Depression and somatic symptoms scale: a new scale with both depression and somatic symptoms emphasized

Relationship between painful physical symptoms and severity of depressive symptomatology and suicidality

We examined the prevalence of painful physical symptoms in patients with major depressive disorder (MDD), clinical correlations therewith, and associations between painful symptoms and depression severity, quality of life, and suicidality, in a clinical sample in Korea. A total of 414 psychiatric outpatients at least 18years of age, with a primary diagnosis of MDD based on the DSM-IV-TR, were enrolled at the discretion of their treating psychiatrist. Patients were assessed for the presence or absence of painful physical symptoms (PPS+ and PPS-, respectively), defined by a total score ≥5 on the pain subscale (PS) of the Depression and Somatic Symptoms Scale (DSSS). DSSS and the Clinical Global Impressions-Severity of Illness scale (CGI-S) determined depression severity, and the EuroQoL Questionnaire-5 dimensions (EQ-5D) determined perceived quality of life. Questions about suicidality during current depressive episode were also asked to the participants. Overall, 30.4% of patients were classified as PPS+. PPS+ patients were older, less educated, less frequently unmarried, and more frequently widowed/divorced/separated compared to PPS- patients. PPS+ patients showed a significantly greater depression severity (CGI-S mean difference 0.92; 95% CI=0.68 to 1.16; DSSS mean difference 18.39; 95% CI=16.28 to 20.50), a significantly lower quality of life (EQ-5D VAS mean difference -18.15; 95% CI=-22.68 to -13.62), and significantly higher suicidal ideation (OR 1.73; 95% CI 1.04-2.86) during the current depressive episode. This study suggests that assessment of depressive patients should include detailed questions about painful physical symptoms, and treatment of MDD should involve management targeting painful physical symptoms as well as emotional and non-painful physical symptoms.

The integral inventory for depression, a new, self-rated clinimetric instrument for the emotional and painful dimensions in major depressive disorder

OBJECTIVE

To assess the reliability and validity of the Integral Inventory for Depression (IID) scale using post hoc analyses of data from a multi-country study (ClinicalTrials.gov: NCT00561509) of patients with major depressive disorder (MDD).

METHODS

Patients (N = 1629) completed the IID (comprising two separate dimensions for emotional and physically painful symptoms; maximum score of 65) and a reference scale (16-item Quick Inventory of Depressive Symptomatology Self-Report) at baseline and at follow-up (8 and 24 weeks). Physicians rated MDD symptoms using the Clinical Global Impressions of Severity scale at each visit. Inter-item correlation, internal consistency, external validity, factor structure, and exploratory analysis of an optimal severity cut-off point were assessed.

RESULTS

The IID displayed two distinct dimensions (i.e. painful and emotional) with little item redundancy and good internal consistency (Cronbach's α > 0.83 at each visit). The IID displayed good external validity (Pearson's correlations coefficients >0.60 at each visit) and statistically significant agreement (McNemar's test; P < 0.001 at follow-up) with the reference scale. Results suggest that a cut-off score of ≤24 had adequate precision (>80%) to identify patients with and without moderate MDD.

CONCLUSIONS

Results suggest that the IID may be a reliable and valid tool for assessing emotional and painful symptoms of MDD.

Nociceptive and anxiety-like behavior in reproductively competent and reproductively senescent middle-aged rats

BACKGROUND

Changes in levels of estradiol and progesterone that occur with the transition to reproductive senescence may influence nociception or affect.

OBJECTIVE

To ascertain whether nociceptive and affective processes change with reproductive senescence, this study examined pain and anxiety-like behaviors in middle-aged female rats that were reproductively competent, transitioning to reproductive senescence, or reproductively senescent.

METHODS

Middle-aged (12-14 months old) female rats (N = 46) were tested in the following tasks to assess pain and anxiety-like behavior: tail flick, elevated plus maze, elevated zero maze, mirror maze, Vogel punished drinking, and defensive burying. For the tail-flick task, the latency for rats to move their tail from a heat source, as an indication of pain sensitivity, was determined. In the elevated plus and elevated zero mazes, the time spent on the open arms or quadrants, respectively, were determined as measures of reduced anxiety behavior. In the mirror maze, the time spent in the mirrored portion of the chamber was used as an indicator of anxiety-like responding. In the Vogel task, the number of punished licks made was determined as a measure of reduced anxiety-like behavior. In the defensive burying task, the duration spent by rats burying an electrified prod postfootshock was utilized as an index of anxietylike responding. All rats were experimentally naive, retired breeders from our colony and had not had a litter or been lactating for 1 to 4 weeks before behavioral testing.

RESULTS

Although tail-flick latencies were not significantly different among rats that were reproductively competent or senescent, reproductively competent rats had less anxiety-like behavior in the elevated plus maze (more time spent on the open arms: F(2,43) = 5.93; P < 0.01), elevated zero maze (more time spent on the open quadrants: F(2,43) = 4.62; P = 0.01), and Vogel punished drinking task (more punished licks made: F(2,43) = 3.76; P = 0.03). There were no statistically significant differences in the mirror maze and defensive burying task.

CONCLUSION

In this study of adult female rats, nociceptive behavior did not vary significantly with reproductive senescence, but anxiety-like behavior of rats did.

Somatic symptoms: an important index in predicting the outcome of depression at six-month and two-year follow-up points among outpatients with major depressive disorder

BACKGROUND

Few studies have simultaneously compared the ability of depression, anxiety, and somatic symptoms to predict the outcome of major depressive disorder (MDD). This study aimed to compare the MDD outcome predictive ability of depression, anxiety, and somatic severity at 6-month and 2-year follow-ups.

