Journal of Psychosomatic Research最新文献_第3页

Impact of optimism training on atherosclerotic biomarkers in coronary artery disease: A randomized controlled trial 乐观训练对冠心病患者动脉粥样硬化生物标志物的影响：一项随机对照试验

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-24 DOI: 10.1016/j.jpsychores.2026.112529

Masoumeh Sadeghi , Nasim Kakavand , Mohammadesmaeil Aramesh Boroujeni , Hamidreza Roohafza , Narges Mohammadi , Alireza Aghayousefi , Mohammad Kermani-Alghoraishi

Background

Atherosclerosis, a chronic inflammatory condition, is the leading cause of cardiovascular disease (CVD) morbidity and mortality worldwide. Intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) are key mediators of leukocyte-endothelial interactions and drivers of atherosclerotic progression. While optimism-based psychological interventions have demonstrated beneficial effects on several inflammatory biomarkers, their impact on adhesion molecules remains unclear.

Methods

We conducted a randomized controlled trial involving 61 outpatients with stable coronary artery disease (CAD) who had completed cardiac rehabilitation. Participants were randomized to an eight-week group-based optimism training program or an attention-matched cardiac education control. Changes in plasma ICAM-1 and VCAM-1 levels were measured by ELISA at baseline and 16 weeks as well as psychological measures of depression, anxiety, and negative affect.

Results

The optimism intervention significantly improved psychological outcomes, with reductions in depression, anxiety, and negative affect compared to controls (p < 0.05). While post-intervention adhesion molecule levels showed significant between-group differences, effect sizes were small and inconclusive, with no significant group-by-time interactions. Correlation analyses found no significant link between changes in optimism and adhesion molecule levels.

Conclusions

Optimism-based interventions yield meaningful psychological benefits in patients with CAD, though changes in adhesion molecule biomarkers were small and uncertain. High variability in biomarker levels and limited detectable effect sizes highlight the need for larger studies to clarify the clinical significance of these findings.

背景：动脉粥样硬化是一种慢性炎症性疾病，是全球心血管疾病（CVD）发病率和死亡率的主要原因。细胞间粘附分子-1 （ICAM-1）和血管细胞粘附分子-1 （VCAM-1）是白细胞-内皮相互作用的关键介质和动脉粥样硬化进展的驱动因素。虽然基于乐观的心理干预已经证明对几种炎症生物标志物有有益的影响，但它们对粘附分子的影响尚不清楚。方法对61例完成心脏康复的稳定型冠心病（CAD）门诊患者进行随机对照试验。参与者被随机分配到为期八周的小组乐观训练计划或注意力匹配的心脏教育控制。在基线和16周时用ELISA检测血浆ICAM-1和VCAM-1水平的变化，以及抑郁、焦虑和消极情绪的心理测量。结果与对照组相比，乐观干预显著改善了心理结局，抑郁、焦虑和负面情绪均有所减少（p < 0.05）。虽然干预后粘附分子水平在组间有显著差异，但效应量很小且不确定，各组间没有显著的相互作用。相关分析发现乐观情绪的变化和粘附分子水平之间没有显著的联系。结论：尽管粘附分子生物标志物的变化很小且不确定，但基于乐观的干预措施对CAD患者产生了有意义的心理益处。生物标志物水平的高度可变性和有限的可检测效应大小突出了需要更大规模的研究来阐明这些发现的临床意义。

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引用次数: 0

Adverse childhood experiences and cancer pain: A national cross-sectional analysis of survivors' pain outcomes 不良的童年经历和癌症疼痛：幸存者疼痛结果的全国横断面分析

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-22 DOI: 10.1016/j.jpsychores.2026.112556

Fares Qeadan, Max Moroz, Benjamin Tingey

Context

Adverse childhood experiences (ACEs) are linked to long-term health impacts, including increased pain prevalence. However, the relationship between ACEs and pain presence and pain control among cancer survivors is not well understood.

Objectives

To examine the association between cumulative ACE exposure and (1) the presence of cancer-related physical pain and (2) the current perceived adequacy of pain control among adult survivors in the United States.

