Poverty increases vulnerability towards somatisation and influences the sense of mastery and well-being. The present study on adolescents living in relative poverty in a high-income group country (Israel) and a low-middle-income group country (India) explored the nature of somatisation tendency (ST) and its relationship with potency and perception of poverty (PP). Potency, a buffer against stress-induced negative health effects, was hypothesized to be negatively related to ST and mediate the link between PP and ST. Purposive sampling was used to collect questionnaire-based data from community youth (12–16 years) of two metropolitan cities—Kolkata (India, N = 200) and Tel-Aviv (Israel, N = 208). A clinically significant level of ST was reported by both Indian and Israeli youth experiencing 5–7 somatic symptoms on average. Potency was found to be a significant predictor of ST in both countries (p < 0.05) and emerged as a significant mediator (p < 0.001) in the PP and ST relationship among Indian adolescents.
1. Introduction
Somatic symptoms are purported manifestations of physical illness accompanied by heightened awareness of certain bodily sensations
[1]. It is found to be high among adolescents globally
[2][3], with a comparatively lower prevalence in Western populations
[4] and males
[5] compared with Eastern populations and females, respectively. Study on the contributing factors has reigned in the research arena in comparison to limited studies on preventive psychological resources. An integrative schematic model is reproduced here (
Figure 1) to highlight the already established sociocultural and physiological factors contributing to somatisation, symptom amplification and distress
[6]. Psychological resources are the protective determinants of health and well-being
[7], especially during transitional periods
[8]. They can be interpersonal, i.e., those generated through one’s relationship with society, and intrapersonal, or those influenced by one’s inherent nature and experiences.
Figure 1. An integrative model of somatisation
[6].
2. Somatisation and Poverty in Low-Income Adolescent Groups
2.1. Somatisation Tendency
Somatisation is the process of ‘transforming’ one’s psychological conflict into bodily symptoms and/or somatic preoccupation in the absence of an identifiable organic cause
[9]. Clinical understanding of ‘somatisation’ or ‘somatic symptom’ has seen a shift in both terminological and theoretical approaches, moving from a causation-centric approach (whether-or-not medically attributable to or associated with an established organic condition) to being effect-centric (severity of experienced impairment or distress) and symptom-centric (the organic system or areas of impairment). Somatisation tendency (ST) here is defined as the propensity (not a formed disorder) to report distress causing somatic symptoms, irrespective of whether it can be fully explained by the currently available biomedical assessments upon investigation. Long-drawn debates around the diagnostic criteria of somatisation have led to the formation of a new label, ‘somatic symptom disorder’ (SSD), in the current diagnostic and statistical manual for mental health disorders (DSM-V). The new diagnosis focused on the temporal extensity and perceived distress severity of the somatic symptoms experienced, forgoing the need to look out for the presence or absence of a medical explanation
[10]. Whether medically explained or not, the somatic symptom is significantly positively correlated with impaired physical health, psychopathology and increased healthcare use across cross-sectional clinical studies
[11] and population-based surveys
[12][13]. Substantial evidence points to its correlation with internalizing psychopathologies, such as anxiety, depression, post-traumatic stress, somatic anxiety
[14], sexual abuse
[15] and alexithymia
[16]. Psycho-social factors
[17], especially poverty and socio-political trauma
[18], also engender somatisation among adolescents.
