Somatization - bodily symptoms for which organic causes are not found - puts costly pressure on the health care system. Somatizers frequently because heavy users of health services and are subject to frustrating misdiagnoses. Previous studies have not thoroughly examined sociocultural differences, barriers to access, and the coexistence of post-traumatic stress disorder (PTSD) is somatization. The proposed research focuses on unexplained, """"""""somatoform"""""""" symptoms among immigrants and refugees who seek primary care. Specifically, the study aims to determine: (a) how war-related, pre- migration experiences, changes in language, and acculturation are associated with the presentation of somatoform symptoms in a primary care setting; (b) how Central American patients differ from other Latino and non-Latino patients in the expression of somatoform complains; (c) the association between somatoform symptoms and PTSD among these patients, (d) the attitudes and behavioral responses of primary care physicians to these patients, and (e) the extent to which barriers to access for health care and mental health services affect the presentation of somatoform symptoms. An interdisciplinary team will study prospectively four subgroups with 500 subjects each - Central American, Mexican, Chicano, and non-Latino. The subjects will be selected by screening new adult patients (approximately 7,000) who present during a one-year period to a community-based primary care clinic. Structured interviews and review by clinicians will assess demographic characteristics, experience of stressful circumstances associated with migration, PTSD, somatoform symptoms, other psychiatric disorders, help-seeking behavior, and acculturation. For patients identified with somatoform symptoms, subsequent studies during a six-month follow-up period will include an in-depth case analysis of patients, interviews. Final chart and financial review of patients originally interviewed will be conducted. Multivariate analyses will examine relationships among dependent variables (measures of somatization, PTSD, other psychiatric disorders, help-seeking behavior, health care utilization and costs, and clinical change over time) and pertinent independent variables (including both patient and practitioner characteristics). The results of this study should assist in the design of appropriate primary care interventions and mental health services for these target populations.
