Functional somatic symptoms, often referred to as medically unexplained physical complaints, remain a persistent challenge in both psychiatry and general medical practice. These symptoms involve recurrent bodily complaints—such as pain, gastrointestinal disturbances, or abnormal skin sensations—that lack a sufficient organic explanation despite repeated medical evaluations.1 Patients experiencing such conditions frequently present to primary care and speciality clinics, contributing to a disproportionate burden on health services. The difficulty lies not only in diagnosis but also in management, as these individuals often resist reassurance and continue to seek medical interventions, frustrating both patients and physicians.2 The phenomenon of somatisation has been described as the tendency to express psychological distress through bodily symptoms, thereby communicating emotional suffering in a physical form.3 This mode of expression is particularly prevalent in non-Western societies, where cultural norms may discourage direct articulation of psychological distress.4 In such contexts, somatic complaints become the socially acceptable language of suffering. Consequently, functional somatic symptoms are not merely medical issues but also cultural and psychosocial constructs that demand a multidimensional approach to care. Psychological distress, including anxiety and depression, is frequently associated with functional somatic symptoms. Studies show that these comorbidities worsen symptom severity and contribute to poorer outcomes.5 However, psychosocial factors—especially perceived social support—play a critical role in moderating the impact of distress. Social support, defined as the perception of being cared for and valued by family, friends, and significant others, has long been recognised as a protective factor against stress and illness.6 Adequate support can enhance resilience, improve coping strategies, and reduce the likelihood of symptom persistence. Conversely, lack of support may intensify distress, perpetuate maladaptive health-seeking behaviours, and worsen functional impairment.7 Family support, in particular, is central in collectivist cultures where family structures are strong and interdependent. Supportive family members can reduce psychological distress by providing emotional reassurance, practical assistance, and a sense of belonging.8 On the other hand, dysfunctional family dynamics or lack of perceived support may contribute to symptom amplification and hinder recovery. Understanding this relationship is crucial, as family support is often the most accessible and sustainable form of psychosocial intervention in resource-limited settings. Research has consistently highlighted the association between social support and health outcomes. Higher levels of perceived support have been linked to reduced risk of depression, lower severity of somatic complaints, and improved overall well-being.9 In patients with functional somatic symptoms, social support may act as a buffer against environmental stressors, thereby mitigating the severity of psychological distress. This buffering effect is particularly important in populations where somatisation is a common mode of expressing emotional suffering. Despite growing recognition of the role of social support, there remains limited empirical evidence focusing specifically on family support and its relationship with psychological distress in patients with functional somatic symptoms. Most studies have examined general social support or have focused on Western populations, leaving a gap in understanding within non-Western cultural contexts.10 Addressing this gap is essential for developing culturally sensitive interventions that integrate psychosocial dimensions into clinical management. The present study seeks to explore the impact of perceived family support on psychological distress among patients presenting with functional somatic symptoms in a tertiary care setting. By examining this relationship, the study aims to clarify how family support influences symptom severity and psychological well-being. These findings may inform holistic treatment strategies beyond pharmacological interventions, emphasising the importance of family involvement and psychosocial care in managing functional somatic disorders

Study Design and Setting This was a hospital based, cross sectional observational study conducted in the Department of Psychiatry, Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal. The study was carried out over a five month period between November 2022 and March 2023. We recruited patients attending the psychiatry outpatient department (OPD) who met the diagnostic criteria for functional somatic symptoms on a consecutive basis. Participants The study included 72 patients. The sample size was determined using the formula for qualitative variables, considering an expected prevalence of functional somatic symptoms of 18% in the clinic population. Inclusion criteria: • Age between 18 and 60 years. • Both sexes. • Diagnosis of functional somatic symptoms as per ICD 10 criteria (F45). • Ability to provide informed consent. Exclusion criteria: • Patients with intellectual disability, epilepsy, or other neurological disorders. • Presence of comorbid psychiatric disorders such as schizophrenia or bipolar disorder. • Severe medical illness requiring immediate intervention. Tools and Instruments 1. Socio demographic proforma: A semi structured questionnaire designed to collect information on age, sex, marital status, education, occupation, and socio economic background. 2. Patient Health Questionnaire 15 (PHQ 15): Used to assess the severity of somatic symptoms. The PHQ 15 is a validated screening tool widely applied in both clinical and research settings.11 3. Multidimensional Scale of Perceived Social Support (MSPSS): A 12 item scale measuring perceived support from family, friends, and significant others. Higher scores indicate greater perceived support.12 4. General Health Questionnaire 12 (GHQ 12): Administered to assess psychological distress levels among participants. Procedure After obtaining ethical clearance from the institutional review board, the researchers obtained informed consent from all participants. Each patient was interviewed in a private setting to ensure confidentiality. Participants first completed the socio-demographic proforma, followed by administration of the PHQ 15, MSPSS, and GHQ 12. Family members accompanying the patients were also briefed about the study objectives to enhance cooperation. Statistical Analysis Data were coded and entered into SPSS version 25 for analysis. Descriptive statistics summarised socio demographic variables. Pearson’s correlation coefficient was applied to examine the relationship between perceived family support, somatic symptoms, and psychological distress scores. Independent t tests and ANOVA were performed to compare mean scores across different socio demographic groups. Linear regression analysis was conducted to identify independent predictors of psychological distress. A p value of <0.05 was considered statistically significant.

