Wie wirken sich somatoforme und depressive Symptome und Syndrome auf die Lebenszufriedenheit aus? Ergebnisse einer bevölkerungsrepräsentativen Befragung in Deutschland

Zusammenfassung

Hintergrund:

Die differenzielle Bedeutung depressiver und somatoformer Symptome/Syndrome für die Lebenszufriedenheit in der Allgemeinbevölkerung wird untersucht.

Material und Methoden:

In einer bevölkerungsrepräsentativen Stichprobe (N=2 510) werden somatische und depressive Symptome mit dem Patient Health Questionnaire (PHQ) und Lebenszufriedenheit mit den Fragen zur Lebenszufriedenheit (FLZ^M) erhoben.

Ergebnisse:

Sowohl depressive und somatoforme Syndrome als auch subklinische depressive und somatische Symptome beeinflussen die Lebenszufriedenheit negativ. Während depressive Symptome/Syndrome alle Bereiche der Lebenszufriedenheit einschränken, zeigen somatische Symptome/somatoforme Syndrome ein differenziertes Zusammenhangsmuster.

Schlussfolgerung:

Unter Berücksichtigung komorbider depressiver Symptome/Syndrome wirken sich somatische Symptome und somatoforme Syndrome nur auf einige Bereiche der Lebenszufriedenheit negativ aus. Eine dimensionale Auswertung ist sinnvoll, um den Einfluss subklinischer Symptome zu beschreiben.

Abstract

Objectives:

The aim of this study is to investigate the differential impact of somatoform and depressive symptoms/syndromes on life satisfaction.

Methods:

In a representative population survey in Germany (N=2 510) depressive and somatic symptoms are screened with the Patient Health Questionnaire (PHQ), Life satisfaction is assessed with the Questions on Life Satisfaction (FLZ^M).

Results:

Both subclinical depressive/somatic symptoms and clinically relevant depressive/somatoform syndromes are associated with decreased life satisfaction. Depressive symptoms/syndromes result in lower satisfaction in all areas of life, whereas somatic symptoms/somatoform syndromes only affect certain domains of life ­satisfaction.

Conclusions:

Considering comorbid depressive symptoms/syndromes, somatic symptoms and somatoform syndromes show negative associations with only some of the subdimensions of life satisfaction. A dimensional approach is useful to consider the effects of subclinical symptoms on life satisfaction.

