder may be quite disabling and it is predicted that one in four individuals will suffer from a mental health or behavioural disorder in his or her lifetime.2 Economically about 200 billion dollars have been lost by way of treatment of mental health disorders, insurance compensations accruing there from and consequent losses of man-hours.3

African figures for mental disorders are not readily available but a study done in South Africa showed a prevalence of between 16.5-26.2% in a population-based study done by Williams and his co-workers spanning 12 months.4

Somatization disorder is a component of the Somatoform disorders complex (otherwise called Briquets Syndrome5),and also being a manifestation of stress, is a mental disorder characterized by physical symptoms that mimic physical injuries or disease where there is no identifiable physical cause.5The physical symptoms which the patient obviously feels have no physiological

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basis. Often, a barrage of physical examinations and laboratory investigations ordered for the patient turns out unsatisfactory.6 The patient may get so frustrated that he ends up losing confidence in the physician and consulting many other physicians with the hope of achieving a diagnosis for his ailment which usually seems not to have a physical basis.6 The symptoms may persist for many years, leaving the patient unsatisfied with their physicians’ diagnoses and treatment. Others sought for a spiritual care for their illness, blaming their symptoms on some past sins or a form of spiritual attack.5 Only a careful understanding of the patient’s history most times and a proper exclusion of co-morbid ailments would enable the discerning physician to help the patient overcome his burden with the right combination of therapeutic measures.6 Evidence exists that patients in western cultures with depression and other stress related mood disorders may present to the primary care physician with non-specific somatic symptoms.7 Therefore, without specific questioning, family physicians may fail to recognize mood disorders in patients with somatic complaints.

The first-line treatment for most patients with somatization disorders consists of antidepressant medication, psychotherapy, or a combination of both. These forms of therapy are reported to be effective in about 60% to 80% of affected patients, and can be delivered in primary care

settings.8

Socioeconomic classification is a system of economic or cultural arrangements of groups in the society.9,10  A person’s or family’s socioeconomic status represents an economic and sociological combined total measure of his work experience.9,10 It also represents an individual’s or a family’s economic and social position relative to others, based on income,education, and occupation.9,10  The household income earners’ education and occupation are examined, as well as their combined income are assessed when analysing a family’s class. 9,10

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Socioeconomic status (SES) is typically classified into three categories, high, middle and lower to describe the three areas a family or an individual may fall into. When placing a family or individual into one of these categories any or all of the three variables (income, education, and

occupation) can be assessed.9,10

Various models for socioeconomic status classification have been proposed internationally including the American model as studied by Thompson and Hickey, the Indian model, the

Iranian model, the Italian, Japanese, the United Kingdom models to mention but a few. Essentially each tries to classify based on the supervening culture and practice in the environment and using parameters such as income, level of education, occupation of the

individual or group.9,10

Locally, a Nigerian model done in 1985 by Oyedeji et al and modified later by the group of Ogunlesi et al in 2008 has since been in use and tries to sub classify individuals into various classes using parameters such as income, level of education, occupation.10

The reason for focussing on individuals in the upper socioeconomic class borders on the peculiarities of this class and the common incidence of stressful conditions seen here.11  These include their lifestyle, high level decisions they have to make every day, working under pressure to achieve so much as well as their personalities (usually the type A group that is the achievement-oriented personalities who are usually under pressure to deliver) and not being aware of effective coping mechanisms. Cohen et al, however, showed that the manifestations of stress seem lower in the higher socioeconomic classes compared to the lower classes.11 The upper socioeconomic class include professionals earning very well with a high job satisfaction. This is as opposed to other two societal strata which include the middle class

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(including semi-professionals), and the lower class (consisting of other less well paid jobs and

the unemployed). 9,10

The impact of stress and its related disorders as well as socioeconomic effects can be seen on the

individual, family, community or even in his workplace.12,13,14

The individual may suffer from a variety of associated psychosomatic to physical disorders which may not be obvious to a non-discerning mind. Illnesses ranging from psychiatric illnesses such as depression, somatization disorders, anxiety neurosis, substance abuse, suicides, homicides, rape and other social crimes, etc. and physical illnesses such as ulcers, hypertension and erectile dysfunctions and some cases of infertility have a definite association with stress.1