2.2. Somatisation and Poverty in Adolescence
Adolescents growing up in poverty face long-standing negative psychophysiological consequences
[19][20], including psychiatric disorders
[21] and stress-related somatic symptoms
[22][23]. Poverty itself has been identified by researchers to be considered a significant adverse childhood experience reinforcing multiple stress-causing pathways and ultimately affecting health and well-being
[24]. The absence of protective factors in such conditions can lead to emotional disorders and cognitive deficits
[25]. Multiple studies have related lower socio-economic levels to an increased prevalence of somatisation within one country
[26], but the same is not observed in multi-country surveys
[27]. The existing correlation between financial distress and somatisation is perhaps not simply due to the lack of monetary resources but the restrictions that come along with limited monetary resources, one’s relative economic position in own society
[28] and the value attached to one’s own income with respect to the country’s average
[29]. Relative poverty has been commonly defined in research as an income level below the 50% median household income
[30][31]. The study focused on adolescents in the lowest 25% of the median household income of each country. The relative poverty and the capability restrictions imposed because of that determine the poverty level experienced
[32][33]. These restrictions can be functional, material, emotional or social in nature; the more the felt experience of being deprived or constricted because of one’s economic position in society, the more distress. Thus, an individual’s perception of poverty-led circumstances, irrespective of the economic position in society, is an important contributor to the effect of poverty. Additionally, the relationship is not a straightforward one, as social positioning and relationships with family, friends, or associates mediate the power of economic resources
[34]. The negative consequences of one’s financial limitation can even be overturned by being part of a strong, supportive social network
[35]. Therefore, not only relative poverty itself but also its subjective consequences are expected to facilitate a somatisation tendency. On the other hand, psychosocial protective factors that increase coping resources at disposal may dilute the negative subjective consequences of relative poverty, thus minimising the occurrence of somatisation.
2.3. Somatisation and Potency in Adolescence
The majority of the adolescents’ common health complaints, such as dizziness, headache and fatigue, are found to be ‘physical functional complaints’ without any direct biomedical aetiology
[36], suggesting underlying emotional and behavioural difficulties, conduct disorder, depression and anxiety problem, hyperactivity/inattention and peer problems
[37]. Individual differences in somatisation under similar stressors can be explained through the mediating roles of resilience
[38], personal mastery, psychological well-being
[39], self-esteem and perceived emotional support
[40]. There is extensive work on resilience as a dynamic, complex adaptive system in the face of disruption and trauma aiding well-being
[41][42][43]. In contrast, psychological resource potency is comparatively less researched. Potency was first conceived by Ben-Sira as a health-protective factor, comprising two intrapersonal (presence of mastery and confidence) and two interpersonal components (absence of alienation and anomie)
[44]. It can be simply understood as one’s own confidence in self and one’s own environment to be impartial and equitable
[45]. Its high presence ensures higher emotional stability and protection from the adverse effects of occasional failures in coping and resource inadequacy. Potency is known to restore emotional homeostasis disrupted during stress by weakening the link between inadequate coping and consequential adverse effects
[44][45]. Previous research on potency has shown its positive role in trauma recovery and adaptation
[45][46][47]. Individuals reporting somatic symptoms are often found to be using inadequate coping mechanisms
[48], disturbing their emotional and bodily homeostasis and generating health-debilitating consequences
[49]. Mastery or feeling self-efficacious in manipulating one’s own course of goal-directed action and confidence in one’s own capacity to overcome the demands of life are the central intrapersonal resources of adolescents
[2]. They help in building a sense of strong personal agency
[50], aiding in healthier coping with health-related stressors
[51]. Alienation reflects powerlessness due to the inability to elicit meaningful social rewards despite their effort, expressed through social isolation, normlessness, meaninglessness and mistrust in society
[52]. The psychologised concept of anomie is an individual’s feeling of disgust, anxiety and insecurity with respect to one’s social positioning, leading to pessimistic worldviews and feelings of lowered control over one’s situation
[53]. In short, an absence of both alienation and anomie ensures the presence of meaningful and predictable social support. Thus, potency consisting of four factors, such as belief in a impartial and ordered society, social support, a sense of personal mastery and confidence, can be expected to prevent the tendency to somatise among the economically vulnerable. One way it perhaps does that is by strengthening the stress-coping pathway and mediating through the probable distress symptoms caused due to poverty-imposed restrictions.
This entry is adapted from the peer-reviewed paper 10.3390/children10071104