Structural Model of Somatic Symptoms based on Perceived Social Support and Childhood Trauma in Patients with Epilepsy: Mediating Role of Depression, Anxiety and Stress
Subject Areas : Health information managementMasoumeh Mohammadbeigi 1 , Afsaneh Taheri 2 , Khadijeh Abolmaali 3 , Koroush Gharergozli 4
1 - - PhD student in Clinical Psychology, Department of Psychology, Roudehen Branch, Islamic Azad University, Tehran, Iran
2 - Assistant Professor, Department of Psychology, Roudehen Branch, Islamic Azad University, Tehran, Iran
3 - Associate Professor, Department of Psychology, Roudehen Branch, Islamic Azad University, Tehran, Iran
4 - Professor, Neurological Diseases, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran
Keywords: Epilepsy, Perceived Social Support, Childhood Trauma, Somatic Symptoms, depression, anxiety, Stress,
Abstract :
Introduction: Considering the importance of examining somatic symptoms in patients with epilepsy, the present study was conducted with the aim of investigating the structural model of somatic symptoms based on perceived social support and childhood trauma with the mediating of depression, anxiety and stress in patients with epilepsy. Methods: This study in terms of purpose was applied and in terms of implementation method was descriptive from type of correlation. The research population was the patients with epilepsy of Iran in the 2021 year, which number of 260 people of them were selected as a sample by simple random sampling method. The research tools were included somatic symptoms questionnaire (Kroenke et al., 2002), perceived social support scale (Zimet et al., 1988), childhood trauma questionnaire (Bernstein et al., 2003) and depression, anxiety and stress scale (Lovibond and Lovibond, 1995). Data were analyzed by structural equation modeling in SPSS-24 and AMOS-26 software. Results: The findings showed that the model of somatic symptoms based on perceived social support and childhood trauma with the mediating of depression, anxiety and stress in patients with epilepsy had a good fit. Also, social support had a significant negative effect on depression, anxiety and stress and somatic symptoms, childhood trauma had a significant positive effect on depression, anxiety and stress, and depression, anxiety and stress had a significant positive effect on somatic symptoms (P<0.05), but trauma childhood had no significant effect on somatic symptoms (P>0.05). In addition, social support with the mediating of depression, anxiety and stress had a significant negative effect on somatic symptoms and childhood trauma with the mediation of depression, anxiety and stress had a significant positive effect on somatic symptoms (P<0.05). Conclusion: According to the results of this study, it is necessary to plan to reduce somatic symptoms in patients with epilepsy by increasing social support and reducing depression, anxiety and stress.
1- Carmassi C, Corsi M, Bertelloni CA, Pedrinelli V, Massimetti G, Peroni D, et al. Post-traumatic stress spectrum symptoms in parents of children affected by epilepsy: Gender differences. Seizure; 2020; 80: 169-174. doi: 10.1016/j.seizure.2020.06.021
2- Lopez-Castroman J, Jaussent I, Pastre M, Baeza-Velasco C, Kahn JP, Leboyer M, et al. Severity features of suicide attempters with epilepsy. Journal of Psychiatric Research; 2022; 154: 44-49. doi: 10.1016/j.jpsychires.2022.07.030
3- Afzalaghaee M, Dehghani M, Alimi R, Mehdinejad M. Predictors of quality of life in patients with epilepsy. Journal of Knowledge & Health, 2015; 10(1): 11-18. doi: 10.22100/jkh.v10i1.534
4- Cano-Lopez I, Hampel KG, Garces M, Villanueva V, Gonzalez-Bono E. Quality of life in drug-resistant epilepsy: relationships with negative affectivity, memory, somatic symptoms and social support. Journal of Psychosomatic Research; 2018; 114: 31-37. doi: 10.1016/j.jpsychores.2018.09.001
5- Cusack CE, VAnzhula IA, Levinson CA. The structure of eating disorder and somatic symptoms. Journal of Affective Disorders, 2022; 319: 397-406. doi: 10.1016/j.jad.2022.09.106