Methods

Behavioral Risk Factor Surveillance-System (BRFSS) data from 2019 to 2023 were analyzed, including 19,046 adults with self-reported cancer diagnoses and complete ACE data. Modified Poisson regression estimated crude and adjusted prevalence ratios (PRs, aPRs) for pain presence and pain control. Subgroup analyses were stratified by cancer type. Random forest models assessed ACE domain importance.

Results

A clear dose-response was found between ACEs and pain presence. Each additional ACE was associated with a 6% higher prevalence of pain (aPR = 1.058; 95% CI: 1.005–1.113). Pain prevalence increased from 7.2% (0 ACEs) to 25.4% (8 ACEs). ACEs were not significantly associated with pain control in adjusted models (aPR = 0.994; 95% CI: 0.973–1.016). Stratified analyses revealed stronger associations in certain cancer types, particularly leukemia, pharyngeal, and bladder. Random forest models identified household dysfunction and emotional/sexual abuse as key predictors of pain presence and pain control.

Conclusion

ACEs are significantly associated with pain presence, but not with perceived pain control. These findings underscore the need for ACE-informed screening and trauma-informed care in survivorship planning to address cancer pain.

Key message

Cancer survivors with adverse childhood experiences report higher prevalence of pain, but not significantly lower prevalence of adequate pain control. This study emphasizes the need for trauma-informed care to address the lasting influence of early adversity on cancer-related symptom burden.

不良童年经历（ace）与长期健康影响有关，包括疼痛发生率增加。然而，ace与癌症幸存者疼痛存在和疼痛控制之间的关系尚不清楚。目的研究累积ACE暴露与(1)癌症相关身体疼痛的存在和(2)美国成年幸存者当前疼痛控制的感知充分性之间的关系。方法分析2019 - 2023年行为风险因素监测系统（BRFSS）数据，包括19046名自我报告癌症诊断的成年人和完整的ACE数据。修正泊松回归估计疼痛存在和疼痛控制的粗患病率和调整患病率（pr, aPRs）。亚组分析按癌症类型分层。随机森林模型评估ACE域的重要性。结果ace与疼痛之间存在明显的剂量反应。ACE每增加一次，疼痛发生率增加6% （aPR = 1.058; 95% CI: 1.005-1.113）。疼痛发生率从7.2%（0次ace）增加到25.4%（8次ace）。在调整后的模型中，ace与疼痛控制无显著相关（aPR = 0.994; 95% CI: 0.973-1.016）。分层分析显示，在某些类型的癌症中，特别是白血病、咽癌和膀胱癌，有较强的相关性。随机森林模型确定家庭功能障碍和情感/性虐待是疼痛存在和疼痛控制的关键预测因素。结论ace与疼痛存在感相关，而与感知疼痛控制无关。这些发现强调了在生存计划中进行ace知情筛查和创伤知情护理以解决癌症疼痛的必要性。有不良童年经历的癌症幸存者报告了更高的疼痛患病率，但没有显著降低适当疼痛控制的患病率。本研究强调创伤知情护理的必要性，以解决早期逆境对癌症相关症状负担的持久影响。

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引用次数: 0

Associations between physical activity, body esteem, and self-esteem among women with breast and gynecological cancer 乳腺癌和妇科癌症患者的身体活动、身体自尊和自尊之间的关系

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-22 DOI: 10.1016/j.jpsychores.2026.112547

Anna Weronika Szablewska , Bartosz Zając , Martyna Lesińska , Rita Santos - Rocha , Anna Szumilewicz

Background

Gynecological and breast cancers are among the most prevalent malignancies in women. While survival has improved due to advances in treatment, many survivors experience challenges such as body image disturbances and reduced self-esteem. Physical activity has been identified as a potential protective factor, but evidence specific to this population remains limited.

Aim

The aim of this study was to evaluate the differences in body image and self-esteem among physically active and inactive women with a history of gynecological and breast cancer, as compared to active and inactive healthy controls.

Methods

A cross-sectional online survey was conducted in Poland. Participants were allocated to four groups according to cancer status and physical activity: inactive controls (CON-PI), active controls (CON-PA), inactive cancer survivors (CAN-PI), and active cancer survivors (CAN-PA). Physical activity was defined based on World Health Organization recommendations. Body image and self-esteem were assessed using the Body-Esteem Scale for Adolescents and Adults (BESAA) and the Rosenberg Self-Esteem Scale (RSES).