The impact on the family would range from domestic violence, tensions, marital separation, divorces, infidelity and developmental problems including failure to thrive in children which may be directly or remotely connected to stress.13 This severely affects family functioning and dynamics which may have its effects directly on the community with the family being a functional unit of the latter. A malfunctioned community results consequently.13

At the work place, stress related disorders which may be individual or corporate in nature would impact on the quality of service delivery available. Here the level of output in the staff is greatly affected resulting in increased loss of man-hours by work absenteeism, avoidable accidents, lack of motivation, poor commitment of staff to company’s vision, disloyalty with a poor command structure and high levels of other counter-productive and illegal practices become the order of the day. Ultimately, such deleterious effects result in poor productivity, poor returns, high retrenchments, under capacity utilization and subsequently a folding up of a once thriving

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business.12,14

1.1   Definition of Research Problem.

Despite the common presentations of somatization in our outpatient clinics in Nigeria, there is still a wide knowledge gap on the matter especially with regards to the various socioeconomic classes. Thus this informed the present study.

Somatization disorder is a recognizable health problem in both developed and developing countries. 2,15  Poverty, economic reform programs, limited public health services, widespread private and traditional healthcare services, civil unrest, cultural diversity and gender inequality are problems people in developing nations also have to cope with.2,15 Mental health services as an aspect of health care is also poorly developed.15 In the face of a dearth of mental health specialists in most societies, treatment is mainly provided by primary health care providers.15,16  However a large proportion of persons with psychological disorders who seek medical assistance do not receive appropriate treatment.8 This is likely to be due to the fact that they present with physical symptoms. Most patients seeking care for certain psychiatric disorders are more concerned with their physical symptoms instead of their psychological symptoms.8,17 Prescription of non specific medications like hypnotics and vitamins by primary health care workers and private general practitioners in the developing nations for somatic complaints does not seem to help the situation while a prompt recognition of the mood disorder gave a better result.18,19 A worrisome dearth of data on outcome of treatment trials in the developing world has continued to persist even in the light of the findings on the public health importance of mental disorders.16

 

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 1.2   Justification of the study

Many of the upper class individuals experience various degrees of stress mostly manifesting as neurotic symptoms and affective disorders in their persons, families and workplaces.11 These effects may cause poor productivity and as many of them occupy executive positions in both private and corporate organizations, this soon manifests as a declining national productivity. Thus for a more effective management, sources and the manifestations of stress in this category of individuals must be identified and nipped.

1.2.1   Relevance of Study to Family Medicine

This study is imperative in any primary care setting- the gateway to other specialties where the family physician is in a position to counsel and implement lifestyle changes, screen for diseases and empower this group with information towards maintaining a good psychosocial health.

1.3   Aim and Objectives

The aim of the study was to assess the association of manifestations of somatization disorder in the upper socio-economic class on family, workplace and social functioning in adult patients attending the general outpatient clinic at the National Hospital Abuja to enable for an effective mental health intervention in these individuals.

Specific Objectives

Specifically, the study sought to:

  1. Determine the prevalence of somatization disorder in the upper socioeconomic class patients attending the general outpatient clinic of the National Hospital Abuja.
  2. Identify the factors associated with somatization disorder in the upper socioeconomic class

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  1. Assess the association between manifestation of somatization disorder and the family functioning.
  2. Determine the association of manifestations of somatization disorder and the workplace functioning.
  3. Determine the association of manifestations of somatization disorder and the social functioning

 

SOMATIZATION DISORDER AMONG THE UPPER SOCIO-ECONOMIC CLASS ADULT PATIENTS ATTENDING THE GENERAL OUTPATIENT CLINIC AT THE NATIONAL HOSPITAL ABUJA

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