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Social Psychiatry and Psychiatric Epidemiology

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01-12-2010 | Original Paper

Somatic distress among Kosovar civilian war survivors: relationship to trauma exposure and the mediating role of experiential avoidance

Authors: Nexhmedin Morina, Julian D. Ford, Anne Katrin Risch, Besim Morina, Ulrich Stangier

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 12/2010

Abstract

Purpose

The current study examined the prevalence and correlates of somatic distress (SD) in the aftermath of war, and the role of a process hypothesized to contribute to posttraumatic stress: experiential avoidance.

Methods

Civilian war survivors (n = 163) from Kosovo were assessed in structured interviews, reporting on average more than ten types of traumatic war exposure.

Results

One in eight (12.9%) of the participants meet criteria for SD, which was associated with greater psychological distress, experiential avoidance, and lower quality of life after accounting for the effects of war-related variables, demographic variables, as well as posttraumatic stress disorder and major depressive episode. Experiential avoidance partially mediated the association between SD and psychological distress and quality of life.

Conclusions

The results indicate that SD is prevalent among war-exposed civilians and that experiential avoidance may be a significant factor in understanding and treating traumatized people who are experiencing SD.

Simon GE, Von Korff M, Piccinelli M, Fullerton C, Ormel J (1999) An international study of the relation between somatic symptoms and depression. N Engl J Med 341:1329–1335CrossRefPubMed

Barsky AJ, Orav J, Bates DW (2005) Somatization increases medical utilization and costs independent of psychiatric and medical morbidity. Arch Gen Psychiatry 62:903–910CrossRefPubMed

Grabe HJ, Baumeister SE, John U, Freyberger HJ, Voelzke H (2009) Association of mental distress with health care utilization and costs: a 5-year observation in a general population. Soc Psychiatry Psychiatr Epidemiol 44:835–844CrossRefPubMed

Kroenke K (2003) Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management. Int J Methods Psychiatr Res 12:34–43CrossRefPubMed

Gillespie N, Zhu G, Heath AC, Hickie IB, Martin NG (2000) The genetic aetiology of somatic distress. Psychol Med 30:1051–1061CrossRefPubMed

Noyes R, Stuart SP, Watson DB (2008) A reconceptualization of the somatoform disorders. Psychosomatics 49:14–22CrossRefPubMed

Epstein RM, Quill TE, McWhinney IR (1999) Somatization reconsidered: incorporating the patient’s experience of illness. Arch Intern Med 159:215–222CrossRefPubMed

Robbins JM, Kirmayer LJ, Hemami S (1997) Latent variable models of functional somatic distress. J Nerv Ment Dis 185:606–615CrossRefPubMed

Gillespie N, Kirk K, Heath A, Martin NG, Hickie I (1999) Somatic distress as a distinct psychological dimension. Soc Psychiatry Psychiatr Epidemiol 34:451–458CrossRefPubMed

10.

Shorter E (1992) From paralysis to fatigue. A history of psychosomatic illness. Free Press, New York

11.

Schnurr PP, Green BL (2004) Trauma and health. American Psychological Association, Washington, DC

12.

Brown RJ, Schrag A, Trimble MR (2005) Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. Am J Psychiatry 162:899–905CrossRefPubMed

13.

Pribor E, Yutzy S, Dean J, Wetzel R (1993) Briquet’s syndrome, dissociation and abuse. Am J Psychiatry 150:1507–1511PubMed

14.

Roelofs K, Spinhoven P (2007) Trauma and medically unexplained symptoms. Towards an integration of cognitive and neuro-biological accounts. Clin Psychol Rev 27:798–820CrossRefPubMed

15.

Brown RJ (2004) Psychological mechanisms of medically unexplained symptoms: an integrative conceptual model. Psychol Bull 130:793–812CrossRefPubMed

16.

Oakley DA (1999) Hypnosis and conversion hysteria: A unifying model. Cogn Neuropsychiatry 4:243–265CrossRefPubMed

17.

Clark DB, Ball S, Pape D (1991) An experimental investigation of thought suppression. Behav Res Ther 29:253–257CrossRefPubMed

18.

Wegner DM (1994) Ironic processes of mental control. Psychol Rev 101:34–52CrossRefPubMed

19.

Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K (1996) Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol 64:1152–1168CrossRefPubMed

20.