Results

Physically active women reported significantly higher BESAA and RSES scores compared to inactive women. The CAN-PI group consistently showed the lowest scores across all domains, while the CON-PA group reported the highest. Differences were particularly marked in appearance, attribution, and global self-esteem.

Conclusions

Meeting WHO-recommended physical activity levels was associated with more positive body image and higher self-esteem in women after gynecological and breast cancer treatment. The findings highlight the potential role of physical activity in psychosocial well-being and support its inclusion in survivorship care.

背景妇科和乳腺癌是女性中最常见的恶性肿瘤。虽然由于治疗的进步，生存率有所提高，但许多幸存者仍面临着身体形象障碍和自尊降低等挑战。体育活动已被确定为潜在的保护因素，但针对这一人群的证据仍然有限。目的本研究的目的是评估有妇科和乳腺癌病史的积极运动和不运动的妇女在身体形象和自尊方面的差异，并与积极运动和不运动的健康对照进行比较。方法在波兰进行横断面在线调查。根据癌症状况和身体活动将参与者分为四组：不活跃对照组（CON-PI），活跃对照组（CON-PA），不活跃癌症幸存者（CAN-PI）和活跃癌症幸存者（CAN-PA）。体育活动的定义是基于世界卫生组织的建议。采用青少年和成人身体自尊量表（BESAA）和罗森博格自尊量表（RSES）对身体形象和自尊进行评估。结果运动女性的BESAA和RSES评分明显高于不运动女性。CAN-PI组在所有领域的得分都是最低的，而CON-PA组的得分最高。在外表、归因和全球自尊方面的差异尤为明显。结论：达到世卫组织推荐的身体活动水平与妇科和乳腺癌治疗后女性更积极的身体形象和更高的自尊相关。研究结果强调了体育活动在心理社会健康中的潜在作用，并支持将其纳入幸存者护理。

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引用次数: 0

Loneliness and somatic complaints: An experience sampling method study 孤独与躯体抱怨：经验抽样法研究

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-22 DOI: 10.1016/j.jpsychores.2026.112554

Martine Smeets , Elody Hutten , Peter Verboon , Yvonne Bol , Viviane Thewissen , Ellen M.M. Jongen

Objective

Previous studies have shown a positive relation between retrospectively measured loneliness and somatic complaints. This study investigated the relation between state loneliness and state somatic complaints as well as the direction of this relation in the context of daily life. It was hypothesized that there is a positive contemporaneous association between state loneliness and state somatic complaints as well as a positive bidirectional temporal association.

Methods

Using the Experience Sampling Method, 16 patients with somatic symptom disorder and 27 participants from the general population received a signal on their smartphones 10 times a day for 14 days to fill out an ESM-item on loneliness and two on somatic complaints. To test our hypotheses, multilevel linear regression models with random effects were estimated.

Results

Associations between state loneliness and state somatic complaints in the context of daily life were demonstrated (B = 0.12, SE = 0.01, p < .001). Temporal analyses revealed, however, that state loneliness (t-1) did not predict somatic complaints (t) in daily life (90-min window; B = 0.01, SE = 0.01, p = .573). Neither did state somatic complaints predict state loneliness (B = 0.02, SE = 0.03, p = .534).

Conclusions

This study demonstrated contemporaneous associations between state loneliness and state somatic complaints in the context of daily life. However, state loneliness did not predict subsequent state somatic complaints, nor did state somatic complaints predict subsequent state loneliness. Future studies are necessary to further disentangle the complex relationship between loneliness and somatic complaints.

