Culture and Somatization: A Cross-Sectional Survey of Somatic Symptom Disorder and Pathways to Care in Eastern India.

Background: Somatic Symptom Disorder (SSD) involves excessive focus on physical symptoms that lack sufficient medical explanation, leading to frequent medical consultations and delays in psychiatric care. Cultural factors significantly influence the experience and reporting of somatic symptoms, yet little research has explored these factors in India, where cultural beliefs and healthcare systems largely shape illness perceptions.

Objective and methods: This cross-sectional study aimed to investigate somatic symptom profiles, healthcare-seeking behaviors, and illness beliefs among 100 SSD patients visiting psychiatric department of a tertiary care hospital in India. The Bradford Somatic Inventory (BSI) assessed patients' reported somatic symptoms, while the World Health Organization (WHO) encounter form was used to evaluate their pathways to care.

Results: Results showed the average age of participants was 38.62 (±10.59) years, with a slight female predominance (51%). Most patients were from rural areas, and the average illness duration was 7.28 (±6.11) years. On average, patients consulted eight different healthcare providers before being referred to a psychiatrist, resulting in substantial financial costs (mean of 50,000 INR). Common symptoms included lack of energy (81%), neck and shoulder pain (79%), headaches (76%), and feeling of constriction of head (76%). Participants had an average of 21.95 (±6.82) symptoms. Most of the patients had moderate or severe degree of symptoms. The prevalence and number of somatic symptoms were not influenced by the socio-demographic variables. A major finding was the discrepancy between patients' beliefs and psychiatric diagnoses. Only 10% believed their symptoms were psychiatric in origin, with most attributing them to medical conditions or stress. This led to indirect healthcare pathways, as 90% sought help from non-psychiatric providers, causing delays in appropriate care.

Conclusion: This study highlights the need for greater awareness regarding SSD and culturally sensitive interventions to reduce delays in psychiatric referrals, improve patient outcomes, and lower unnecessary healthcare costs in India.