METHODS

One-hundred and thirty-five outpatients (men/women=34/101) with MDD were enrolled. Depression and anxiety were evaluated by the Hamilton Depression Rating Scale, Hospital Anxiety and Depression Scale, and depression subscale of the Depression and Somatic Symptoms Scale (DSSS). Somatic severity was evaluated by the somatic subscale of the DSSS. Subjects undergoing pharmacotherapy in the follow-up month were categorized into the treatment group; the others were categorized into the no-treatment group. Multiple linear regressions were used to identify the scales most powerful in predicting MDD outcome.

RESULTS

Among the 135 subjects, 119 and 106 completed the 6-month and 2-year follow-ups, respectively. Somatic severity at baseline was correlated with the outcomes of the three scales at the two follow-ups. After controlling for demographic variables, somatic severity independently predicted most outcomes of the three scales at the two follow-ups in the no-treatment group and the cost of pharmacotherapy and DSSS score at the 6-month follow-up in the treatment group.

LIMITATIONS

Division of the subjects into treatment and no-treatment groups was not based on randomization and bias might have been introduced.

CONCLUSIONS

Somatic severity was the most powerful index in predicting MDD outcome. Psychometric scales with appropriate somatic symptom items may be more accurate in predicting MDD outcome.

Migraine: a missing link between somatic symptoms and major depressive disorder

BACKGROUND

Research into the role of migraine in somatic symptoms of major depressive disorder (MDD) has long been neglected; hence, the aim of this study was to compare the impact of migraine and anxiety comorbidities on the somatic symptoms of patients with MDD.

METHODS

Consecutive psychiatric outpatients with MDD in a medical center were enrolled. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR; migraine was diagnosed according to the International Classification of Headache Disorders, 2nd edition. Four scales were administered and evaluated: the Hamilton Depression Rating Scale, the Depression and Somatic Symptoms Scale, the somatization subscale of the Symptom Checklist-90-Revised, and the Hospital Anxiety and Depression Scale. Multiple linear regressions were used to find the most powerful comorbidities in predicting somatic symptoms.

RESULTS

One hundred and fifty five patients (106F, 49M) completed the study. Subjects with migraine had higher somatic, depression and anxiety severities. Panic disorder was the most important factor when predicting somatic severity among anxiety comorbidities. Migraine (R(2) change=0.28 to 0.04, p<.01) was the strongest independent factor in predicting somatic severity, even after controlling for anxiety comorbidities and demographic variables.

LIMITATIONS

This study used certain exclusion criteria when enrolling MDD outpatients, possibly introducing bias.

CONCLUSIONS

Comorbidity with migraine was found to be associated with more somatic symptoms in patients with MDD, and migraine was a strong and independent predictor for the somatic symptoms of MDD. Future studies on the somatic symptoms of MDD should therefore take migraine into consideration.

Validation of the Depression and Somatic Symptoms Scale by comparison with the Short Form 36 scale among psychiatric outpatients with major depressive disorder

BACKGROUND

The Depression and Somatic Symptoms Scale (DSSS) is a self-administered scale developed for monitoring both depression and somatic symptoms. The aims of this study were to establish the criterion-related validity of the DSSS by testing the correlation between the DSSS and the Short Form 36 (SF-36) scale and to compare the ability of the DSSS and two other scales in predicting the outcome of the SF-36.

METHODS

The study enrolled 135 outpatients with a major depressive episode, 95 of whom received treatment for 1 month. Four scales were administered and evaluated: the DSSS, the SF-36, the Hospital Anxiety and Depression Scale, and the Hamilton Depression Rating Scale. Pearson correlation was used to test correlations among scales. Multiple linear regressions were used to find the scales most effective in predicting the SF-36.

RESULTS

The three scales were significantly correlated with most of the SF-36 subscales. The depression and somatic subscales of the DSSS significantly correlated with the mental and physical subscales of the SF-36, respectively. The DSSS and the Hospital Anxiety and Depression Scale were better able to predict physical and mental subscales of the SF-36, respectively. The Hamilton Depression Rating Scale had a good ability to predict functional impairment.

CONCLUSIONS

Psychometric scales with appropriate somatic symptoms might be more compatible with both physical and mental dimensions of the SF-36. DSSS proved to be a valid scale for monitoring both depression and somatic symptoms in patients with depression. Future studies should test whether the DSSS is better at predicting the treatment and prognosis of depression than conventional scales for depression.

The impacts of migraine, anxiety disorders, and chronic depression on quality of life in psychiatric outpatients with major depressive disorder

OBJECTIVE

Our purpose was to determine if migraine, anxiety comorbidities, and chronic depression were independently related to health-related quality of life (HRQoL) in outpatients with major depressive disorder (MDD).

METHOD

Consecutive psychiatric outpatients with MDD in a medical center were enrolled. MDD, chronic depression, and seven anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. Migraine was diagnosed based on the International Classification of Headache Disorders, 2nd edition. The acute version of the Short-Form 36 and the Hamilton Depression Rating Scale (HAMD) were used to evaluate the HRQoL and the severity of depression, respectively. Multiple linear regressions were used to determine the independent factors related to HRQoL.

RESULTS

There were 135 participants (34 men, 101 women) with MDD. Subjects with migraine, anxiety comorbidities, or chronic depression had higher HAMD scores and poor HRQoL. Migraine, specific phobia, and panic disorder were important and independent comorbidities predicting HRQoL. The impact of migraine on HRQoL, especially on bodily pain, was not inferior to those of some anxiety comorbidities or chronic depression.

CONCLUSION

Future studies related to HRQoL of MDD should consider migraine and anxiety comorbidities simultaneously.