目的以往的研究表明，回顾性测量的孤独感与躯体抱怨之间存在正相关关系。本研究探讨了状态孤独与状态躯体抱怨的关系，以及这种关系在日常生活中的走向。假设状态孤独与状态躯体抱怨之间存在正相关，同时存在正相关的双向时间关系。方法采用体验抽样法，选取16例躯体症状障碍患者和27例普通人群，在14天内每天10次通过智能手机接收信号，填写一份关于孤独感的esm项目和两份关于躯体抱怨的esm项目。为了检验我们的假设，我们估计了具有随机效应的多水平线性回归模型。结果在日常生活情境下，状态孤独与状态躯体抱怨之间存在相关性（B = 0.12, SE = 0.01, p < 0.001）。然而，时间分析显示，状态孤独（t-1）不能预测日常生活中的躯体抱怨(t)（90分钟窗口；B = 0.01, SE = 0.01, p = .573）。状态躯体抱怨也不能预测状态孤独（B = 0.02, SE = 0.03, p = .534）。结论：本研究证明了日常生活中状态孤独和状态躯体抱怨之间的同步关联。然而，状态孤独并不能预测随后的状态躯体抱怨，状态躯体抱怨也不能预测随后的状态孤独。未来的研究有必要进一步理清孤独与躯体抱怨之间的复杂关系。

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引用次数: 0

The association among social participation, loneliness and depression in stroke survivors: A longitudinal cross-lagged panel analysis 脑卒中幸存者社会参与、孤独和抑郁之间的关系：纵向交叉滞后面板分析

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-21 DOI: 10.1016/j.jpsychores.2026.112553

Liping Sun , Yuexia Liao , Zhi'e Gu , Xiaojuan Wan , Ningning Liu

Objective

To examine longitudinal associations among depressive symptoms, loneliness, and social participation in stroke survivors, and the temporal role of loneliness between social participation and depressive symptoms.

Methods

277 stroke survivors were conveniently sampled from two tertiary hospitals in Yangzhou, China. Depressive symptoms, loneliness, and social participation were assessed using the Patient Health Questionnaire-9, UCLA Loneliness Scale, and Utrecht Scale for Evaluation of Rehabilitation-Participation, respectively. Data were collected at baseline (T1), 3 months (T2), and 6 months (T3) post-stroke, with a cross-lagged panel model used to examine the reciprocal relationships among variables.

Results

Cross-lagged panel analysis revealed: T1 depressive symptoms positively predicted T2 loneliness (β = 0.133, P = 0.046)；T1 social participation negatively predicted T2 loneliness (β = −0.226, P < 0.001) and depressive symptoms (β = −0.256, P < 0.001)；T2 depressive symptoms negatively predicted T3 social participation (β = −0.098, P = 0.027)；T2 loneliness positively predicted T3 depressive symptoms (β = 0.171, P = 0.006)；T2 social participation negatively predicted T3 loneliness (β = −0.174, P = 0.001). Mediation analysis showed T2 loneliness mediated T1 social participation's effect on T3 depressive symptoms (indirect effect = −0.037, 95% CI [−0.082, −0.010]).

Conclusion

Alternating cross-lagged effects were observed among depressive symptoms, loneliness, and social participation in stroke survivors, with loneliness potentially acting as a mediator between social participation and subsequent depressive symptoms. These findings suggest hypotheses for phase-specific interventions, which should be tested in future studies.

目的探讨脑卒中幸存者抑郁症状、孤独感和社会参与之间的纵向关系，以及孤独感在社会参与和抑郁症状之间的时间作用。方法从扬州市两所三级医院抽取277例脑卒中幸存者。抑郁症状、孤独感和社会参与分别采用患者健康问卷-9、UCLA孤独感量表和乌得勒支康复参与评估量表进行评估。在脑卒中后基线（T1）、3个月（T2）和6个月（T3）收集数据，采用交叉滞后面板模型来检验变量之间的倒数关系。结果交叉滞后面板分析显示：T1抑郁症状正预测T2孤独（β = - 0.226, P < 0.001）和抑郁症状（β = - 0.256, P < 0.001）；T2抑郁症状负预测T3社会参与（β = - 0.098, P = 0.027）；T2孤独正预测T3抑郁症状（β = 0.171, P = 0.006）；T2社会参与负预测T3孤独（β = - 0.174, P = 0.001）。中介分析显示T2孤独感介导T1社会参与对T3抑郁症状的影响（间接效应= - 0.037,95% CI[- 0.082, - 0.010]）。结论脑卒中幸存者抑郁症状、孤独感和社会参与之间存在交变滞后效应，孤独感可能在社会参与与随后的抑郁症状之间起中介作用。这些发现提出了针对特定阶段干预措施的假设，这些假设应该在未来的研究中得到检验。

