Somatisation in primary care in Spain: II. Differences between somatisers and psychologisers. Working Group for the Study of the Psychiatric and Psychosomatic Morbidity in Zaragoza.

BACKGROUND

This study is the first attempt to document the differences between somatisers (STs) and psychologisers (PGs) in Spanish primary care patients.

METHOD: A sample of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, were examined in a two-phase screening using Spanish versions of GH-28, CAGE questionnaire, substance abuse, MMSE and SPPI. STs and PGs were diagnosed according to operationalised Bridges & Goldberg's criteria.

RESULTS

ST was found to be three times more prevalent than PG, but the ratio ST: PG was highest (10.5) in the DSM-IV category dysthymia. Generalised anxiety disorder was the most frequent diagnosis in STs and major depressive episode the most frequent in PGs. No significant differences between the two groups have been found in demographic characteristics. Total GHQ scores were significantly higher in PGs, but global SPPI scores were not. Most psychopathological scores were higher in PGs, but both somatic symptoms and suspiciousness were higher in STs. The psychopathological findings are consistent with hypotheses related to blame avoidance and defensiveness in STs.

CONCLUSIONS

ST is three times more prevalent than PG, but the ratio ST: PG depends heavily on diagnostic categories. While most psychopathological scores are higher in PGs, both patient groups are similarly disturbed. Previously assumed socio-demographic differences between STs and PGs have not been found in this study.