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

A control study on pain characteristics and influencing factors in patients with depressive disorders-based on a 5-year follow-up report from the epidemiological survey of mental disorders in Shandong Province, China

BACKGROUND

This study extends from the 2015 Shandong Province Epidemiological Survey of Mental Disorders in adults aged 18 and above. Over five years, it investigates pain characteristics and influencing factors in individuals with depressive disorders in Shandong Province.

METHODS

The study encompasses 871 individuals who met DSM-IV criteria for depressive disorders in 2015. Using 1:1:1 matching by gender, age, and residence, 825 non-afflicted individuals were selected as high-risk controls, and 825 screening-negative individuals became low-risk controls. A follow-up study in 2020 involved 1848 participants. Survey tools included a general information questionnaire, General Health Questionnaire-12 (GHQ-12), SCID-I/P, Global Pain Scale (GPS), Quality of Life Questionnaire (QLQ), PSQI, MoCA, and clinical data questionnaire.

RESULTS

GPS scores in the current depressive group were higher than in non-current depressive group (Z = 14.36, P < 0.01). GPS scores in study group exceeded those in high-risk and low-risk control groups (H = 93.71, P < 0.01). GPS scores in non-remission group were higher than in the remission group (Z = 8.90, P < 0.01). Regression analysis revealed positive correlations between GPS scores and physical illnesses, current depression, incumbency, GHQ-12 total score, and PSQI total score. Negative correlations were observed with QLQ total score and MoCA total score.

LIMITATIONS

The study could not assess pain during the 2015 survey, limiting controlled pain analysis before and after five years.

CONCLUSION

Depression sufferers may experience prolonged heightened pain, potentially relieved when depression subsides. Individual pain is influenced by depression, physical illnesses, sleep quality, quality of life, cognitive function, gender, residence, and occupation.

Predictors of somatic symptoms during the COVID-19 pandemic: a national longitudinal survey in Japan

OBJECTIVES

The COVID-19 pandemic has highlighted the long-term consequences of SARS-CoV-2 infection, termed long COVID. However, in the absence of comparative groups, the differentiation of disease progression remains difficult, as COVID-19 symptoms become indistinguishable from symptoms originating from alternative etiologies. This study aimed to longitudinally investigate the association between COVID-19 exposure and the somatic symptoms in the Japanese general population.

DESIGN

This was a longitudinal cohort study with 1-year follow-up.

SETTING AND PARTICIPANTS

Longitudinal data from 19 545 individuals who participated in the Japan Society and New Tobacco Internet Survey (JASTIS) 2022 and 2023 were included. In this study, we used data from the 2022 JASTIS as baseline data and the 2023 JASTIS as follow-up data. Based on questionnaire responses, respondents were classified into three categories of exposure to COVID-19.

OUTCOME MEASURES

The somatic symptoms were assessed by the Somatic Symptom Scale-8 (SSS-8). Using generalised linear models adjusted for baseline covariates, we calculated the ORs of having very high somatic symptoms assessed by SSS-8, attributable to COVID-19 exposure (no COVID-19 cases as the reference group).

RESULTS

Follow-up completers were divided into three groups according to COVID-19 exposure (no COVID-19, n=16 012; COVID-19 without O2 therapy, n=3201; COVID-19 with O2 therapy, n=332). After adjusting for all covariates, COVID-19 cases with O2 therapy had a significant positive association (OR 7.60, 95% CI 5.47 to 10.58) with a very high somatic symptoms burden while other COVID-19 exposure groups did not. Pre-existing physical and psychological conditions were also associated with increased risk of somatic symptoms.

CONCLUSION

The findings of our study suggest that the severity of COVID-19 symptoms requiring O2 therapy in the acute phase led to high somatic symptoms. Pre-existing conditions were also associated with a subsequent risk of somatic symptoms.

Association between cognitive functioning and lifetime suicidal ideation among Chinese older adults: the mediating effect of depression

PURPOSE

Existing evidence indicates an association between cognitive functioning and both geriatric depression and suicidality, with mixed evidence regarding the direction of the relationship between cognitive functioning and aspects of geriatric lifetime suicidal ideation. This study aims to examine the relationship between cognitive functioning, depression, and suicide ideation and to explore the intermediary role of depression between cognitive functioning and suicidal ideation in the older adults.

METHODS

A multi-stage random cluster sampling method was used to collect a sample of 3896 individuals aged 60 and above. Descriptive statistics of the sample data were analyzed using one-way ANOVA, and then the correlation between variables was obtained by binary logistic regression analysis. SPSS macro program PROCESS V3.5 was used to test the mediating role of depression in the relationship between cognitive function and lifetime suicidal ideation.