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引用次数: 0

Distress in postural orthostatic tachycardia syndrome (POTS) is largely driven by ineffective healthcare, not patients' attitudes 体位性心动过速综合征（POTS）的痛苦主要是由无效的医疗保健驱动的，而不是患者的态度

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-21 DOI: 10.1016/j.jpsychores.2026.112552

Svetlana Blitshteyn , Blair P. Grubb

引用次数: 0

Quality of life trajectory in breast cancer survivors: A longitudinal, two-year post treatment follow-up study 乳腺癌幸存者的生活质量轨迹：一项治疗后两年的纵向随访研究。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jpsychores.2026.112551

Aashruti Pathania , SreeRekha KR , K. Ramdas , Ankita Chakrawal , Manoj Pandey

Background

Advances in breast cancer treatment have improved survival, making Quality of Life (QOL) a critical endpoint. This study examines longitudinal QOL in Indian breast cancer survivors using the Functional Assessment of Cancer Therapy for Breast (FACT-B) questionnaire.

Methods

A longitudinal cohort study followed 338 women with curable breast cancer, assessing QOL at baseline (before treatment), 3 months, 6 months, 12 months, and 24 months post-treatment. The FACT-B provided total and subscale scores (Physical, Social, Emotional, Functional, and Breast-specific well-being).

Results

Of 338 patients, 63 (18.64%) completed all assessments up to 24 months, and 68 (20.12%) completed up to 12 months. QOL decreased significantly at 3 months post-treatment (mean 74.98 vs. 85.6 at baseline, p < 0.001), remained below baseline at 6 months (79.34, p < 0.001), returned to baseline by 12 months (87.94, p = 0.147), and improved significantly by 24 months (110.92, p < 0.001). Physical and Functional well-being showed early declines, Social and Emotional well-being remained stable or improved, and Breast-specific well-being remained low, reflecting body image concerns.

Conclusion

The U-shaped QOL trajectory highlights the need for interventions at 3–6 months post-treatment, particularly for body image and physical function. These findings provide a foundation for targeted supportive care in Indian breast cancer survivors.

背景：乳腺癌治疗的进步提高了生存率，使生活质量（QOL）成为一个关键的终点。本研究使用乳腺癌治疗功能评估（FACT-B）问卷调查印度乳腺癌幸存者的纵向生活质量。方法：采用纵向队列研究方法，对338例治愈乳腺癌患者进行基线（治疗前）、治疗后3个月、6个月、12个月和24个月的生活质量评估。FACT-B提供了总分和子量表得分（身体、社会、情感、功能和乳房特定幸福感）。结果：在338例患者中，63例（18.64%）完成了24个月的所有评估，68例（20.12%）完成了12个月的评估。治疗后3个月，生活质量显著下降（平均74.98比基线时的85.6,p）。结论：u型生活质量轨迹强调了治疗后3-6个月干预的必要性，特别是身体形象和身体功能。这些发现为印度乳腺癌幸存者的针对性支持性护理提供了基础。

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引用次数: 0

Stressful life events, PTSD symptoms and mental health in people living with HIV 艾滋病毒感染者的压力生活事件、创伤后应激障碍症状和心理健康

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jpsychores.2026.112545

Oscar Royuela , Francesco Oliva , Joana Bucker , Cristina De Córdoba Gil , Marta Fontana-McNally , Daniela L. Gatto , Daniel Guinart , Hernando Knobel-Freud , Pablo Knobel , Walter Lupo , Cristina Macias , Mila Montero , Ana Moreno-Alcázar , Johannes Wolf , Frank Padberg , Benedikt L. Amann , Alicia Valiente-Gómez , Bridget Hogg

Background

People living with human immunodeficiency virus (HIV; PLWH) can perceive aspects of the disease as traumatic. Objectives: 1) This study examined the trauma profile and sociodemographic and clinical correlates of HIV-related trauma; 2) to compare the impact of a post-traumatic stress disorder (PTSD) on clinical variables and biological markers in PLWH with HIV-related trauma; 3) to investigate the factors associated with PTSD; 4) to examine the relationship between childhood maltreatment, dissociation, and psychopathology.