6- McFarlane AC, Graham K. The ambivalence about accepting the prevalence somatic symptoms in PTSD: Is PTSD a somatic disorder? Journal of Psychiatric Research, 2021; 143: 388-394. doi: 10.1016/j.jpsychires.2021.09.030
7- Bae EJ, Kim DE, Sagong H, Yoon JY. Problematic smartphone use and functional somatic symptoms among adolescents: Mediating roles of depressive symptoms and peer relationships by gender. Archives of Psychiatric Nursing, 2022; 40: 25-31. doi: 10.1016/j.apnu.2022.04.003
8- Tian X, Jin Y, Chen U, Tang L, Jimenez-Herrera MF. Relationships among social support, coping style, perceived stress, and psychological distress in Chinese lung cancer patients. Asia-Pacific Journal of Oncology Nursing, 2021; 8(2): 172-179. doi: 10.4103/apjon.apjon_59_20
9- Bektas I, Arkan G. The effect of perceived social support of Syrian mothers on their infant feeding attitudes. Journal of Pediatric Nursing, 2021; 57: 40-45. doi: 10.1016/j.pedn.2020.10.005
10- Wizla M, Glica A, Gola M, Lewczuk K. The relation of perceived social support to compulsive sexual behavior. Journal of Psychiatric Research, 2022; 156: 141-150. doi: 10.1016/j.jpsychires.2022.10.021
11- Hao R, Jin H, Zuo J, Wu Y, Sun X, Hu J. The multiple mediating effect of family health and perceived social support on depressive symptoms in older adults: A cross-sectional national survey in China. Journal of Affective Disorders, 2023; 327: 348-354. doi: 10.1016/j.jad.2023.01.097
12- Kealy D, Rice SM, Ogrodniczuk JS, Spidel A. Childhood trauma and somatic symptoms among psychiatric outpatients: Investigating the role of shame and guilt. Psychiatry Research, 2018; 268: 169-174. doi: 10.1016/j.psychres.2018.06.072
13- Cancel A, Dallel S, Zine A, El-Hage W, Fakra E. Understanding the link between childhood trauma and schizophrenia: A systematic review of neuroimaging studies. Neuroscience & Biobehavioral Reviews, 2019; 107: 492-504. doi: 10.1016/j.neubiorev.2019.05.024
14- Hoffman SN, Stein MB, Taylor CT. Childhood trauma predicts positive expressive suppression during social affiliation in adults with anxiety and/or depression: Implications for social functioning. Behavior Therapy, 2023; 54(2): 375-385. doi: 10.1016/j.beth.2022.10.003
15- Steenkamp LR, Parrish EM, Chalker SA, Badal VD, Pinkham AE, Harvey PD, Depp CA. Childhood trauma and real-world social experiences in psychosis. Schizophrenia Research, 2023; 252: 279-286. doi: 10.1016/j.schres.2022.12.039
16- Landman DM, Sewpersadh A, Peterson C. Depression, anxiety, and stress among chiropractors in South Africa during the early COVID-19 pandemic. Journal of Chiropractic Humanities, 2022; 29: 37-43. doi: 10.1016/j.echu.2022.08.001
17- Lee EH, Moon SH, Cho MS, Park ES, Kim SY, Han JS, Cheio JH. The 21-item and 12-item versions of the depression anxiety stress scales: Psychometric evaluation in a Korean population. Asian Nursing Research, 2019; 13(1): 30-37. doi: 10.1016/j.anr.2018.11.006
18- Patten EV, Vaterlaus JM. Prevalence of depression, anxiety, and stress in undergraduate dietetics students. Journal of Nutrition Education and Behavior, 2021; 53(1): 67-74. doi: 10.1016/j.jneb.2020.10.005
19- Erdogan S, Can AA, Abic A, Yilmaz DV. Examination of individuals' depression, anxiety, and stress levels during the COVID-19 pandemic in Turkey. Archives of Psychiatric Nursing, 2022; 41: 96-102. doi: 10.1016/j.apnu.2022.07.021
20- Guo K, Zhang X, Bai S, Minhat HS, Nazan AINM, Feng J, et al. Assessing social
support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic of China. PLoS ONE, 2021; 16(7): e0253891: 1-10. doi: 10.1371/journal.pone.0253891
21- Nariman H, Hassanzadeh A, Ghamarani A, Amidi Mazaheri M. The study of relationship between depression, anxiety, and stress with social support and life satisfaction in mothers of children with autism spectrum disorder. Journal of Health System Research, 2020; 16(3): 199-205. doi: 10.22122/jhsr.v16i3.3847
22- Bodaghi E, Alipour F, Bodaghi M, Nori R, Peiman N, Saeidpour S. The role of spirituality and social support in pregnant women's anxiety, depression and stress symptoms. Community Health Journal, 2016; 10(2): 72-82.
