Perceived social support and life satisfaction in persons with somatization disorder.

BACKGROUND: Life satisfaction and perceived social support been shown to improve the well-being of a person and also affect the outcome of treatment in somatization disorder. The phenomenon of somatization was explored in relation to the perceived social support and life satisfaction. AIM: This study aimed at investigating perceived social support and life satisfaction in people with somatization disorder.
MATERIALS AND METHODS: The study was conducted on persons having somatization disorder attending the outpatient unit of LGB Regional Institute of Mental Health, Tezpur, Assam. Satisfaction with life scale and multidimensional scale of perceived social support were used to assess life satisfaction and perceived social support respectively.
RESULTS: Women reported more somatic symptoms than men. Family perceived social support was high in the patient in comparison to significant others' perceived social support and friends' perceived social support. Perceived social support showed that a significant positive correlation was found with life satisfaction.
CONCLUSION: Poor social support and low life satisfaction might be a stress response with regard to increased distress severity and psychosocial stressors rather than a cultural response to express psychological problems in somatic terms.

The term “somXatization” describes a presentation to communicate psychological distress in the form of physical symptoms. Somatic symptoms often occur in reaction to stressful situations and are not considered abnormal if they occur sporadically. Some individuals, however, experience continuing somatic symptoms, attribute them to physical illness in spite of the absence of medical findings, and seek medical care for them. Somatization may also coexist with a medical disease, but when it does, the symptoms are out of proportion to the demonstrable medical findings. In the literature of medical sociology and anthropology, the term has been used to describe a pattern of illness behavior, especially a style of clinical presentation, in which somatic symptoms are presented to the exclusion or eclipse of emotional distress and social problems.[1] The notion that somatization is more common among or characteristic of patients from certain non-Western cultures, particularly Asians and Africans, has become well entrenched.[2] Research suggests that somatization is ubiquitous – although its prevalence and specific features vary considerably across cultures, the processes of focusing on, amplifying, and clinically presenting somatic distress are universal and somatic symptoms are the most common clinical expression of emotional distress worldwide.[34]

Social support is postulated to serve as a protective factor that facilitates coping and competence, thus modulating the deleterious effects of social and environmental stressors. Life satisfaction is a subjective assessment of the quality of one's life. As it is inherently an evaluation, judgments of life satisfaction have a large cognitive component. According to Diener et al.,[5] subjective well-being, or happiness, has both an affective (i.e., emotional) and a cognitive (i.e., judgmental) component. The affective component consists of how frequently an individual reports experiencing positive and negative effects. Life satisfaction is considered to be the cognitive component of this broader construct. Researchers differentiate between life-domain satisfaction and life as a whole (or global) life satisfaction. Life-domain satisfaction refers to satisfaction with specific areas of an individual's life, such as work, marriage, and income, whereas judgments of global life satisfaction are much more broad, consisting of an individual's comprehensive judgment of his/her life. The broad impact on the lives of the severely and persistently mentally ill and the resulting completion of the needs generated by such illnesses pose a particular challenge in the assessment of services for these persons. Relevant outcome areas include psychiatric symptoms, functional status, and access to resources and opportunities, subjective well-being, burden to the family and community safety. Somatic symptoms as expressions of psychological conflict and emotional distress due to intrapsychic or interpersonal conflict can give rise to physiological disturbances with a wide range of somatic symptoms. Physical symptoms then may simply be viewed as an index of psychosocial problems. Social support, social relationship, and various psychosocial factors are associated with perceived quality of life. Subjective quality of life has been found to be associated with social support invariably among subjects in a clinically stable phase or recovering from a severe episode.[6] Researchers have assessed the quality of life on various psychological, clinical, and socio demographic variables among persons with psychiatric disorder and found that psychosocial factors are more associated with subjective quality of life rather than psychopathologic symptoms in various clinical groups.[7-9] It is reported that in addition to severity of symptoms, family support and friendship appear to be a predictor of subjective and objective quality of life.[1011]

Although many researchers are concerned with the significant effect of social support on individual mental health, only few research studies have been carried out to explore the relationship between social support and life satisfaction for people with somatization. Hence, the present study was conducted to assess the perceived social support and life satisfaction among the individuals with somatization disorder, and to explore the relationship between perceived social support and life satisfaction among them.

MATERIALS AND METHODS

The study was conducted on persons having somatization disorder attending the outpatient unit of LGB Regional Institute of Mental Health, Tezpur, Assam. The data were collected in a period of 3 months from September 2008 to November 2008. A total of 60 patients were selected of both genders fulfilling the criteria of somatization disorder according to ICD 10 criteria. However, persons with mental retardation, epilepsy, any other neurological disorder, and with comorbid mental disorder were excluded. The mean age of persons with somatization was 42.33 (SD=6.13) years. The sociodemographic characteristics of the persons with somatization are summarized in Table 1. Majority of them were females (86.7%), Muslims (93.3%), married (91.7%), illiterates (88.3%), homemakers (95%), hailing from a rural background (88%), belonging from a nuclear family (70%), and having a monthly family income of below Rs. 3000 (61.7%).

