Enhancing Psychosomatic Medicine Skills in General Practitioners: Insights from Ecological Systems Theory

Based on the Ecological Systems Theory, this study aims to identify multilevel factors that influence the psychosomatic medical service competency (PMSC) of general practitioners (GPs).

A cross-sectional survey was conducted among 699 community general practitioners in Shanghai from December 2022 to March 2023 using a stratified random cluster sampling method. GPs' PMSC was assessed using a validated 27-item scale, covering knowledge, attitude and skills dimensions, with additional self-evaluative measures on perceived competency and training needs. Based on ecological systems theory, individual, institutional and systemic factors were examined. A three-stage hierarchical regression analysis was performed to identify multilevel determinants of PMSC.

A total of 713 questionnaires were distributed, yielding 699 valid responses. The response rate was 98.04%. According to the multiple hierarchical regression analysis, higher educational attainment (p < 0.05) and greater empathy (β = 0.256, p < 0.001) were significantly associated with higher PMSC, explaining 7% of the variance (R² = 0.07, p < 0.001). While institutional factors (including psychological services, medication availability and referral pathways) were associated with PMSC in bivariable analysis (p < 0.01), they were not significant in multivariable models. PMSC training emerged as the strongest predictor of PMSC (R² = 0.263, p < 0.001), emphasizing its critical role in competency development.

Educational attainment, empathy, and training significantly influence general practitioners' psychosomatic medical service competency, with training coverage being the strongest predictor. This study highlighted the urgent need for targeted training and policy reforms to enhance psychosomatic care in Chinese primary care settings.