Somatization in cross cultural perspective: a World Health Organization study in primary care. Am J Psychiatry 154:989–995

Objective: The purpose of this study was to examine the phenomenon of somatization in different cultures by determining its frequency and correlates in primary care settings in 14 countries. Method: Consecutive primary care patients (N=25,916) were screened with the 12-item General Health Questionnaire, and a stratified sample (N=5,438) was interviewed with the Composite International Diagnostic Interview. Interviewed patients were also as-sessed for physical disease burden, self-rated overall health, physician-rated physical health status, number of disability days, and interviewer-rated occupational role functioning. The authors determined center-specific associations with the use of logistic regression analyses in which confounding variables were controlled. Results: ICD-10-defined somatization disorder was relatively uncommon in most primary care settings. A less restrictively defined form was more common. Symptom rates were much higher in the South American sites. There was a modest association with low education. Otherwise, frequency of unexplained somatic symp-toms did not clearly vary according to geography or level of economic development. Somatiz-ing patients were at elevated risk for self-reported disease burden, negative perception of their health, and comorbid depression and generalized anxiety disorder. Somatization was als