Table 1

Showing sociodemographic characteristics of persons with somatization

Tools used

Semi-structured clinical and sociodemographic data sheet

Relevant sociodemographic and clinical details were collected using this pro forma.

Satisfaction with the life scale[12]

It is a measure of life satisfaction consisting of five items. Its internal consistency is above 0.80.

Multidimensional scale of perceived social support[13]

It is a 12-items scale, and divides perceived social support from family members, friends, and from significant others. Norms for the general population have been published with higher scores indicating more social support. Its internal consistency reliability is 0.88.

Procedure

Informed consent was taken from the patients and informant before eliciting relevant information. The nature and purpose of the study was explained. All the subjects were interviewed and were then assessed with the help of a semi structured clinical and sociodemographic data sheet. Thereafter, satisfaction with life scale and multidimensional scale of perceived social support were administered.

Statistical analysis

The statistical package for social sciences (SPSS), version 14.0, was used for the analysis of the data of this study. Data were described using the number and percentage. A chi square test was applied for group comparison. Correlation was computed between social support and life satisfaction.

RESULTS

The finding of social support is given in Table 2. According to the manual of the test a higher score indicates better support. Findings suggest that in comparison to significant others’ perceived social support and friends’ social support, family perceived social support was higher. Response on life satisfaction is recorded as extremely satisfied, satisfied, slightly satisfied, neutral, slightly dissatisfied, dissatisfied, and extremely dissatisfied. Findings show that 41% patients were slightly satisfied [Table 3]. Only 9% persons with somatization were dissatisfied and none of the patient was extremely dissatisfied. Perceived social support was found to have a significant positive correlation with life satisfaction (correlation value 0.639, P<0.01) which suggests that higher perceived social support is associated with better life satisfaction.

Table 2

Showing perceived social support

Table 3

Life satisfaction reported by persons with somatization

DISCUSSION

Overall health can be influenced by multiple factors, including a person's psychological behavioral, and social well-being. Studies have demonstrated an association between increased levels of social support and reduced risk for physical and mental disease. Social support includes real or perceived sources provided by others that enable a person to feel cared for, valued, and part of network of communication and mutual obligation. Social support can be an important factor for those with somatization disorder who rely on family friends, or organization to assist them with daily activities, provide companionship, and care for their well-being. A patient's support system may come from several sources apart from the family such as friends, residential or day care providers, shelter operators, roommates, and others. It is necessary to know from whom the patient perceives social support. This will ensure proper social support, encouragement, and treatment. Research has shown that a family with a mentally ill patient does suffer from network contraction and condensation, which in turn, increases the vulnerability of the family to stressors due to lack of social support. Results indicated that female gender was suffering more from somatization. These findings are consistent with the result of the previous studies.[14-17] A physiological difference between males and females is proposed as a cause for it.[16] Accordingly, gender differences in brain function, hormones, and reproductive processes were considered as possible factors related to the increased risk to complaint for somatic symptoms in women. The occurrence of somatization varies across the sociocultural group and seems to be influenced by environmental stressors. In the present study it is found that majority of the persons with somatization were illiterate, Muslim, belonging to rural background, and of lower economic status. Similar findings are reported by Barskey[18] who observed that somatization is more common among those who are less educated, of lower socioeconomic status, of rural background, and among ethnic groups that discourage the direct expression of emotional distress.

In the present study a positive correlation between perceived social supports and life satisfaction was found. Higher perceived social support was associated with better life satisfaction. Life satisfaction has been found to moderate the effects of stress on symptoms of psychological distress.[19] Intimate social relationships, rather than family relationships, predict an individual's overall life satisfaction. Social support is one of the most important factors in predicting the physical health and well-being of every one, ranging from childhood through older adults. The absence of social support shows some disadvantage among the affected individuals. In most cases, it can predict the deterioration of physical and mental health among the victims. The presence of social support significantly predicts the individual's ability to cope with stress. Knowing that they are valued by illness is an important psychological factor in helping them to forget the negative aspect of life, and thinking more positively about their environment. Somatizing patients experience or express emotional discomfort and psychosocial distress as physical symptoms. Somatization occurs in a broad spectrum of illnesses, in association with a wide variety of mental disorders, including depression, anxiety, and the somatoform disorders. Primary care providers must detect and treat these patients. Care rests upon conservative medical management and evaluation; a physician-patient relationship based on acceptance, caring, and trust; reinforcement of positive behaviors and elimination of destructive ones; and the gradual use of the relationship to promote healthy relating in the patient. These data do not support the common belief that females somatize more than males or the traditional view that somatization is a basic orientation prevailing in developing countries. Instead, somatic symptoms, emotional distress, life satisfaction, and perceived social support are strongly associated with each other and need psychosocial support and intervention to overcome their distress.