Association Between COVID-19 Symptoms, COVID-19 Vaccine, and Somatization Among A Sample of the Lebanese Adults
Main Article Content
Keywords
COVID persistent symptoms, Somatoform disorders, Somatization; COVID 19, Vaccine, Lebanon
Abstract
Objectives: Long COVID syndrome, the poorly defined illness, has been increasingly mentioned in recent studies yet is still poorly understood especially when it comes to precipitating and modulating factors, the high prevalence of mental health problems associated with the COVID-19 pandemic has brought to light the hypothesis of the existence of a psychological component associated with the persistence of symptoms and if vaccination may serve as a modulating factor. This study aims to examine the prevalence of somatization disorders and association between persistent COVID-19 symptoms and COVID-19 vaccine with somatization among a sample of the Lebanese general population. Methods: A cross-sectional study was carried out between September and October 2021. The snowball sampling technique was picked to choose a sample that addressed all Lebanese Mohafazat. Patient Health Questionnaire-15 (PHQ-15) was used to assess somatization. Results: A total of 403 participants was enrolled in this study, with a mean age of 32.76 ± 13.24 years, 108 (26.8%) had medium somatization symptoms (PHQ-15 scores ≥10). Having persistent COVID symptoms (β=2.15) was significantly associated with more somatization, whereas the intake of COVID vaccine (β=-1.17) was significantly associated with less somatization. Conclusion: Long lasting COVID-19 symptoms were closely related to somatization, although the administration of the COVID-19 vaccine was associated with less somatization. However, further studies are needed to
References
1. LIPOWSKI ZJ. Somatization: the concept and its clinical application. The American Journal of Psychiatry. 1988;145(11):1358-1368. https://doi.org/10.1176/ajp.145.11.1358
2. Jadhakhan F, Lindner O, Blakemore A, et al. Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol. BMJ Open. 2019;9(7). https://doi.org/10.1136/
bmjopen-2018-027922
3. D’Souza RS, Hooten WM. Somatic Syndrome Disorders. StatPearls Treasure Island (FL): StatPearls Publishing; 2022.
4. Garrusi B, Danaei M, Aboosaeidi R. The prevalence and predictive factors of somatization and its relationship with anxiety and depression in Iranian population. J Prev Med Hyg. 2019;60(4):E400-E406.
5. Keskin G. Approach to stress endocrine response: somatization in the context of gastroenterological symptoms: a systematic review. Afr Health Sci. 2019;19(3):2537-2545. https://doi.org/10.4314/ahs.v19i3.29
6. Somatic symptom disorder. Mayo Clinic Health Information Library: Diseases and Conditions. 2020.
7. Escalona R, Achilles G, Waitzkin H, et al. PTSD and Somatization in Women Treated at a VA Primary Care Clinic. Psychosomatics. 2004;45(4):291-296. https://doi.org/10.1176/appi.psy.45.4.291
8. Stewart DE. The Changing Faces of Somatization. Psychosomatics. 1990;31(2):153-158. https://doi.org/10.1016/s0033-3182(90)72188-3
9. WHO Coronavirus (COVID-19) Dashboard. Available at: https://covid19.who.int. Accessed Jan 15, 2022.
10. Coronavirus Disease 2019 (COVID-19) – Symptoms. 2021; Available at: https://www.cdc.gov/coronavirus/2019-ncov/ symptoms-testing/symptoms.html. Accessed Jan 15, 2022.
11. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb
Mortal Wkly Rep. 2020;69(30):993-998. https://doi.org/10.15585/mmwr.mm6930e1
12. Moreno-Pérez O, Merino E, Leon-Ramirez J, et al. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect. 2021;82(3):378-383. https://doi.org/10.1016/j.jinf.2021.01.004
13. Sallam M, Al-Sanafi M, Sallam M. A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review. J Multidiscip Healthc. 2022;15:21-45. https://doi.org/10.2147/jmdh.s347669
14. Khoury P, Azar E, Hitti E. COVID-19 Response in Lebanon: Current Experience and Challenges in a Low-Resource Setting. JAMA. 2020;324(6):548-549. https://doi.org/10.1001/jama.2020.12695
15. Lindert J, Jakubauskiene M, Bilsen J. The COVID-19 disaster and mental health—assessing, responding and recovering. European Journal of Public Health. 2021;31(Supplement_4):iv31-iv35. https://doi.org/10.1093/eurpub/ckab153
16. Cheaito MA, Al-Hajj S. A brief report on the Beirut port explosion. Mediterranean Journal of Emergency Medicine & Acute Care. 2020;1(4). https://doi.org/10.52544/2642-7184(1)4001
17. Farran N. Mental health in Lebanon: Tomorrow’s silent epidemic. Ment Health Prev. 2021;24:200218. https://doi.org/10.1016/j. mhp.2021.200218
18. Karam EG, Karam GE, Farhat C, et al. Determinants of treatment of mental disorders in Lebanon: barriers to treatment and changing patterns of service use. Epidemiol Psychiatr Sci. 2018;28(6):655-661. https://doi.org/10.1017/s2045796018000422
19. Melki IS, Beydoun HA, Khogali M, et al. Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. Journal of Epidemiology and Community Health. 2004;58(6):476-480. https://doi.org/10.1136/
jech.2003.012690
20. Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms. Psychosomatic Medicine. 2002;64(2):258-266. https://doi.org/10.1097/00006842-200203000-00008
21. Kroenke K, Spitzer RL, Williams JBW, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry. 2010;32(4):345-359. https://doi.org/10.1016/j.genhosppsych.2010.03.006
22. Sawaya H, Atoui M, Hamadeh A, et al. Adaptation and initial validation of the Patient Health Questionnaire – 9 (PHQ-9) and the Generalized Anxiety Disorder – 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample.
Psychiatry Research. 2016;239:245-252. https://doi.org/10.1016/j.psychres.2016.03.030
23. Kroenke K, Spitzer R, Williams J. The PHQ-9. J Gen Intern Med. 2001;16(9):606-613.
24. Malaeb D, Farchakh Y, Haddad C, et al. Validation of the Beirut Distress Scale (BDS‐10), a short version of BDS‐22, to assess psychological distress among the Lebanese population. Perspectives in Psychiatric Care. 2022;58(1):304-313.
25. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. annual convention of the international society for traumatic stress studies, San Antonio, TX: San Antonio, TX; 1993.
26. Hallit S, Obeid S, Haddad C, et al. Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients. International Journal of Psychiatry in Clinical Practice. 2020;24(3):270-277. https://doi.org/10.1080/13651501.202
0.1744662
27. Merhy G, Azzi V, Salameh P, et al. Anxiety among Lebanese adolescents: scale validation and correlates. BMC Pediatr. 2021;21. https://doi.org/10.1186/s12887-021-02763-4
28. George D, Mallery P. SPSS for Windows step by step: a simple guide and reference, 17.0 update. 10th ed. ed.: Boston: Allyn & Bacon; 2010.
29. Nabavi N. Long covid: How to define it and how to manage it. BMJ. 2020;370:m3489. https://doi.org/10.1136/bmj.m3489
30. Lam MH, Wing Y, Yu MW, et al. Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Longterm Follow-up. Archives of Internal Medicine. 2009;169(22):2142-2147. https://doi.org/10.1001/archinternmed.2009.384
31. Ahmed H, Patel K, Greenwood DC, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and metaanalysis.
Journal of Rehabilitation Medicine. 2020;52(5):jrm00063. https://doi.org/10.2340/16501977-2694
32. Staudt A, Jörres RA, Hinterberger T, et al. Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave. European Journal of Internal Medicine. 2022;95:50-60. https://
doi.org/10.1016/j.ejim.2021.10.031
33. Simon, Michael A, Luginbuhl, et al. Reduced Incidence of Long-COVID Symptoms Related to Administration of COVID-19 Vaccines Both Before COVID-19 Diagnosis and Up to 12 Week. 2021.
34. Gaber, Tarek AK, Ashish A, et al. Are mRNA Covid 19 vaccines safe in Long Covid patients? A Health Care Workers perspective. British Journal of Medical Practitioners. 2021;14(1):9. https://doi.org/10.1007/s40278-022-09792-6
35. Prevalence, characteristics, and predictors of Long COVID among diagnosed cases of COVID-19. Vaccine Weekly. 2022:146.
36. The effectiveness of vaccination against long COVID A rapid evidence briefing.
37. Baker N, Ledford H. Coronapod: vaccines and long COVID, how protected are you? Nature (London). 2021.
38. Bermingham SL, Cohen A, Hague J, et al. The cost of somatisation among the working‐age population in England for the year 2008–2009. Ment Health Fam Med. 2010;7(2):71-84.