23- Grigaityte I, Soderberg P. Why does perceived social support protect against somatic symptoms: Investigating the roles of emotional self-efficacy and depressive symptoms? Nordic Psychology, 2021; 73(3): 226-241. doi: 10.1080/19012276.2021.1902845
24- Fisher HM, Winger JG, Miller SN, Wright AN, Vilardaga JCP, Majestic C, et al. Relationship between social support, physical symptoms, and depression in women with breast cancer and pain. Support Care Cancer, 2021; 29: 5513-5521. doi: 10.1007/s00520-021-06136-6
25- Atadokht A, Narimani M, Ahadi B, Abolghasemi A, Zahed A, Iranparvar M. Study of the psychological profile in diabetic patient and its relationship with their social support. Journal of Ardabil University of Medical Sciences, 2013; 13(2): 195-205.
26- Kuzminskaite E, Penninx BWJH, Van Harmelen AL, Elzinga BM, Hovens JGFM, Vinkers CH. Childhood trauma in adult depressive and anxiety disorders: An integrated review on psychological and biological mechanisms in the NESDA cohort. Journal of Affective Disorders, 2021; 283: 179-191. doi: 10.1016/j.jad.2021.01.054
27- Mahmoudi M, Saberi H, Bashardoust SPredicting psychological distress based on childhood trauma with the mediating role of alexithymia. Journal of Advances in Cognitive Sciences, 2022; 24(3): 41-56. doi: 10.30514/icss.24.3.41
28- Basharpoor S, Narimani M, Issazadegan A. Role of experiencing traumatic life events in the prediction of psychological symptoms in male high school students in city of Uremia in 2010-11 school-year. Scientific Journal of Ilam University of Medical Sciences, 2013; 20(4): 96-106.
29- Gavurova B, Ivankova V, Rigelsky M, Mudarri T, Miovsky M. Somatic symptoms, anxiety, and depression among college students in the Czech Republic and Slovakia: A cross-sectional study. Frontiers in Public Health, 2022; 10(859107): 1-17. doi: 10.3389/fpubh.2022.859107
30- Salehmirhassani V, Ghorbani N, Alipour A, Farzad V. The mediating role self-knowledge processand self-control in regulating of relationship between perceived and objective stress and anxiety, depression, and physical symptoms. Research in Psychological Health, 2016; 10(3): 1-15. doi: 10.18869/acadpub.rph.10.3.1
31- Kroenke K, Spitzer RL, Williams JB. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 2002; 64(2): 258-266. doi: 10.1097/00006842-200203000-00008
32- Abdolmohammadi K, Ghadiri Sourman Abadi F, Seyed Pourmand NS, Falsafinejad MR. The validation of somatization inventory in the students of Tabriz Universities (Iran). Qom University of Medical Sciences, 2018; 11(12): 61-67.
33- Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. Journal of Personality Assessment, 1988; 52(1): 30-41. doi: 10.1207/s15327752jpa5201_2
34- Adl HA, ShafiAbadi A, Pirani Z. The effectiveness of group therapy based on quality of life on perceived social support in infertile women. Journal of Applied Psychology, 2016; 10(2): 175-191.
35- Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 2003; 27(2): 169-190. doi: 10.1016/S0145-2134(02)00541-0
36- Ebrahimi H, Dejkam M, Seghatoleslam T. Childhood traumas and suicide attempt in adulthood . Iranian Journal of Psychiatry & Clinical Psychology, 2014; 19(4): 275-282.
37- Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy, 1995; 33(3): 335-343. doi: 10.1016/0005-7967(94)00075-U
38- Abdolkarimi M, Sarrafi M, Nejad Torshabi2 M, Khodadadi H, Zareipour M. Stress, anxiety and depression and related factors in secondary school girls in Rafsanjan in 2019. Journal of Pediatric Nursing, 2021; 7(3): 69-75.
