A scale development study on the investigation of the risk of somatic symptom disorder from a clinical health psychology perspective

Perspectives on clinical somatization situations, including Somatic Symptom Disorder (SSD), have been in an important transformation in recent years. One of the cornerstones of this transformation process is the innovations brought to the field with the DSM-5 published by APA in 2013. With this innovative point of view, Somatoform Disorder (SMD) and Somatization Disorder (SD), which dominated nearly 30 years prior to the publication of DSM-5, are based on the medical inability to explain "dualist" and "etiological" understanding and methods of evaluating patients of this understanding have been abandoned, instead, SSD understanding has been introduced, which will ensure that these cases are handled with an understanding relatively more "biopsychosocial" in both clinical practice and academic sense. Accordingly, when we look at the clinical somatization studies presented even in the international literature, it is observed that these studies have not been able to keep up with the new approach introduced by the DSM-5, and the diagnosis of SSD, which especially represents the psychological dimension of the patients in question, has been inadequate in terms of measurement tools and methods to facilitate the evaluation process of B criterion questioning the existence of "excessive thoughts, feelings and behaviours related to the physical symptoms or accompanying health concerns." In the light of this information, it was aimed to develop a measurement tool named "Scale for Assessment of Somatic Symptom Disorder" (SASS), as a clinical somatization scale specific to Turkish culture that will contribute to the problem of psychologically identifying patients with SSD (Henningsen et al., 2007), which is one of the most important problems in the field of clinical somatization. In this study, exploratory and confirmatory factor analyzes, criterion-dependent validity and discriminant validity within the scope of the construct validity of SASS; Cronbach Alpha internal consistency coefficient and test-retest reliability were evaluated within the scope of reliability. Exploratory and confirmatory factor analyzes, criterion validity and Cronbach's alpha internal consistency reliability of the scale were conducted on the data obtained from 314 SSD patients who presented to seven different units of five different health institutions. Moreover, the discriminant validity of the SASS was performed on a total of 80 participants, who were matched with 40 SSD patients in the SSD group and 40 healthy participants in terms of age, education, and gender, and the test-retest reliability of the SASS was performed on a sample of 73 university students. Informed Consent Form, Psychosiodemographic Question Form, General Health Screening Form, Patient Health Questionnaire-Somatic, Anxiety and Depressive Symptoms Scales, Somatosensory Amplification Scale, Symptom Interpretation Questionnaire, Whiteley Index, Scale for the Assessment of Illness Behaviour, Eysenck Personality Questionnaire-Revised Abbreviated Form and SASS were administered to all participants. The data showed that the SASS has a three-factor structure, as in the B criterion in which the psychological characteristics of the DSM-5 SSD diagnosis are defined. These factors, which were confirmed by the results of the Confirmatory Factor Analysis (CFA) conducted with the Structural Equation Model (SEM), were decided to be named "Cognitive Factors," "Emotional Factors," and Behavioral Factors. When the relationship of the SASS with other scales seen in connection was analyzed, it was noticed that it met the criteria for sufficient criterion dependent validity. In the reliability study of the SASS, which was observed to be able to distinguish between SSD and healthy participants, the internal consistency of its factors and the test-retest coefficients were respectively revealed to be for the "Cognitive Factors Subscale" .93 and .83, for "Emotional Factors Subscale" .90 and .77, and for the "Behavioral Factors Subscale" .89 and .76. The results indicate that the SASS is a valid and reliable scale specific to Turkish culture that can be used in the assessment of the psychological characteristics of SSD patients. Within this context, it is thought that the scale will contribute to the clinical and academic determination of SSD patients.