Among the 100 referred patients, insomnia was the commonest symptom complained of (over three-fifth of the patients complained of insomnia). The next commonest symptom was frequent headache which occurred in about one-third of the patients. The above findings are in keeping with that of Mume43 where insomnia was reported as the commonest symptom (though the proportion of his subjects that reported insomnia was far greater than that found in this present study). Again, in that Mume’s study, frequent headache was next to insomnia in terms of frequency.
Some previous studies81,82 reported different findings for example; Ayorinde81 found pains to be the commonest symptom reported by the subjects he studied while Okhomina and Ebie82 found heat as the commonest symptom (occurring in about three-fifth of their subjects). Although it apparently appears that the findings of this present study contrast these previous ones it must be emphasised that comparing this present study with the previous ones may not give us a true picture of the situation. This is because these previous studies though hospital based were mainly in psychiatric clinics unlike this present study that was done in a general out patient setting where patients with these symptoms are more likely to present first63. In addition to this, this present study took into consideration the anatomical parts of the body affected by the somatic symptoms unlike in those previous studies (except
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that of Mume) where the parts of the body (whether selective or generalised) affected by the “heat” or “pain” symptoms were not specified. However, from the above, one can reasonably conclude as Morakinyo34 did, that the relative prevalence rate of each of these symptoms in patients population remain inconclusive.
This study found that the patients diagnosed of psychiatric disorders reported more severe symptoms than those who were not diagnosed. The implication of this is that patients that complain of moderate/severe symptoms should be taken more seriously. Some studies have observed an increased rate of psychiatric disorders in those with severe somatization45,46. It could be that the more severe the symptoms are, the more likely the “defence mechanism” is overwhelmed, thus giving way for the manifestation of psychiatric disorder.
More than two-third of the patients recruited in this study had psychiatric diagnoses using the SCAN interview. This high rate of psychiatric disorder amongst patients with somatic complaints had been reported by some other authors80,83. In a national ambulatory medical care survey in the United States, it was reported that about two-third of patients in whom psychiatric disorders were found, presented with somatic complaints83. Goldberg and Bridges (1988)57 pointed out that many patients with psychiatric disorder seek care for somatic symptoms. Morakinyo84 had stressed that the stigma attached to mental illness in Nigeria might lead to tendency for patients to repress their mental symptoms and replace them with somatic ones. He argued that the illness having been perceived as a physical one would then attract sympathy and understanding, thus becoming more acceptable to society. In the
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light of this, one could reason why a high prevalence of psychiatric morbidity was arrived at in the patients recruited in this study.
In view of the earlier findings15,85 that patients with depression and anxiety frequently complain of somatic symptoms, It is not surprising that the most common SCAN diagnoses reached in this study were Depression and Anxiety Disorders. Mokanjuola15 observed that depression and anxiety were the most common DSM III diagnoses among subjects diagnosed of “Ode-Ori” (a syndrome of somatic complaints) by the traditional healers in Yoruba, Nigeria. Outside Nigeria, Hamilton et al86 found that anxiety and depression were diagnosed in 33%
of patients with medically unexplained symptoms who presented in an out patient clinic at a large teaching hospital.
Depressive disorders were the commonest psychiatric diagnoses found in this study. This confirms other studies which showed that depression is not as rare in Africa as had been thought87,88. Binitie89 in a study of depression across cultures showed that somatic symptoms were prominent features amongst the depressed patients from Benin, Nigeria. Inferring from the above, one can say that core symptoms of depression could be elicited from patients presenting with somatic complaints, if careful interview about their emotional state was done.
Amongst the depressed cases identified in this study, mild depression was the more predominant diagnosis. This is in keeping with Ilechukwu’s study90 which showed that somatic symptoms were common amongst patients with mild depression as those with severe depression tend to have more of psychomotor retardation.
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This study found significant difference in age interval of somatizing patients with SCAN diagnoses of depression compared with those with other diagnoses. It was found that the rate of depression increased significantly in somatizing patients who were older than 50 years. Although the reason for this is not clear, it is possible that the increase rate of physical disabilities in old people contributed to this increased rate of depression.
With regards to patients in whom SCAN diagnoses of anxiety disorders were reached, significant findings occurred in their age interval and work status. It was found that young somatizing patients were more likely to have anxiety disorder than the older somatizing patients. This finding agrees with that of Awaritefe91 in a study on clinical anxiety in Nigeria. In that study, it was found that the most vulnerable age group was between 18 and 23 years. The present study also found that patients who were employed were least likely to have anxiety disorders.