Hayes SC, Strosahl K, Wilson KG, Bissett RT, Pistorello J, Toarmino D et al (2004) Measuring experiential avoidance: a preliminary test of a working model. Psychol Rec 54:553–578

21.

Wenzlaff RM, Eisenberg AR (2001) Mental control after dysphoria: evidence of a suppressed, depressive bias. Behav Ther 32:27–45CrossRef

22.

Campbell-Sills L, Barlow DH, Brown TA, Hofmann SG (2006) Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behav Res Ther 44:1251–1263CrossRefPubMed

23.

Batten SV, Follette VM, Aban IB (2001) Experiential avoidance and high-risk sexual behavior in survivors of child sexual abuse. J Child Sex Abus 10:101–120CrossRefPubMed

24.

Marx BP, Sloan DM (2002) The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse. Behav Ther 33:563–577CrossRef

25.

Plumb JC, Orsillo SM, Luterek JA (2004) A preliminary test of the role of experiential avoidance in post-event functioning. J Behav Ther Exp Psychiatry 35:245–257CrossRefPubMed

26.

Tull MT, Gratz KL, Salters K, Roemer L (2004) The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. J Nerv Ment Dis 192:754–761CrossRefPubMed

27.

Kashdan TB, Morina N, Priebe S (2009) Anxiety and depressive disorders in survivors of the Kosovo War: experiential avoidance as a maintenance factor. J Anxiety Disord 23:185–196CrossRefPubMed

28.

Morina N (2007) The role of experiential avoidance in psychological functioning following war-related stress in Kosovar civilians. J Nerv Ment Dis 195:697–700CrossRefPubMed

29.

Haenen MA, Schmidt AJM, Schoenmakers M, van den Hout MA (1997) Tactual sensitivity in hypochondriasis. Psychother Psychosom 66:128–132CrossRefPubMed

30.

Steptoe A, Noll A (1997) The perception of bodily sensations with special reference to hypochondriasis. Behav Res Ther 35:901–910CrossRefPubMed

31.

Meagher MW, Arnau RC, Rhudy JL (2001) Pain and emotion: effects of affective picture modulation. Psychosom Med 63:79–90PubMed

32.

Montoya P, Sitges C, Garcia-Herrera M, Izquierdo R, Truyols M, Blay N et al (2005) Abnormal affective modulation of somatosensory brain processing among patients with fibromyalgia. Psychosom Med 67:957–963CrossRefPubMed

33.

Morina N, Ford JD (2008) Complex sequelae of trauma exposure among Kosovar civilian war victims. Int J Soc Psychiatry 54:425–436CrossRefPubMed

34.

Johnson H, Thompson A (2008) The development and maintenance of post traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev 28:36–47CrossRefPubMed

35.

Van Ommeren M, Sharma B, Sharma GK, Komproe I, Cardena E, De Jong JT (2002) The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression. J Trauma Stress 15:415–421CrossRefPubMed

36.

Kirmayer LJ (1996) Confusions of the senses: Implications of ethnocultural variations in somatoform and dissociative disorders. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM (eds) Ethnocultural aspect of posttraumatic stress disorder. American Psychological Association, Washington, DC, pp 131–165CrossRef

37.

Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, Schinka J, Knapp E, Sheehan MF, Dunbar GC (1997) The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry 12:232–241CrossRef

38.

Sheehan DV, Lecrubier Y, Harnett-Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry 59:22–33PubMed

39.

Morina N (2006) Versioni shqip i [Albanian version of the] Mini International Neuropsychiatric Interview. Zana, Prishtina

40.

Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 282:1737–1744CrossRefPubMed

41.

Clarke DM, Piterman L, Byrne CJ, Austin DW (2008) Somatic symptoms, hypochondriasis and psychological distress: a study of somatisation in Australian general practice. Med J Aust 189:560–564PubMed

42.

Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, Buchholz C, Witte S, Herzog W (2004) Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 78:131–140CrossRefPubMed

43.

Van Ravesteijn H, Wittkampf K, Lucassen P, van de Lisdonk E, van den Hoogen H, van Weert H, Huijser J, Schene A, van Weel C, Speckens A (2009) Detecting somatoform disorders in primary care with the PHQ-15. Ann Fam Med 7:232–238CrossRefPubMed

44.

Kroenke K, Spitzer RL, Williams JB (2002) The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 64:258–266PubMed

45.

Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J (2000) Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obstet Gynecol 183:759–769CrossRefPubMed

46.

Horowitz M, Wilner N, Alvarez W (1979) Impact of Event Scale: a measure of subjective stress. Psychosom Med 41:209–218PubMed

47.

Morina N (2003) Albanian version of Impact of Event Scale—revised (IES-R). Eur Soc Trauma Stress Stud Bull 10:7–10

48.

Goldberg D, Williams P (1988) User’s guide to the general health questionnaire. NFER-Nelson, Berkshire

49.

Smith P (1998) The role of the general health questionnaire in general practice consultations. Br J Gen Pract 48:1565–1569PubMed

50.

Doi Y, Minowa M (2003) Factor structure of the 12-item General Health Questionnaire in the Japanese general adult population. Psychiatry Clin Neurosci 57:379–383CrossRefPubMed

51.

Makowska Z, Merecz D, Moscicka A, Kolasa W (2002) The validity of general health questionnaires, GHQ-12 and GHQ-28, in mental health studies of working people. Int J Occup Med Environ Health 15:353–362PubMed

52.

Power M (2003) Development of a common instrument for quality of life. In: Nosikov A, Gudex C (eds) EUROHIS: developing common instruments for health surveys. IOS Press, Amsterdam, pp 143–163

53.

Group WHOQOL (1998) Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 28:551–558CrossRef

54.

Schmidt S, Mühlan H, Power M (2005) The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study. Eur J Public Health 16:420–428CrossRefPubMed

55.

Baron RM, Kenny DA (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182CrossRefPubMed

56.

Fink P, Hansen M, Oxhoj J (2004) The prevalence of somatoform disorders among internal medical inpatients. J Psychosom Res 56:413–418CrossRefPubMed

57.

Kessler R, Chiu W, Demier O, Merikangas K, Walters E (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627CrossRefPubMed

58.

De Jong JT, Komproe IH, Van Ommeren MH (2003) Common mental disorders in postconflict settings. Lancet 361:2128–2130CrossRefPubMed

59.

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

60.

Beckham JC, Moore SD, Feldman ME, Hertzberg MA, Kirby AC, Fairbank JA (1998) Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. Am J Psychiatry 155:1565–1569PubMed

61.

Ford JD, Campbell K, Storzbach D, Binder L, Anger WK, Rohlman D (2001) Posttraumatic stress symptomatology is associated with unexplained illness attributed to Persian Gulf War military service. Psychosom Med 63:842–849PubMed

62.

Kroenke K, Spitzer R (1998) Gender differences in the reporting of physical and somatoform symptoms. Psychosom Med 60:150–155PubMed

63.

Norris FH, Slone LB (2007) The epidemiology of trauma and PTSD. In: Friedman MJ, Keane TM, Resick PA (eds) Handbook of PTSD: science and practice. Guilford Press, New York, pp 78–98

64.

Marx B, Sloan D (2005) Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behav Res Ther 43:569–583CrossRefPubMed

65.

Escobar JI, Gureje O (2007) Influence of cultural and social factors on the epidemiology of idiopathic somatic complaints and syndromes. Psychosom Med 69:841–845CrossRefPubMed

66.

Escobar JI, Gara MA, Diaz-Martinez AM, Interian A, Warman M, Allen LA, Woolfolk RL, Jahn E, Rodgers D (2007) Effectiveness of a time-limited cognitive behavior therapy type intervention among primary care patients with medically unexplained symptoms. Ann Fam Med 5:328–335CrossRefPubMed

67.

Mayou R (2007) Are treatments for common mental disorders also effective for functional symptoms and disorder? Psychosom Med 69:876–880CrossRefPubMed

68.

Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and commitment therapy. Guilford Press, New York

69.

Nijenhuis ERS (2000) Somatoform dissociation: major symptoms of dissociative disorders. J Trauma Dissociation 1:7–29CrossRef

Title: Somatic distress among Kosovar civilian war survivors: relationship to trauma exposure and the mediating role of experiential avoidance
Authors: Nexhmedin Morina
Julian D. Ford
Anne Katrin Risch
Besim Morina
Ulrich Stangier
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 12/2010
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-009-0160-z

At a glance: The STEP trials

Springer Medicine

Somatic distress among Kosovar civilian war survivors: relationship to trauma exposure and the mediating role of experiential avoidance

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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