The socio demographic profile of the 72 participants shows that most belonged to the 30–45 year age group (52.7%), with a mean age of approximately 39.8 years. A smaller proportion were younger than 30 years (16.7%), while nearly one third were above 45 years (30.6%). The sample was predominantly female (88.9%), indicating that women reported functional somatic symptoms more frequently than men (11.1%). Most participants were married (76.4%), suggesting that marital status may influence perceived family support and coping mechanisms. In terms of habitat, most were from rural backgrounds (81.9%), while only 18.1% resided in urban areas, reflecting the hospital's rural catchment area. Occupational distribution showed that 62.5% were unemployed, while 37.5% were employed. This highlights the potential link between unemployment and increased vulnerability to psychological distress and somatic complaints. Socio economic status analysis revealed that 69.4% belonged to the lower class, while 30.6% were from the middle class, indicating that financial constraints may contribute to both symptom severity and reduced access to psychosocial resources (Table 1). Table 1: Socio Demographic Characteristics of Participants (N = 72) Variable Subcategory Frequency (%) Age <30 years 12 (16.7) 30–45 years 38 (52.7) >45 years 22 (30.6) Gender Male 8 (11.1) Female 64 (88.9) Marital Status Married 55 (76.4) Unmarried 17 (23.6) Habitat Rural 59 (81.9) Urban 13 (18.1) Occupation Employed 27 (37.5) Unemployed 45 (62.5) Socio economic Status Lower class 50 (69.4) Middle class 22 (30.6) Table 2 presents the correlation analysis between family support, somatic symptoms, and psychological distress. A strong negative correlation was observed between family support and somatic symptoms (r = –0.68, p < 0.001), indicating that patients who perceived greater family support reported fewer somatic complaints. Similarly, family support was also negatively correlated with psychological distress (r = –0.71, p < 0.001), suggesting that higher levels of perceived support were associated with reduced distress. In contrast, somatic symptoms showed a positive correlation with psychological distress (r = +0.64, p < 0.001). This finding implies that patients experiencing more severe somatic complaints were also more likely to report higher levels of psychological distress. Table 2: Correlation between Family Support, Somatic Symptoms, and Psychological Distress Variable Pair Correlation Coefficient (r) p value Family Support vs Somatic Symptoms –0.68 <0.001 Family Support vs Psychological Distress –0.71 <0.001 Somatic Symptoms vs Psychological Distress +0.64 <0.001 Table 3 compares mean scores of somatic symptoms (PHQ 15) and perceived family support (MSPSS) across demographic groups. • Gender: Females reported higher somatic symptom severity (mean PHQ 15 = 13.9, SD = 4.2) compared to males (mean = 11.2, SD = 3.8). Despite this, females also perceived slightly greater family support (mean MSPSS = 4.3, SD = 1.1) than males (mean = 3.9, SD = 1.0). This suggests that although women experienced more somatic complaints, they benefited from stronger family support networks. • Marital Status: Married participants had lower somatic symptom scores (mean = 13.4, SD = 4.0) and higher family support (mean = 4.4, SD = 1.0) compared to unmarried individuals (mean PHQ 15 = 14.1, SD = 4.3; MSPSS = 3.8, SD = 1.2). This indicates that marriage may provide a protective effect through enhanced family support, which helps reduce distress. • Occupation: Employed participants reported fewer somatic symptoms (mean PHQ 15 = 12.7, SD = 3.9) and higher family support (mean MSPSS = 4.5, SD = 1.0) compared to unemployed individuals (mean PHQ 15 = 14.2, SD = 4.2; MSPSS = 4.0, SD = 1.1). Employment appears to be associated with both reduced symptom severity and stronger perceived support, possibly due to financial stability and social integration. Table 3: Mean Scores of Somatic Symptoms and Family Support across Demographic Groups Variable Subcategory Mean PHQ 15 (SD) Mean MSPSS Family (SD) Gender Male (n=8) 11.2 (3.8) 3.9 (1.0) Female (n=64) 13.9 (4.2) 4.3 (1.1) Marital Status Married (n=55) 13.4 (4.0) 4.4 (1.0) Unmarried (n=17) 14.1 (4.3) 3.8 (1.2) Occupation Employed (n=27) 12.7 (3.9) 4.5 (1.0) Unemployed (n=45) 14.2 (4.2) 4.0 (1.1) Table 4 presents the results of the linear regression analysis predicting psychological distress (GHQ 12 scores) from somatic symptoms, family support, age, and gender. • Somatic symptoms (PHQ 15): The regression coefficient was positive (β = +0.42, p < 0.001), indicating that higher somatic symptom severity significantly predicted greater psychological distress. This confirms that physical complaints are closely linked with emotional suffering. • Family support (MSPSS): The coefficient was negative (β = –0.38, p < 0.001), showing that stronger perceived family support significantly reduced psychological distress. This highlights the protective role of supportive family relationships in buffering stress and mitigating symptom burden. • Age: Although the coefficient was negative (β = –0.11), suggesting that older age may be associated with slightly lower distress, the result was not statistically significant (p = 0.12). • Gender (female): The coefficient was positive (β = +0.09), implying that being female may be linked to higher distress scores, but this association was not statistically significant (p = 0.14). Table 4: Linear Regression Analysis Predicting Psychological Distress (GHQ 12 Scores) Predictor Variable β Coefficient Standard Error t value p value Somatic Symptoms (PHQ 15) +0.42 0.09 4.67 <0.001 Family Support (MSPSS) –0.38 0.08 –4.25 <0.001 Age –0.11 0.07 –1.57 0.12 Gender (Female) +0.09 0.06 1.48 0.14

