Somatization in a primary care service for immigrants

Abstract

Aim. To study somatization in a large sample of immigrants attending a first visit to a primary care service. Differences in somatization among four large immigrant groups (Europeans, Asians, South Americans, and Africans) and 16 subgroups based on nationality were assessed.

Design. A total of 3105 patients were asked to participate in the study, of whom 3051 completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or higher on the BSI-21 were considered to be somatizers. A multiple logistic regression analysis adjusting for intervening variables tested the relative risk of somatization in and among the groups.

Results. Among the 3051 patients who completed the BSI-21, 782 (25.6%) were somatizers. Somatizers were significantly more prevalent among South Americans (30.1%). After adjusting for covariates, Asians and Europeans, but not Africans, showed a significantly lower risk of somatization compared to South Americans. Among national subgroups, somatization occurred more frequently in Peruvians (32.9%). Compared to Peruvians, migrants from Eastern Europe, Morocco, the Philippines, Sri Lanka, and El Salvador demonstrated a significantly lower risk of somatization.

Conclusions. Approximately one-fourth of socially disadvantaged immigrants who accessed primary care services used somatization to express their distress. However, the likelihood of somatization varied widely among the different groups, and was significantly higher in South Americans and in some African groups, and lower in some Asian groups.

Keywords:

• somatization
• somatoform disorders
• psychosomatic
• trans-cultural psychiatry
• liaison psychiatry
• primary care
• family medicine
• epidemiology
• migration
• immigrants