Illness attribution of patients with medically unexplained physical symptoms in China.

The illness behavior of patients with medically unexplained physical symptoms (MUS) depends largely on what the patient believes to be the cause of the symptoms. Little data are available on the illness attributions of patients with MUS in China. This cross-sectional study investigated the illness attributions of 96 patients with MUS in the outpatient departments of Psychosomatic Medicine, biomedicine (Neurology, Gynecology), and Traditional Chinese Medicine in Shanghai. Patients completed the Illness Perception Questionnaire (IPQ) for illness attribution, the Screening Questionnaire for Somatoform Symptoms, the Hospital Anxiety and Depression Scale for emotional distress, and questionnaires on clinical and sociodemographic data. The physicians also filled out a questionnaire regarding the cause of the illness (IPQ). In contrast to previous research, both physicians and patients from all three areas of medicine most frequently reported "psychological attributions." The concordance between the physicians' and the patients' illness attributions was low. Emotional distress was an important predictor of psychological attributions. Further research should include large-scale studies among patients from different regions of China and qualitative studies to deepen our understanding of cultural influences on illness attribution.

The treatment of patients with medically unexplained physical symptoms in China: a study comparing expectations and treatment satisfaction in psychosomatic medicine, biomedicine, and traditional Chinese medicine.

OBJECTIVE: Little is known about treatment for patients with medically unexplained symptoms (MUS) in China. This study investigates the treatment expectations and treatment satisfaction of patients with MUS in psychosomatic medicine, biomedicine, and Traditional Chinese Medicine (TCM). METHOD: In a cross-sectional survey, n = 96 (10.3%) out of 931 participating patients were screened positive for multiple somatoform symptoms. These patients answered questionnaires concerning symptom duration, number of doctor visits, functional impairment, emotional distress, treatment expectations, treatment satisfaction, and empathy in the consultation. The physicians filled in a questionnaire about applied or recommended treatment. RESULTS: Most of the patients from psychosomatic medicine wanted psychotherapy. In TCM, 55% of the patients had already received TCM treatment and most of them wanted to continue TCM treatment. Patients in biomedicine did not express clear expectations; most of them had had no previous treatment. A combination of treatment methods was most prevalent in biomedicine in comparison to psychosomatic medicine and TCM. The outcome from the patients' point of view was significantly better in TCM than in psychosomatic medicine and biomedicine. Psychosomatic medicine's strength was the empathetic physician-patient interaction. CONCLUSIONS: From a biopsychosocial perspective, these results suggest that various treatment approaches with various emphases can be effective depending on the patient's complaints, his illness beliefs, and what the physician offers. The results will be verified in a larger multicenter longitudinal study.