The present study examined the relationship between perceived family support, somatic symptom severity, and psychological distress among patients with functional somatic symptoms attending the Department of Psychiatry, Dr. Bidhan Chandra Roy Hospital, Haldia. The findings revealed a significant negative correlation between family support and both somatic symptoms and psychological distress, underscoring the protective role of supportive family relationships in this population. Family Support and Somatic Symptoms Our results demonstrated that patients with higher perceived family support reported fewer somatic complaints. This aligns with previous studies which have emphasised the buffering effect of social support on stress and illness expression.13,14 Somatic symptoms often serve as a culturally sanctioned idiom of distress, particularly in non Western societies where direct articulation of psychological suffering may be discouraged.15 In such contexts, family support provides an alternative coping mechanism, reducing the need to express distress through bodily complaints. The subgroup analysis further highlighted that married individuals and those who were employed perceived greater family support and reported lower symptom severity. Marriage may provide emotional reassurance and stability, while employment offers financial security and social integration; both strengthen family bonds and reduce vulnerability to somatic distress.16,17 Conversely, unmarried and unemployed individuals reported higher symptom severity and lower family support, suggesting that the absence of these protective factors may exacerbate vulnerability. Family Support and Psychological Distress The study also found a strong negative correlation between family support and psychological distress. Patients who perceived greater support from family members reported lower levels of distress, consistent with earlier findings that social support reduces risk for depression and anxiety.18,19 Family support may enhance resilience by fostering belonging, providing practical assistance, and validating emotional experiences. In collectivist cultures such as India, family remains the primary source of psychosocial support, making its role particularly critical in mental health outcomes.20 Regression analysis confirmed that family support was an independent predictor of psychological distress, even after controlling for age and gender. This finding emphasises that interventions to strengthen family involvement could significantly improve patient outcomes. Psychoeducation for family members, family therapy, and community based support programs may therefore be valuable adjuncts to conventional treatment. Somatic Symptoms and Psychological Distress The positive correlation between somatic symptoms and psychological distress observed in this study is consistent with the well established comorbidity of somatisation, anxiety, and depression.21,22 Patients with more severe somatic complaints were more likely to report higher distress, suggesting a bidirectional relationship where psychological suffering amplifies somatic symptoms, and persistent bodily complaints further increase distress. This cycle underscores the need for integrated management approaches that address both physical and psychological dimensions of illness. Gender and Socio Demographic Influences The predominance of female participants and their higher symptom scores reflect findings from earlier studies which reported that women are more prone to somatic complaints.23 Biological factors such as hormonal fluctuations, as well as psychosocial factors including caregiving roles and gendered expectations, may contribute to this vulnerability.24 Interestingly, while females reported higher distress, gender did not emerge as a significant independent predictor in regression analysis, suggesting that family support and symptom severity play more decisive roles. Socio economic status also influenced outcomes, with lower class participants reporting higher symptom severity and distress. This aligns with literature indicating that financial hardship and limited access to healthcare exacerbate somatic complaints and psychological suffering.25,26 Rural participants made up the majority of the sample, reflecting the hospital’s catchment area, and their higher symptom burden may reflect reduced mental health awareness and limited psychosocial resources in rural communities. Clinical Implications This study's findings highlight the importance of incorporating family support into managing functional somatic symptoms. Clinicians should assess not only the severity of somatic complaints but also the patient’s perception of family support. Strengthening family involvement through psychoeducation, counselling, and supportive interventions may reduce distress and improve treatment adherence. Moreover, addressing socio economic vulnerabilities and providing community based resources could further enhance outcomes. Limitations and Future Directions This cross-sectional design limits its ability to establish causality between family support and psychological distress. The sample size was adequate, but it was drawn from a single tertiary care hospital, which may limit generalizability. Future research should employ longitudinal designs to examine causal pathways and explore the role of other forms of social support, such as peer or community networks. Additionally, qualitative studies could provide deeper insights into cultural perceptions of family support and its influence on illness expression.

In summary, the study demonstrates that perceived family support plays a crucial role in reducing both somatic symptom severity and psychological distress among patients with functional somatic symptoms. Strengthening family involvement in care may serve as a cost-effective and culturally appropriate intervention strategy, particularly in resource-limited settings. These findings reinforce the need for holistic approaches that integrate psychosocial dimensions into managing somatic disorders.

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