_||_1- Carmassi C, Corsi M, Bertelloni CA, Pedrinelli V, Massimetti G, Peroni D, et al. Post-traumatic stress spectrum symptoms in parents of children affected by epilepsy: Gender differences. Seizure; 2020; 80: 169-174. doi: 10.1016/j.seizure.2020.06.021
2- Lopez-Castroman J, Jaussent I, Pastre M, Baeza-Velasco C, Kahn JP, Leboyer M, et al. Severity features of suicide attempters with epilepsy. Journal of Psychiatric Research; 2022; 154: 44-49. doi: 10.1016/j.jpsychires.2022.07.030
3- Afzalaghaee M, Dehghani M, Alimi R, Mehdinejad M. Predictors of quality of life in patients with epilepsy. Journal of Knowledge & Health, 2015; 10(1): 11-18. doi: 10.22100/jkh.v10i1.534
4- Cano-Lopez I, Hampel KG, Garces M, Villanueva V, Gonzalez-Bono E. Quality of life in drug-resistant epilepsy: relationships with negative affectivity, memory, somatic symptoms and social support. Journal of Psychosomatic Research; 2018; 114: 31-37. doi: 10.1016/j.jpsychores.2018.09.001
5- Cusack CE, VAnzhula IA, Levinson CA. The structure of eating disorder and somatic symptoms. Journal of Affective Disorders, 2022; 319: 397-406. doi: 10.1016/j.jad.2022.09.106
6- McFarlane AC, Graham K. The ambivalence about accepting the prevalence somatic symptoms in PTSD: Is PTSD a somatic disorder? Journal of Psychiatric Research, 2021; 143: 388-394. doi: 10.1016/j.jpsychires.2021.09.030
7- Bae EJ, Kim DE, Sagong H, Yoon JY. Problematic smartphone use and functional somatic symptoms among adolescents: Mediating roles of depressive symptoms and peer relationships by gender. Archives of Psychiatric Nursing, 2022; 40: 25-31. doi: 10.1016/j.apnu.2022.04.003
8- Tian X, Jin Y, Chen U, Tang L, Jimenez-Herrera MF. Relationships among social support, coping style, perceived stress, and psychological distress in Chinese lung cancer patients. Asia-Pacific Journal of Oncology Nursing, 2021; 8(2): 172-179. doi: 10.4103/apjon.apjon_59_20
9- Bektas I, Arkan G. The effect of perceived social support of Syrian mothers on their infant feeding attitudes. Journal of Pediatric Nursing, 2021; 57: 40-45. doi: 10.1016/j.pedn.2020.10.005
10- Wizla M, Glica A, Gola M, Lewczuk K. The relation of perceived social support to compulsive sexual behavior. Journal of Psychiatric Research, 2022; 156: 141-150. doi: 10.1016/j.jpsychires.2022.10.021
11- Hao R, Jin H, Zuo J, Wu Y, Sun X, Hu J. The multiple mediating effect of family health and perceived social support on depressive symptoms in older adults: A cross-sectional national survey in China. Journal of Affective Disorders, 2023; 327: 348-354. doi: 10.1016/j.jad.2023.01.097
12- Kealy D, Rice SM, Ogrodniczuk JS, Spidel A. Childhood trauma and somatic symptoms among psychiatric outpatients: Investigating the role of shame and guilt. Psychiatry Research, 2018; 268: 169-174. doi: 10.1016/j.psychres.2018.06.072
13- Cancel A, Dallel S, Zine A, El-Hage W, Fakra E. Understanding the link between childhood trauma and schizophrenia: A systematic review of neuroimaging studies. Neuroscience & Biobehavioral Reviews, 2019; 107: 492-504. doi: 10.1016/j.neubiorev.2019.05.024
14- Hoffman SN, Stein MB, Taylor CT. Childhood trauma predicts positive expressive suppression during social affiliation in adults with anxiety and/or depression: Implications for social functioning. Behavior Therapy, 2023; 54(2): 375-385. doi: 10.1016/j.beth.2022.10.003
15- Steenkamp LR, Parrish EM, Chalker SA, Badal VD, Pinkham AE, Harvey PD, Depp CA. Childhood trauma and real-world social experiences in psychosis. Schizophrenia Research, 2023; 252: 279-286. doi: 10.1016/j.schres.2022.12.039
16- Landman DM, Sewpersadh A, Peterson C. Depression, anxiety, and stress among chiropractors in South Africa during the early COVID-19 pandemic. Journal of Chiropractic Humanities, 2022; 29: 37-43. doi: 10.1016/j.echu.2022.08.001
17- Lee EH, Moon SH, Cho MS, Park ES, Kim SY, Han JS, Cheio JH. The 21-item and 12-item versions of the depression anxiety stress scales: Psychometric evaluation in a Korean population. Asian Nursing Research, 2019; 13(1): 30-37. doi: 10.1016/j.anr.2018.11.006
18- Patten EV, Vaterlaus JM. Prevalence of depression, anxiety, and stress in undergraduate dietetics students. Journal of Nutrition Education and Behavior, 2021; 53(1): 67-74. doi: 10.1016/j.jneb.2020.10.005
19- Erdogan S, Can AA, Abic A, Yilmaz DV. Examination of individuals' depression, anxiety, and stress levels during the COVID-19 pandemic in Turkey. Archives of Psychiatric Nursing, 2022; 41: 96-102. doi: 10.1016/j.apnu.2022.07.021
20- Guo K, Zhang X, Bai S, Minhat HS, Nazan AINM, Feng J, et al. Assessing social
support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic of China. PLoS ONE, 2021; 16(7): e0253891: 1-10. doi: 10.1371/journal.pone.0253891
21- Nariman H, Hassanzadeh A, Ghamarani A, Amidi Mazaheri M. The study of relationship between depression, anxiety, and stress with social support and life satisfaction in mothers of children with autism spectrum disorder. Journal of Health System Research, 2020; 16(3): 199-205. doi: 10.22122/jhsr.v16i3.3847
22- Bodaghi E, Alipour F, Bodaghi M, Nori R, Peiman N, Saeidpour S. The role of spirituality and social support in pregnant women's anxiety, depression and stress symptoms. Community Health Journal, 2016; 10(2): 72-82.
