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Embitterment and post-traumatic embitterment disorder (PTED) is critical, merging through different cultures. We explored the prevalence and related clinical characteristics of PTED of inpatients in a general hospital in China.Two hundred inpatients (aged 18-65 years) from different departments were recruited by convenient sampling and standardized diagnostic interviews of PTED. Demographic data, Post-traumatic Embitterment Disorder Self-Rating Scale (PTED-21), the Patient Health Questionnaire depression scale (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire depression scale (PHQ-15) were collected on all participants.The prevalence of PTED was 21% (42/200) in inpatients in China; besides, the rate of increased syndromal embitterment is 28% (56/200), including 42 patients diagnosed with PTED. PTED was mainly associated with stressful events, such as illness, work and complicated interpersonal relationships. Rheumatology department and respiratory department have the highest and second highest prevalence of PTED among all departments. PTED-21 scores were significantly correlated with PHQ-9, GAD-7 and PHQ-15 (all P 0.01).The present study shows that embitterment is a critical negative emotion in inpatients with somatic illnesses with comorbid depression, anxiety and somatic symptoms. PTED and feelings of embitterment should be given proper attention in diagnosing somatic patients, and it is crucial to enhance PTED screening and intervention in the future. Future intervention studies on post-traumatic embitterment disorder could be done in general and especially in psychosomatic and somatic medicine.

Embitterment and in some cases also post-traumatic embitterment disorder (PTED) is a relevant problem in the general population an even more so in psychiatric patients. PTED screening should be an essential component of routine mental health management, which can be done by the 21-item Post-traumatic Embitterment Disorder Self-Rating Scale (C-PTED-21), which measures the intensity of reactive stimulus bound embitterment. The PTED-21 German version was translated into Chinese and 200 non-psychiatric inpatients, reporting major negative life events, were recruited through convenience sampling to evaluate test performance. Ninety patients were selected for retest two weeks later to examine scale reliability. Factor analysis was used to assess construct validity and receiving operating characteristic curve analysis based on the "PTED standardized diagnostic interview" to assess diagnostic utility. Correlations with depression, somatic symptom, and anxiety scales were examined to assess aggregate validity. The C-PTED-21 demonstrated high internal consistency (Cronbach's α = 0.944) and good test-retest reliability (total score r = 0.783, individual item r value range, 0.635-0.889). Factor analysis revealed three common factors consistent with PTED core features. Total C-PTED-21 score was strongly correlated with the score on the nine-item Patient Health Questionnaire depression scale (PHQ-9, r = 0.735). Mean PTED-21 score ≥ 1.6 points distinguished clinical PTED as defined by diagnostic interview with 97.6% sensitivity and 90.5% specificity (AUC = 0.988, 95%CI: 0.976-0.999). The results show that the C-PTED-21 can assess the severity of PTED with good reliability and validity.