Methods

93 Hospital del Mar Barcelona outpatient adults living with HIV with HIV-related trauma were included in this cross-sectional study. Participants were assessed with validated scales for PTSD, trauma, psychopathology, quality of life, functionality, and HIV-related stigma. CD4/CD8 ratio was also collected. PLWH with and without PTSD were compared in terms of clinical and sociodemographic factors and a pathway analysis was conducted.

Results

PLWH with PTSD reported significantly more anxious, depressive, and general psychiatric symptoms, poorer health-related quality of life and more stigma related to HIV compared to those with trauma symptoms only (all p < 0.0024). Age (OR = 1.08, p = 0.045) and previous psychiatric disorder (OR = 15.57, p = 0.010) can predict a PTSD diagnosis. PLWH with PTSD showed stronger correlations between childhood maltreatment, dissociation, and psychiatric symptoms than those with trauma symptoms only.

Conclusions

PTSD is associated with more psychiatric symptoms, lower quality of life and increased HIV-related stigma. Dissociation and PTSD were identified as a potential mechanism linking childhood maltreatment and mental health outcomes, suggesting a target for intervention. These findings support the need for PTSD screening and trauma-focused treatments in HIV care settings.

人类免疫缺陷病毒（HIV； PLWH）感染者可以将该疾病的某些方面视为创伤性疾病。目的：1)本研究探讨了hiv相关创伤的创伤概况、社会人口学和临床相关因素；2)比较创伤后应激障碍（PTSD）对hiv相关创伤PLWH患者临床指标和生物学指标的影响；3)探讨PTSD的相关因素；4)研究童年虐待、精神分离和精神病理之间的关系。方法对巴塞罗那德尔玛医院门诊的93例HIV相关创伤患者进行了横断面研究。用PTSD、创伤、精神病理、生活质量、功能和hiv相关污名的有效量表对参与者进行评估。同时采集CD4/CD8比值。比较合并与不合并PTSD的PLWH患者的临床及社会人口学因素，并进行通路分析。结果与仅有创伤症状的患者相比，患有PTSD的splwh患者报告的焦虑、抑郁和一般精神症状明显更多，健康相关生活质量更差，与HIV相关的耻辱感更多（p < 0.0024）。年龄（OR = 1.08, p = 0.045）和既往精神障碍（OR = 15.57, p = 0.010）可以预测PTSD的诊断。与仅有创伤症状的患者相比，患有PTSD的PLWH在儿童期虐待、精神分离和精神症状之间表现出更强的相关性。结论sptsd患者存在较多的精神症状、较低的生活质量和hiv相关的耻辱感。分离和创伤后应激障碍被确定为联系儿童虐待和心理健康结果的潜在机制，提出了干预的目标。这些发现支持在HIV护理环境中进行创伤后应激障碍筛查和以创伤为重点的治疗的必要性。

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引用次数: 0

Stigma in functional neurological disorder; a longitudinal study 功能性神经障碍的病耻感；纵向研究

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jpsychores.2026.112550

Caoimhe Mcloughlin , Neil Ramsay , Lineke Tak , Alan Carson , Jon Stone

Background

Stigma in Functional Neurological Disorder has been consistently reported by patient organisations as one of their biggest challenges. We aimed to longitudinally evaluate different components of stigma, namely perceived, internalised (self) and anticipated stigma experienced by patients with FND, and to explore associated factors.

Methods

Participants were mainly recruited prospectively via outpatient clinics at two centres, shortly after communicating the diagnosis. Measures included: perceived, internalised and anticipated stigma, somatic symptom burden, quality of life, depression, anxiety, illness attribution, and experience of care.

Results

Ninety-six respondents completed the baseline survey, of which 80 completed the follow-up (mean duration 7 months). Perceived stigma (Stigma Scale for Chronic Illness-8, mean 21.2) scores were in the moderate range. Regarding internalised stigma, 32% agreed they had considered that FND was their fault. Anticipated stigma was experienced most from work, followed by healthcare, then friends and family. Participants held a balanced view of their condition as physical and psychological in contrast to their perception of others' understanding of FND as psychological – which in turn significantly related to higher stigma scores. Identifying as a man, being in a relationship, higher age and level of education were statistically significantly protective against stigma. At follow up, perceived, self, and anticipated stigma, somatic symptom burden, quality of life, anxiety and depression scores did not change significantly.