23- Grigaityte I, Soderberg P. Why does perceived social support protect against somatic symptoms: Investigating the roles of emotional self-efficacy and depressive symptoms? Nordic Psychology, 2021; 73(3): 226-241. doi: 10.1080/19012276.2021.1902845
24- Fisher HM, Winger JG, Miller SN, Wright AN, Vilardaga JCP, Majestic C, et al. Relationship between social support, physical symptoms, and depression in women with breast cancer and pain. Support Care Cancer, 2021; 29: 5513-5521. doi: 10.1007/s00520-021-06136-6
25- Atadokht A, Narimani M, Ahadi B, Abolghasemi A, Zahed A, Iranparvar M. Study of the psychological profile in diabetic patient and its relationship with their social support. Journal of Ardabil University of Medical Sciences, 2013; 13(2): 195-205.
26- Kuzminskaite E, Penninx BWJH, Van Harmelen AL, Elzinga BM, Hovens JGFM, Vinkers CH. Childhood trauma in adult depressive and anxiety disorders: An integrated review on psychological and biological mechanisms in the NESDA cohort. Journal of Affective Disorders, 2021; 283: 179-191. doi: 10.1016/j.jad.2021.01.054
27- Mahmoudi M, Saberi H, Bashardoust SPredicting psychological distress based on childhood trauma with the mediating role of alexithymia. Journal of Advances in Cognitive Sciences, 2022; 24(3): 41-56. doi: 10.30514/icss.24.3.41
28- Basharpoor S, Narimani M, Issazadegan A. Role of experiencing traumatic life events in the prediction of psychological symptoms in male high school students in city of Uremia in 2010-11 school-year. Scientific Journal of Ilam University of Medical Sciences, 2013; 20(4): 96-106.
29- Gavurova B, Ivankova V, Rigelsky M, Mudarri T, Miovsky M. Somatic symptoms, anxiety, and depression among college students in the Czech Republic and Slovakia: A cross-sectional study. Frontiers in Public Health, 2022; 10(859107): 1-17. doi: 10.3389/fpubh.2022.859107
30- Salehmirhassani V, Ghorbani N, Alipour A, Farzad V. The mediating role self-knowledge processand self-control in regulating of relationship between perceived and objective stress and anxiety, depression, and physical symptoms. Research in Psychological Health, 2016; 10(3): 1-15. doi: 10.18869/acadpub.rph.10.3.1
31- Kroenke K, Spitzer RL, Williams JB. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 2002; 64(2): 258-266. doi: 10.1097/00006842-200203000-00008
32- Abdolmohammadi K, Ghadiri Sourman Abadi F, Seyed Pourmand NS, Falsafinejad MR. The validation of somatization inventory in the students of Tabriz Universities (Iran). Qom University of Medical Sciences, 2018; 11(12): 61-67.
33- Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. Journal of Personality Assessment, 1988; 52(1): 30-41. doi: 10.1207/s15327752jpa5201_2
34- Adl HA, ShafiAbadi A, Pirani Z. The effectiveness of group therapy based on quality of life on perceived social support in infertile women. Journal of Applied Psychology, 2016; 10(2): 175-191.
35- Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, et al. Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 2003; 27(2): 169-190. doi: 10.1016/S0145-2134(02)00541-0
36- Ebrahimi H, Dejkam M, Seghatoleslam T. Childhood traumas and suicide attempt in adulthood . Iranian Journal of Psychiatry & Clinical Psychology, 2014; 19(4): 275-282.
37- Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy, 1995; 33(3): 335-343. doi: 10.1016/0005-7967(94)00075-U
38- Abdolkarimi M, Sarrafi M, Nejad Torshabi2 M, Khodadadi H, Zareipour M. Stress, anxiety and depression and related factors in secondary school girls in Rafsanjan in 2019. Journal of Pediatric Nursing, 2021; 7(3): 69-75.
