The Somatic Symptom Scale-8 (SSS-8): A brief measure of somatic symptom burden

Benjamin Gierk, Sebastian Kohlmann, Kurt Kroenke, Lena Spangenberg, Markus Zenger, Elmar Braḧler, Bernd Loẅe

Research output: Contribution to journalArticle

133 Scopus citations


IMPORTANCE: Somatic symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of somatic symptom burden, but its reliability, validity, and usefulness have not yet been tested. OBJECTIVE: To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8. DESIGN, SETTING, AND PARTICIPANTS: A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years. MAIN OUTCOMES AND MEASURES: The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire-2 depression scale, Generalized Anxiety Disorder-2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores. RESULTS: The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general somatic symptom burden. Somatic symptom burden as measured by the SSS-8 was significantly associated with depression (r = 0.57 [95% CI, 0.54 to 0.60]), anxiety (r = 0.55 [95% CI, 0.52 to 0.58]), general health status (r = -0.24 [95% CI, -0.28 to -0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) somatic symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits. CONCLUSIONS AND RELEVANCE: The SSS-8 is a reliable and valid self-report measure of somatic symptom burden. Cutoff scores identify individuals with low, medium, high, and very high somatic symptom burden.

Original languageEnglish (US)
Pages (from-to)399-407
Number of pages9
JournalJAMA Internal Medicine
Issue number3
StatePublished - Mar 2014

ASJC Scopus subject areas

  • Internal Medicine

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