PTSD symptom severity and somatic symptom burden among adult medical outpatients in the Kurdistan Region of Iraq: a cross-sectional study

Abstract Background Somatic symptoms and PTSD symptoms may co-occur among medical outpatients in conflict-affected settings. This exploratory cross-sectional study examined the concurrent associations of cumulative trauma exposure and PCL-5 symptom severity with PHQ-15 somatic symptom burden among Kurdish-speaking outpatients in the Kurdistan Region of Iraq. Methods We recruited 100 eligible Kurdish-speaking adults through clinic-based non-probability convenience sampling from nine internal medicine, gastroenterology, and neurology outpatient clinics in Erbil, Sulaymaniyah, and Koya. Interviewer-administered measures assessed trauma exposure, PTSD symptoms, and somatic symptom burden. Hierarchical regression estimated the adjusted concurrent PCL-5–PHQ-15 association; a secondary exploratory model examined PTSD symptom clusters. Results PCL-5 symptom severity was strongly correlated with somatic symptom burden ( r = 0.66, p < 0.001), whereas cumulative trauma exposure was not statistically correlated with somatic symptom burden ( r = 0.12, p = 0.24). Adding PCL-5 symptom severity accounted for additional variance (ΔR² = 0.401, p < 0.001); the final model had R² = 0.481 and adjusted R² = 0.448. In the model adjusted for the available covariates, PCL-5 symptom severity was associated with somatic symptom burden (B = 0.38, β = 0.68, BCa 95% CI [0.29, 0.47]). In the exploratory cluster model, only negative alterations in cognition and mood had a bootstrap confidence interval excluding zero. Conclusions In this selected convenience sample, greater PCL-5 symptom severity was concurrently associated with greater PHQ-15 somatic symptom burden. Limited medical characterisation and unmeasured psychological factors mean that medical and broader psychological explanations cannot be excluded. The findings do not establish causality, screening utility, or regional representativeness.