Conclusion

People with FND experience high levels of perceived, self and anticipated stigma, and have high rates of physical and psychological comorbidity, which, in this cohort, did not improve over time. Counter-stigma approaches need to consider these different sources of stigma, outside just healthcare professionals.

背景：功能性神经障碍的病耻感一直被患者组织报道为他们最大的挑战之一。我们的目的是纵向评估耻辱感的不同组成部分，即FND患者所经历的感知、内化（自我）和预期的耻辱感，并探讨相关因素。方法研究对象主要是在确诊后不久通过两个中心的门诊进行前瞻性招募。测量包括：感知的、内化的和预期的病耻感、躯体症状负担、生活质量、抑郁、焦虑、疾病归因和护理经历。结果96人完成基线调查，其中80人完成随访（平均随访时间7个月）。感知耻感（慢性疾病耻感量表-8，平均21.2）得分处于中等范围。至于内在化的污名，32%的人认为他们认为FND是他们的错。预期的耻辱最多来自工作，其次是医疗保健，然后是朋友和家人。参与者对自己的身体和心理状况持有平衡的看法，而不是他们认为其他人对FND的理解是心理上的——这反过来又与更高的污名得分显著相关。从统计数据来看，男性身份、恋爱关系、较高的年龄和教育水平都能显著地保护女性免受耻辱感的侵害。在随访中，感知、自我和预期的病耻感、躯体症状负担、生活质量、焦虑和抑郁评分无显著变化。结论FND患者经历了高水平的感知、自我和预期的耻辱感，并且有很高的身体和心理合并症发生率，在本队列中，这些并没有随着时间的推移而改善。反污名方法需要考虑这些不同的污名来源，而不仅仅是医疗保健专业人员。

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引用次数: 0

Persistent somatic symptoms in the Dutch healthcare system. 荷兰医疗保健系统中持续的躯体症状

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2026-01-20 DOI: 10.1016/j.jpsychores.2026.112548

T C Olde Hartman, L M Tak, D J C Hanssen

Persistent somatic symptoms (PSS) are common in primary care and often associated with functional impairment, dissatisfaction with medical care, and high societal costs. In the Netherlands, a strong primary care system has provided fertile ground for the development of a comprehensive approach to PSS, including evidence-based guidelines, stepped care pathways, and national patient information resources. This Editorial describes how PSS care is organized in the Dutch health system, the evolution of terminology and clinical concepts, the role of coordinators of PSS care in primary, secondary, and tertiary care, and the integration of psychosomatic interventions within this care. We highlight system innovations such as Thuisarts.nl (i.e. GPinfo.nl), a national, evidence-based patient information platform aligned with Dutch general practice guidelines, national care standards and regional collaborative care networks, reflect on implementation challenges, and describe the Dutch approach. The Dutch experience illustrates that PSS care can be coherently organized when anchored in general practice and supported by national guidance, patient information, psychosomatic and allied interventions, and collaborative networks. Remaining challenges include embedding consultation skills in training, ensuring equitable access, measuring patient-valued outcomes, and aligning system incentives to sustain implementation.

持续性躯体症状（PSS）在初级保健中很常见，通常与功能损害、对医疗保健的不满和高社会成本有关。在荷兰，强大的初级保健系统为PSS综合方法的发展提供了肥沃的土壤，包括循证指南、阶梯式护理途径和国家患者信息资源。这篇社论描述了荷兰卫生系统如何组织PSS护理，术语和临床概念的演变，PSS护理协调员在初级、二级和三级护理中的作用，以及在该护理中整合心身干预措施。我们强调系统创新，如Thuisarts。nl（即GPinfo）。nl)，一个与荷兰全科实践指南、国家护理标准和区域协作护理网络相一致的国家循证患者信息平台，反映了实施挑战，并描述了荷兰的方法。荷兰的经验表明，如果以全科实践为基础，并得到国家指导、患者信息、身心和相关干预措施以及协作网络的支持，PSS护理可以有条理地组织起来。其余的挑战包括将咨询技能纳入培训，确保公平获取，衡量患者重视的结果，以及调整系统激励措施以维持实施。

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