39. Hung CI, Yu NW, Liu CY, et al. The impact of the duration of an untreated episode on improvement of depression and somatic
symptoms. Neuropsychiatr Dis Treat. 2015;11:2245-2252. https://doi.org/10.2147/ndt.s89498
40. Sancak B, Ozer Agirbas U, Kilic C. Long COVID and Its Psychiatric Aspects. Journal of the Academy of Consultation-Liaison Psychiatry. 2021;62(4):480-481. https://doi.org/10.1016/j.jaclp.2021.03.003
2. Jadhakhan F, Lindner O, Blakemore A, et al. Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol. BMJ Open. 2019;9(7). https://doi.org/10.1136/
bmjopen-2018-027922
3. D’Souza RS, Hooten WM. Somatic Syndrome Disorders. StatPearls Treasure Island (FL): StatPearls Publishing; 2022.
4. Garrusi B, Danaei M, Aboosaeidi R. The prevalence and predictive factors of somatization and its relationship with anxiety and depression in Iranian population. J Prev Med Hyg. 2019;60(4):E400-E406.
5. Keskin G. Approach to stress endocrine response: somatization in the context of gastroenterological symptoms: a systematic review. Afr Health Sci. 2019;19(3):2537-2545. https://doi.org/10.4314/ahs.v19i3.29
6. Somatic symptom disorder. Mayo Clinic Health Information Library: Diseases and Conditions. 2020.
7. Escalona R, Achilles G, Waitzkin H, et al. PTSD and Somatization in Women Treated at a VA Primary Care Clinic. Psychosomatics. 2004;45(4):291-296. https://doi.org/10.1176/appi.psy.45.4.291
8. Stewart DE. The Changing Faces of Somatization. Psychosomatics. 1990;31(2):153-158. https://doi.org/10.1016/s0033-3182(90)72188-3
9. WHO Coronavirus (COVID-19) Dashboard. Available at: https://covid19.who.int. Accessed Jan 15, 2022.
10. Coronavirus Disease 2019 (COVID-19) – Symptoms. 2021; Available at: https://www.cdc.gov/coronavirus/2019-ncov/ symptoms-testing/symptoms.html. Accessed Jan 15, 2022.
11. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb
Mortal Wkly Rep. 2020;69(30):993-998. https://doi.org/10.15585/mmwr.mm6930e1
12. Moreno-Pérez O, Merino E, Leon-Ramirez J, et al. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect. 2021;82(3):378-383. https://doi.org/10.1016/j.jinf.2021.01.004
13. Sallam M, Al-Sanafi M, Sallam M. A Global Map of COVID-19 Vaccine Acceptance Rates per Country: An Updated Concise Narrative Review. J Multidiscip Healthc. 2022;15:21-45. https://doi.org/10.2147/jmdh.s347669
14. Khoury P, Azar E, Hitti E. COVID-19 Response in Lebanon: Current Experience and Challenges in a Low-Resource Setting. JAMA. 2020;324(6):548-549. https://doi.org/10.1001/jama.2020.12695
15. Lindert J, Jakubauskiene M, Bilsen J. The COVID-19 disaster and mental health—assessing, responding and recovering. European Journal of Public Health. 2021;31(Supplement_4):iv31-iv35. https://doi.org/10.1093/eurpub/ckab153
16. Cheaito MA, Al-Hajj S. A brief report on the Beirut port explosion. Mediterranean Journal of Emergency Medicine & Acute Care. 2020;1(4). https://doi.org/10.52544/2642-7184(1)4001
17. Farran N. Mental health in Lebanon: Tomorrow’s silent epidemic. Ment Health Prev. 2021;24:200218. https://doi.org/10.1016/j. mhp.2021.200218
18. Karam EG, Karam GE, Farhat C, et al. Determinants of treatment of mental disorders in Lebanon: barriers to treatment and changing patterns of service use. Epidemiol Psychiatr Sci. 2018;28(6):655-661. https://doi.org/10.1017/s2045796018000422
19. Melki IS, Beydoun HA, Khogali M, et al. Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. Journal of Epidemiology and Community Health. 2004;58(6):476-480. https://doi.org/10.1136/
jech.2003.012690
20. Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms. Psychosomatic Medicine. 2002;64(2):258-266. https://doi.org/10.1097/00006842-200203000-00008
21. Kroenke K, Spitzer RL, Williams JBW, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry. 2010;32(4):345-359. https://doi.org/10.1016/j.genhosppsych.2010.03.006
22. Sawaya H, Atoui M, Hamadeh A, et al. Adaptation and initial validation of the Patient Health Questionnaire – 9 (PHQ-9) and the Generalized Anxiety Disorder – 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample.
