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A cluster analysis-derived classification of psychological distress and illness behavior in the medically ill

Published online by Cambridge University Press:  18 July 2011

G. A. Fava ,
J. Guidi ,
P. Porcelli ,
C. Rafanelli ,
A. Bellomo ,
S. Grandi ,
L. Grassi ,
L. Mangelli ,
P. Pasquini  and
A. Picardi
...Show all authors
G. A. Fava*
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
J. Guidi
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
P. Porcelli
Affiliation:
Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Bari, Italy
C. Rafanelli
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
A. Bellomo
Affiliation:
Section of Psychiatry and Clinical Psychology, Department of Medical Sciences, University of Foggia, Foggia, Italy
S. Grandi
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
L. Grassi
Affiliation:
Section of Psychiatry, Department of Medical Sciences of Communication and Behavior, University of Ferrara, Ferrara, Italy
L. Mangelli
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
P. Pasquini
Affiliation:
Clinical Epidemiology Unit, Istituto Dermapatico dell'Immacolata (IDI-IRCCS), Roma, Italy
A. Picardi
Affiliation:
Mental Health Unit, Italian National Institute of Health Center of Epidemiology, Surveillance and Health Promotion, Roma, Italy
R. Quartesan
Affiliation:
Section of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
M. Rigatelli
Affiliation:
Department of Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
N. Sonino
Affiliation:
Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA Department of Statistical Sciences, University of Padova, Padova, Italy Department of Mental Health, Padova, Italy
*
*Address for correspondence: G. A. Fava, M.D., Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy. (Email: giovanniandrea.fava@unibo.it)
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Abstract

Background

The classification of psychological distress and illness behavior in the setting of medical disease is still controversial. Current psychiatric nosology does not seem to cover the spectrum of disturbances. The aim of this investigation was to assess whether the joint use of DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR), that provide identification of syndromes related to somatization, abnormal illness behavior, irritable mood, type A behavior, demoralization and alexithymia, could yield subtyping of psychosocial variables in the medically ill.

Method

A cross-sectional assessment using both DSM-IV and the DCPR was conducted in eight medical centers in the Italian Health System. Data were submitted to cluster analysis. Participants were consecutive medical out-patients and in-patients for whom a psychiatric consultation was requested. A total of 1700 subjects met eligibility criteria and 1560 agreed to participate.

Results

Three clusters were identified: non-specific psychological distress, irritability and affective disturbances with somatization.

Conclusions

Two-step cluster analysis revealed clusters that were found to occur across clinical settings. The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, illness behavior and subclinical distress encompassed by the DCPR.

Keywords

Anxietydepressiondiagnostic criteria for psychosomatic researchillness behaviourcluster analysis
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 2 , February 2012 , pp. 401 - 407
Copyright
Copyright © Cambridge University Press 2011

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