Schlüsselwörter

Lebenszufriedenheit - somatoforme Syndrome - Depression - subklinisch

Keywords

life satisfaction - somatization - depression - subclinical

• Literatur

• 1 Moons P, Budts W, De Geest S. Critique on the conceptualisation of quality of life: a review and evaluation of different conceptual approaches. Int J Nurs Stud 2006; 43: 891-901
• 2 Koller M, Lorenz W. Survival of the quality of life concept. Br J Surg 2003; 90: 1175-1177
• 3 Ravens-Sieberer U, Wille N, Nickel J et al. Wohlbefinden und gesundheitsbezogene Lebensqualität aus einer bevölkerungsbezogenen Perspektive – Ergebnisse aus aktuellen internationalen und nationalen Studien. Z Gesundheitspsychol 2009; 17: 56-68
• 4 Bullinger M. Assessing health related quality of life in medicine. An overview over concepts, methods and applications in international research. Restor Neurol Neurosci 2002; 20: 93-101
• 5 Daig I, Lehmann A. Verfahren zur Messung der Lebensqualität. Z Med Psychol 2007; 16: 5-23
• 6 Anderson KL, Burckhardt CS. Conceptualization and measurement of quality of life as an outcome variable for health care intervention and research. J Adv Nurs 1999; 29: 298-306
• 7 Goldbeck L, Schmitz TG, Besier T et al. Life satisfaction decreases during adolescence. Qual Life Res 2007; 16: 969-979
• 8 Henrich G, Herschbach P. Questions on Life Satisfaction (FLZ^M) – A short questionnaire for assessing subjective quality of life. Eur J Psychol Assess 2000; 16: 150-159
• 9 Weller I. Beachtliche Unterschiede in der Lebenszufriedenheit zwischen den Ländern der Europäischen Union: eine Untersuchung auf der Basis des Eurobarometers. Informationsdienst Soziale Indikatoren 1997;
• 10 Hiller W, Rief W, Brähler E. Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 704-712
• 11 Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15: 357-376
• 12 Ladwig KH, Marten-Mittag B, Erazo N et al. Identifying somatiza­tion disorder in a population-based health examination survey: psychosocial burden and gender differences. Psychosomatics 2001; 42: 511-518
• 13 Faravelli C, Salvatori S, Galassi F et al. Epidemiology of somatoform disorders: a community survey in Florence. Soc Psychiatry Psychiatr Epidemiol 1997; 32: 24-29
• 14 Grabe HJ, Meyer C, Hapke U et al. Specific somatoform disorder in the general population. Psychosomatics 2003; 44: 304-311
• 15 World Health Organisation . The global Burden of Disease: 2004 Update. Geneva: WHO Library Cataloguing-in-Publication Data; 2008
• 16 Moussavi S, Chatterji S, Verdes E et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet 2007; 370: 851-858
• 17 Löwe B, Spitzer RL, Williams JB et al. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry 2008; 30: 191-199
• 18 Alonso J, Angermeyer MC, Bernert S et al. Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 2004; 109: 38-46
• 19 Spitzer RL, Kroenke K, Linzer M et al. Health-related quality of life in primary care patients with mental disorders – results from the PRIME-MD 1000 Study. JAMA 1995; 274: 1511-1517
• 20 Schmidt S, Petermann F, Beutel ME et al. Psychisches Befinden, Beschwerden und Belastungen: Ergebnisse einer repräsentativen Studie. Z Psychiatr Psychol Psychother 2011; 59: 155-165
• 21 Daig I, Herschbach P, Lehmann A et al. Gender and age differences in domain-specific life satisfaction and the impact of depressive and anxiety symptoms: a general population survey from Germany. Qual Life Res 2009; 18: 669-678
• 22 Herschbach P. Das Zufriedenheitsparadox in der Lebensqualitätsforschung. Wovon hängt unser Wohlbefinden ab?. Psychother Psychosom Med Psychol 2002; 52: 141-150
• 23 Goldbeck L, Schmitz TG. Comparison of three generic questionnaires measuring quality of life in adolescents and adults with cystic fibrosis: The 36-item short form health survey, the quality of life profile for chronic diseases, and the questions on life satisfaction. Qual Life Res 2001; 10: 23-36
• 24 Löwe B, Spitzer RL, Zipfel S et al. Gesundheitsfragebogen für Patienten (PHQ − D). 2. Aufl. Karlsruhe: Pfizer; 2002
• 25 Saß H, Wittchen H-U, Zaudig M et al. Diagnostische Kriterien DSM-IV-TR. 1. Aufl. Göttingen: Hogrefe; 2003
• 26 Dilling H. Internationale Klassifikation psychischer Störungen: ICD-10, Kapitel V, klinisch diagnostische Leitlinien. 2. Aufl.: Weltgesundheitsorganisation; 1993
• 27 Häuser W, Biewer W, Gesmann M et al. A comparison of the clinical features of fibromyalgia syndrome in different settings. Eur J Pain 2011; 15: 936-941
• 28 Kroenke K, Spitzer RL, Williams JBW et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345-359
• 29 Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002; 64: 258-266
• 30 Rief W, Martin A, Klaiberg A et al. Specific effects of depression, panic, and somatic symptoms on illness behavior. Psychosom Med 2005; 67: 596-601
• 31 van Ravesteijn H, Wittkampf K, Lucassen P et al. Detecting somatoform disorders in primary care with the PHQ-15. Ann Fam Med 2009; 7: 232-238
• 32 Gräfe K, Zipfel S, Herzog W et al. Screening psychischer Störungen mit dem „Gesundheitsfragebogen für Patienten (PHQ-D)“. Diagnostica 2004; 50: 171-181
• 33 Kroenke K, Spitzer RL, Williams JBW. The PHQ-9 – Validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613
• 34 Löwe B. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 2004; 78: 131-140
• 35 Stein MB, Heimberg RG. Well-being and life satisfaction in generalized anxiety disorder: comparison to major depressive disorder in a community sample. J Affect Disord 2004; 79: 161-166
• 36 Dear K, Henderson S, Korten A. Well-being in Australia – Findings from the National Survey of Mental Health and Well-being. Soc Psychiatry Psychiatr Epidemiol 2002; 37: 503-509
• 37 Rief W, Hiller W. Somatiserungsstörung und Hypochondrie. Göttingen: Hogrefe; 1998
• 38 Kroenke K, Rosmalen JG. Symptoms, syndromes, and the value of psychiatric diagnostics in patients who have functional somatic disorders. Med Clin North Am 2006; 90: 603-626
• 39 Jackson JL, Kroenke K. Prevalence, impact, and prognosis of multisomatoform disorder in primary care: a 5-year follow-up study. Psychosom Med 2008; 70: 430-434
• 40 Creed F. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 2004; 56: 391-408
• 41 Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 2005; 62: 903-910
• 42 Clarke DM, Piterman L, Byrne CJ et al. Somatic symptoms, hypochondriasis and psychological distress: a study of somatisation in Australian general practice. Med J Aust 2008; 189: 560-564
• 43 Patten SB, Schopflocher D. Longitudinal epidemiology of major depression as assessed by the Brief Patient Health Questionnaire (PHQ-9). Compr Psychiatry 2009; 50: 26-33
• 44 Rief W, Nanke A, Klaiberg A et al. Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J Affect Disord 2004; 82: 271-276
• 45 Meyer C, Rumpf HJ, Hapke U et al. Impact of psychiatric disorders in the general population: satisfaction with life and the influence of comorbidity and disorder duration. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 435-441
• 46 Al-Windi A. The influence of complaint symptoms on health care utilisation, medicine use, and sickness absence. A comparison between retrospective and prospective utilisation. J Psychosom Res 2005; 59: 139-146
• 47 Hessel A, Geyer M, Hinz A et al. Inanspruchnahme des Gesundheitssystems wegen somatoformer Beschwerden – Ergebnisse einer bevölkerungsrepräsentativen Befragung. Z Psychosom Med Psychother 2005; 51: 38-56
• 48 Mewes R, Rief W, Brähler E et al. Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population. Gen Hosp Psychiatry 2008; 30: 349-355
• 49 Nanke A, Rief W. Zur Inanspruchnahme medizinischer Leistungen bei Patienten mit somatoformen Störungen. Psychotherapeut 2003; 48: 329-335
• 50 Kapfhammer HP. Somatoforme Störungen Konzept, Klinik, Ätiopathogenese und Therapie. Nervenarzt 2008; 79: 99-115
• 51 Diener E, Suh EM, Lucas RE et al. Subjective well-being: Three decades of progress. Psychol Bull 1999; 125: 276-302
• 52 Sher KJ, Trull TJ. Methodological issues in psychopathology research. Annu Rev Psychol 1996; 47: 371-400
• 53 Aigner M, Forster-Streffleur S, Prause W et al. What does the WHOQOL-Bref measure? Measurement overlap between quality of life and depressive symptomatology in chronic somatoform pain disorder. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 81-86
• 54 Beck JS. Cognitive Therapy: Basics and Beyond. New York: The Guilford Press; 1995