The Somatic Symptom Scale - 8 (SSS-8) [1] is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. [1] [2] The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15). [3]
Respondents rate how much they were bothered by common somatic symptoms within the last seven days on a five-point Likert scale. Ratings are summed up to make a simple sum score (which can vary between 0 and 32 points). The SSS-8 includes the following symptoms:
The SSS-8 is a short version of the frequently used and well-validated Patient Health Questionnaire - 15 (PHQ-15). [2] [3] The SSS-8 was designed to be used in settings with restricted measurement time. [1] The items from the PHQ-15 which were included in the SSS-8 were selected according to three criteria: Symptom prevalence in primary care settings, associations with measures of functioning and health related quality of life, and commonalities with other items included in the scale. [1]
Psychometric properties were examined in a representative German general population sample (sample size N = 2510, age > 13 years, year 2012). [1]
Internal consistency is demonstrated by Cronbach's α = 0.81. [1]
The content validity is supposed to be high because the items are derived from the well-validated PHQ-15. [2] [3] [4] In addition, Zijlema et al. (2013) [2] reviewed 99 scientific publications which presented 40 instruments designed to assess somatic symptoms, somatization, or medically unexplained symptoms. They conclude that a valid measure of somatic symptom burden should include items about "cardiopulmonary (including autonomic symptoms), gastrointestinal, musculoskeletal, and general symptoms." [2] The SSS-8 includes items from all four domains.
The SSS-8 showed positive associations with measures of depression and anxiety. [1] This is consistent with previous studies that demonstrated high co-morbidity of somatic, depressive, and anxious symptoms (i.e. the somatization-anxiety-depression triad). [5] [6] [7] Moreover, high SSS-8 scores were associated with poor self-reported general well-being and frequent health care use. [1]
The SSS-8 has a higher order general factor structure. It consists of a general factor and four lower order facets (gastrointestinal symptoms, pain, cardiopulmonary symptoms, and fatigue). This factor structure is invariant for age and gender. [1]
The instrument is straightforward to complete, has an easy scoring algorithm (addition of the responses), and has two simple interpretation methods (i.e. severity categories and gender and age specific percentiles). [1] Given this, the objectivity of the instrument is supposed to be high.
In a sample of patients with mental disorders who received evidence based treatment, Gierk et al. 2017 [8] showed that the SSS-8 is sensitive to change. A decrease of 3 points reflected a minimal clinically important difference.
Severity categories: [1]
| Score | Severity |
|---|---|
| 0-3 | No to minimal |
| 4-7 | Low |
| 8-11 | Medium |
| 12-15 | High |
| 16-32 | Very high |
Furthermore, Gierk et al. (2014) [1] published gender and age specific percentiles from the German general population. The sample included respondents who were older than 13 years.
Gierk et al. (2015) [9] compared the psychometric properties of the SSS-8 and the PHQ-15 in a sample of 131 psychosomatic patients. The sum scores of both questionnaires showed a very high correlation (r = 0.83). The internal consistency was comparable (SSS-8 Cronbach's α = 0.76 vs. PHQ-15 Cronbach's α = 0.80). Moreover, they found a similar pattern of correlations with measures of depression, anxiety, health anxiety, health related quality of life, and health care use. However, poor agreement was found for the severity classifications (the SSS-8 uses five severity categories whereas the PHQ-15 uses only four). The authors note that the severity classification needs "further evaluation in other populations." [9] Overall, they conclude that "the SSS-8 performed well as a short version of the PHQ-15 which makes it preferable for assessment in time restricted settings." [9]
The original SSS-8 was published in English. [1] To date (February 2017), two official psychometrically validated and culturally adapted translations are available:
Planned translations:
Psychological testing refers to the administration of psychological tests. Psychological tests are administered or scored by trained evaluators. A person's responses are evaluated according to carefully prescribed guidelines. Scores are thought to reflect individual or group differences in the construct the test purports to measure. The science behind psychological testing is psychometrics.
Somatization disorder was a mental and behavioral disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes somatization syndrome.
The Beck Depression Inventory, created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.
The Hamilton Rating Scale for Depression (HRSD), also called the Hamilton Depression Rating Scale (HDRS), sometimes also abbreviated as HAM-D, is a multiple-item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery. Max Hamilton originally published the scale in 1960 and revised it in 1966, 1967, 1969, and 1980. The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms.
Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.
Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatization was introduced by Wilhelm Stekel in 1924.
Somatosensory amplification (SSA) is a tendency to perceive normal somatic and visceral sensations as being relatively intense, disturbing and noxious. It is a common feature of hypochondriasis and is commonly found with fibromyalgia, major depressive disorder, some anxiety disorders, Asperger syndrome, and alexithymia. One common clinical measure of SSA is the Somatosensory Amplification Scale (SSAS).
The Beck Anxiety Inventory (BAI), created by Aaron T. Beck and other colleagues, is a 21-question multiple-choice self-report inventory that is used for measuring the severity of anxiety in adolescents and adults ages 17 and older. The questions used in this measure ask about common symptoms of anxiety that the subject has had during the past week. It is designed for individuals who are of 17 years of age or older and takes 5 to 10 minutes to complete. Several studies have found the Beck Anxiety Inventory to be an accurate measure of anxiety symptoms in children and adults.
A depression rating scale is a psychometric instrument (tool), usually a questionnaire whose wording has been validated with experimental evidence, having descriptive words and phrases that indicate the severity of depression for a time period. When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. Several rating scales are used for this purpose.
Functional disorder is an umbrella term for a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.
Hospital Anxiety and Depression Scale (HADS) was originally developed by Zigmond and Snaith (1983) and is commonly used by doctors to determine the levels of anxiety and depression that a person is experiencing. The HADS is a fourteen item scale that generates: Seven of the items relate to anxiety and seven relate to depression. Zigmond and Snaith created this outcome measure specifically to avoid reliance on aspects of these conditions that are also common somatic symptoms of illness, for example fatigue and insomnia or hypersomnia. This, it was hoped, would create a tool for the detection of anxiety and depression in people with physical health problems.
Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not purposefully produced or feigned, and they may or may not coexist with a known medical ailment.
The Generalized Anxiety Disorder 7 (GAD-7) is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder (GAD). The GAD-7 is normally used in outpatient and primary care settings for referral to a psychiatrist pending outcome.
The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report screening questionnaire for anxiety disorders developed in 1997. The SCARED is intended for youth, 9–18 years old, and their parents to complete in about 10 minutes. It can discriminate between depression and anxiety, as well as among distinct anxiety disorders. The SCARED is useful for generalized anxiety disorder, social anxiety disorder, phobic disorders, and school anxiety problems. Most available self-report instruments that measure anxiety in children look at general aspects of anxiety rather than Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizations. The SCARED was developed as an instrument for both children and their parents that would encompass several DSM-IV and DSM-5 categorizations of the anxiety disorders: somatic/panic, generalized anxiety, separation anxiety, social phobia, and school phobia.
The term functional somatic syndrome (FSS) refers to a group of chronic diagnoses with no identifiable organic cause. This term was coined by Hemanth Samkumar. It encompasses disorders such as chronic fatigue syndrome, fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia and dizziness. General overlap exists between this term, somatization and somatoform.
The nine-item Patient Health Questionnaire (PHQ-9) is a depressive symptom scale and diagnostic tool introduced in 2001 to screen adult patients in primary care settings. The instrument assesses for the presence and severity of depressive symptoms and a possible depressive disorder. The PHQ-9 is a component of the larger self-administered Patient Health Questionnaire (PHQ), but can be used as a stand-alone instrument. The PHQ is part of Pfizer's larger suite of trademarked products, called the Primary Care Evaluation of Mental Disorders (PRIME-MD). The PHQ-9 takes less than three minutes to complete. It is scored by simply adding up the individual items' scores. Each of the nine items reflects a DSM-5 symptom of depression. Primary care providers can use the PHQ-9 to screen for possible depression in patients.
The Somatic Symptom Disorder - B Criteria Scale (SSD-12) is a brief self-report questionnaire used to assess the B criteria of DSM-5 somatic symptom disorder, i.e. the patients’ perceptions of their symptom-related thoughts, feelings, and behaviors.
The Occupational Depression Inventory (ODI) is a psychometric instrument, the purpose of which is to assess the severity of work-related depressive symptoms and arrive at a provisional diagnosis of depressive disorder. The ODI can be used by occupational health specialists and epidemiologists.