In 1818, a German psychiatrist named Heinroth, coined the word “Psychosomatic,” and Felix Deutsch then later coined the word with the extension “Psychosomatic medicine” in 1922. The word “Psychosomatic” is derived from Greek words “Psyche” and “soma,” which mean mind and body, respectively. The term psyche originally meant “soul or mind,” but it has subsequently been referred to as behavior. In contrast, soma denotes the organism’s body Psychosomatic refers to a wide range of concepts, from illnesses to biopsychosocial research and consultation-liaison work (Chandrashekar and Math, 2006; Shamim, 2012; Dhimole et al., 2016). According to the biopsychosocial model (Engel, 1977), it refers to the connection of psychological and biological factors that are associated with the concept of health and disease. This paradigm entails the idea that physical and psychological conditions are not separated in psychosomatic assessments. Moreover, individuals with psychosomatic diseases are focused on their somatic symptoms generally ignoring their psychological difficulties (Engel, 1977; Bauer et al., 2011; Bolton and Gillett, 2019). Clinicians only rely on the easily administered tool Psychosomatic Symptoms Scale (PSSS) to assess and diagnose the psychosomatic symptoms which was developed by Li et al. (2020). PSSS measures both the aspects of psychological and somatic problems, which provided adequate support to psychologists, clinicians, and psychiatrists in making precise diagnoses and characterizing other features affecting treatment. Moreover, the scale can convey a baseline for finding progress in illness during follow-up over a period in answer to a particular intervention (Shafique et al., 2017; Li et al., 2020).

In Pakistan, the national language is Urdu, and a massive fraction of the population cannot read, write, or speak English. There are few culturally adopted scales in the Urdu language used to diagnose and assess psychosomatics. In clinical settings and for research purposes, Symptoms Check List (SCL-90) is used widely, which is a multidisciplinary and lengthy scale with 90 items that is rather time-consuming. A short, reliable, and easily administered tool is required to assess the patients (Gaynes et al., 2008). Other than the SCL-90, the PSSS is very easy to administer in general hospitals and clinical setups. The PSSS is a shorter and valid scale with 26 items, which is time-saving for both the patients and doctors. However, the PSSS is only available in English and Chinese language. Therefore, the urge was felt to translate and adapt the PSSS in the Urdu language. The Urdu version of this scale will be filled by patients themselves without assistance for translation and will be handy for both clinicians and researchers. Moreover, the Urdu version of this scale will aid in avoiding misdiagnosis or inappropriate diagnosis. Therefore, the main objective of the current study was to provide a valid and reliable Urdu version of the PSSS scale to doctors, psychologists, and researchers.

Informed consent was received from patients before filling out the questionnaires. The present study was approved by the ethical committee of the hospital (2021ZDSYLL347-P01). In phase 1, the PSSS scale was translated into the Urdu language, and in phase II, the psychometric properties of the PSSS scale were calculated. The confirmatory factor analysis (CFA) was used to assess the factorial structure of two dimensions of PSSS. The correlation was inspected among the PSSS, SCL-90, and Patient Health Questionnaire- 9 (PHQ-9).

The data were taken from 982 diagnosed patients with psychiatric disorders from different departments, as shown in Table 1. The questionnaires were filled in, and the basic demographic characteristics were obtained for the current study, including sex, education, age, employment status, financial status, marital status, and department.

The current study was aimed to validate and translate the PSSS into the Urdu language. PSSS is the first scale for the assessment of patients measuring both psychological symptoms and physical complaints and their association because physical symptoms frequently occurred with psychological distress (Li et al., 2020).

Pakistan has more than 200 million human population, and the mental health is poorest but there are less than 500 psychiatrists serving this population. This low number of mental health professionals creates a big treatment gap, which is why more than 90% of the common mental disorders remain untreated (Bashir, 2018; Sikander, 2020). The needs for the care of individuals suffering from mental illnesses have been documented in this region for many centuries. Indigenous healthcare systems, such as Unani and Ayurveda treatment models, had a considerable influence on healthcare over the decades. The religious and cultural ideas about indigenous and traditional healthcare were always visible in local systems. They significantly impacted choices, awareness, and perception for several health-related treatments (World Health Organization [WHO], 2009).

Public health sectors are the key spots for mental health problems, but recently, private sectors have contributed to mental health treatment (Ali and Gul, 2018). Gender-based analysis for PSSS revealed that women score high on the P and S subscale of PSSS, wherein the score represents that women show severe symptoms compared to patients who are men. Previous studies reported that women rated higher for somatic symptoms than men (Bardel et al., 2019), supporting our results. However, in Pakistan, the literacy rate among women is relatively lower than men, which possibly be the cause of women scoring high on PSSS. Most of the patients are unaware of mental health, wherein they go to various clinics and hospitals for a checkup which diagnose them with various diseases. Due to a large number of patients, the psychiatrists cannot provide the deserving duration of time to diagnose or educate the patients about their illness. The patient’s attendants were unaware of the illness and frequently checked their patient with various medical professionals. Misdiagnosis of the patient, which leads to the wrong prescription of medicine, may progressively exacerbate the disease. Other reasons are additional responsibilities of women, such as caring for children and their housekeeping duties (Kishi et al., 2002; Scott et al., 2006; Bashir, 2018; Sikander, 2020). Also, the studies suggest a negative impact of conflict between the physical and mental wellbeing of women (Bourbonnais et al., 1999; Artazcoz et al., 2004). In this study, men have fewer psychosomatic complaints than women. Previous research reported that women have higher psychosomatic symptoms compared to men (Östberg et al., 2006; Brooks et al., 2021), which supports our results for translated versions of PSSS.

Therefore, the PSSS Urdu version is a valid and reliable tool for psychosomatics, and it could be used in Urdu-speaking communities for convenient and precise diagnosis.

In conclusion, our study demonstrated that the PSSS Urdu version is a useful and reliable instrument for screening, monitoring, and assessing Pakistani patients’ psychosomatics symptoms. The lower educational level of women compared to men, the reliance on spiritual healers, and the lack of health literacy might contribute to the gender difference in the prevalence of symptoms.

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/Supplementary Material.

The studies involving human participants were reviewed and approved by the Ethical Committee of Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China (2021ZDSYLL347-P01). The patients/participants provided their written informed consent to participate in this study.

SS and YY: conceptualization and methodology and data analysis. SS: writing original draft preparation. YY, WX, and MJ: review. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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