Psychiatry Research. 2016;239:245-252. https://doi.org/10.1016/j.psychres.2016.03.030
23. Kroenke K, Spitzer R, Williams J. The PHQ-9. J Gen Intern Med. 2001;16(9):606-613.
24. Malaeb D, Farchakh Y, Haddad C, et al. Validation of the Beirut Distress Scale (BDS‐10), a short version of BDS‐22, to assess psychological distress among the Lebanese population. Perspectives in Psychiatric Care. 2022;58(1):304-313.
25. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. annual convention of the international society for traumatic stress studies, San Antonio, TX: San Antonio, TX; 1993.
26. Hallit S, Obeid S, Haddad C, et al. Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients. International Journal of Psychiatry in Clinical Practice. 2020;24(3):270-277. https://doi.org/10.1080/13651501.202
0.1744662
27. Merhy G, Azzi V, Salameh P, et al. Anxiety among Lebanese adolescents: scale validation and correlates. BMC Pediatr. 2021;21. https://doi.org/10.1186/s12887-021-02763-4
28. George D, Mallery P. SPSS for Windows step by step: a simple guide and reference, 17.0 update. 10th ed. ed.: Boston: Allyn & Bacon; 2010.
29. Nabavi N. Long covid: How to define it and how to manage it. BMJ. 2020;370:m3489. https://doi.org/10.1136/bmj.m3489
30. Lam MH, Wing Y, Yu MW, et al. Mental Morbidities and Chronic Fatigue in Severe Acute Respiratory Syndrome Survivors: Longterm Follow-up. Archives of Internal Medicine. 2009;169(22):2142-2147. https://doi.org/10.1001/archinternmed.2009.384
31. Ahmed H, Patel K, Greenwood DC, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and metaanalysis.
Journal of Rehabilitation Medicine. 2020;52(5):jrm00063. https://doi.org/10.2340/16501977-2694
32. Staudt A, Jörres RA, Hinterberger T, et al. Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave. European Journal of Internal Medicine. 2022;95:50-60. https://
doi.org/10.1016/j.ejim.2021.10.031
33. Simon, Michael A, Luginbuhl, et al. Reduced Incidence of Long-COVID Symptoms Related to Administration of COVID-19 Vaccines Both Before COVID-19 Diagnosis and Up to 12 Week. 2021.
34. Gaber, Tarek AK, Ashish A, et al. Are mRNA Covid 19 vaccines safe in Long Covid patients? A Health Care Workers perspective. British Journal of Medical Practitioners. 2021;14(1):9. https://doi.org/10.1007/s40278-022-09792-6
35. Prevalence, characteristics, and predictors of Long COVID among diagnosed cases of COVID-19. Vaccine Weekly. 2022:146.
36. The effectiveness of vaccination against long COVID A rapid evidence briefing.
37. Baker N, Ledford H. Coronapod: vaccines and long COVID, how protected are you? Nature (London). 2021.
38. Bermingham SL, Cohen A, Hague J, et al. The cost of somatisation among the working‐age population in England for the year 2008–2009. Ment Health Fam Med. 2010;7(2):71-84.
39. Hung CI, Yu NW, Liu CY, et al. The impact of the duration of an untreated episode on improvement of depression and somatic
symptoms. Neuropsychiatr Dis Treat. 2015;11:2245-2252. https://doi.org/10.2147/ndt.s89498
40. Sancak B, Ozer Agirbas U, Kilic C. Long COVID and Its Psychiatric Aspects. Journal of the Academy of Consultation-Liaison Psychiatry. 2021;62(4):480-481. https://doi.org/10.1016/j.jaclp.2021.03.003
Article Sidebar
Published
Mar 30, 2023
Article Details
How to Cite
1.
Association Between COVID-19 Symptoms, COVID-19 Vaccine, and Somatization Among A Sample of the Lebanese Adults. Pharm Pract (Granada) [Internet]. 2023 Mar. 30 [cited 2025 Jan. 21];21(1):1-6. Available from: https://pharmacypractice.org/index.php/pp/article/view/2763
Section
Original Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Author Biography
Souheil Hallit, School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
Lebanon
How to Cite
1.
Association Between COVID-19 Symptoms, COVID-19 Vaccine, and Somatization Among A Sample of the Lebanese Adults. Pharm Pract (Granada) [Internet]. 2023 Mar. 30 [cited 2025 Jan. 21];21(1):1-6. Available from: https://pharmacypractice.org/index.php/pp/article/view/2763