RESULTS

The prevalence of lifetime suicidal ideation among older adults was 3.9%. Lifetime suicidal ideation was associated with depression (OR = 1.308, P < 0.001) but was not significantly correlated with cognitive function (OR = 0.972, P > 0.05). The relationship between cognitive function and depression was also supported in this study (β = - 0.0841, P < 0.001). Depression completely mediated the relationship between cognitive function and lifetime suicidal ideation.

CONCLUSION

There was no significant correlation between cognitive impairment in older adults and a heightened risk of lifetime suicidal ideation. However, this relationship was completely mediated by depression. It is crucial to prevent the onset of depression among older adults with cognitive impairment, as depression is strongly linked to lifetime suicidal ideation.

Cause-specific mortality after hospital discharge for suicide attempt or suicidal ideation: A cohort study in Piedmont Region, Italy

BACKGROUND

Suicide attempters are at higher risk of death than the general population. The present study aims to investigate the excess of all-cause mortality and cause-specific mortality in a cohort of patients who have attempted suicide or had suicidal ideation compared with the general population.

METHOD

The cohort included 826 patients residing in the Piedmont Region of Northwest Italy who were admitted to a hospital or emergency department for suicide attempts or suicidal ideation between 2010 and 2016. Mortality excesses of the study population compared to the general population were estimated by applying indirect standardization. Standardized Mortality Ratios and 95% Confidence Intervals were calculated for all-cause, and cause-specific, natural, and unnatural causes of death by gender and age.

RESULTS

During the 7 years of follow-up, 8.2% of the study sample died. The mortality of suicide attempters and ideators was significantly higher than that of the general population. Mortality was about twice than expected from natural causes, and 30 times than expected from unnatural causes. The mortality due to suicide was 85 times higher than that of the general population, with an excess of 126 times for females. The SMRs for all-cause mortality decreased with increasing age.

CONCLUSIONS

Patients who access hospitals or emergency departments for suicide attempts or suicidal ideation are a frail group at high risk of dying from natural or unnatural causes. Clinicians should pay special attention to the care of these patients, and public health and prevention professionals should develop and implement appropriate interventions to timely identify individuals at higher risk for suicide attempts and suicidal ideation and provide standardized care and support services.

Predictive potential of somatic symptoms for the identification of subthreshold depression and major depressive disorder in primary care settings

BACKGROUND

The presence of heterogenous somatic symptoms frequently obscures the recognition of depression in primary care. We aimed to explore the association between somatic symptoms and subthreshold depression (SD) and Major Depressive Disorder (MDD), as well as to determine the predictive potential of somatic symptoms in identifying SD and MDD in primary care.

METHODS

Data were derived from the Depression Cohort in China study (ChiCTR registry number: 1900022145). The Patient Health Questionnaire-9 (PHQ-9) was used to assess SD by trained general practitioners (GPs), and the Mini International Neuropsychiatric Interview depression module was used to diagnose MDD by professional psychiatrists. Somatic symptoms were assessed using the 28-item Somatic Symptoms Inventory (SSI).

RESULTS

In total of 4,139 participants aged 18-64 years recruited from 34 primary health care settings were included. The prevalence of all 28 somatic symptoms increased in a dose-dependent manner from non-depressed controls to SD, and to MDD (P for trend <0.001). Hierarchical clustering analysis grouped the 28 heterogeneous somatic symptoms into three clusters (Cluster 1: energy-related symptoms, Cluster 2: vegetative symptoms, and Cluster 3: muscle, joint, and central nervous symptoms). Following adjustment for potential confounders and the other two clusters of symptoms, per 1 increase of energy-related symptoms exhibited significant association with SD (OR = 1.24, 95% CI, 1.18-1.31) and MDD (OR = 1.50, 95% CI, 1.41-1.60) The predictive performance of energy-related symptoms in identifying individuals with SD (AUC = 0.715, 95% CI, 0.697-0.732) and MDD (AUC = 0.941, 95% CI, 0.926-0.963) was superior to the performance of total SSI and the other two clusters (P < 0.05).

CONCLUSIONS

Somatic symptoms were associated with the presence of SD and MDD. In addition, somatic symptoms, notably those related to energy, showed good predictive potential in identifying SD and MDD in primary care. The clinical implication of the present study is that GPs should consider the closely related somatic symptoms for early recognition for depression in practice.

The prevalence of painful physical symptoms in major depressive disorder: A systematic review and meta-analysis of observational studies

BACKGROUND

Painful physical symptoms (PPS) are common in patients with major depressive disorder (MDD), but their prevalence has been mixed. This is a systematic review and meta-analysis of the pooled prevalence of PPS in MDD patients.

METHODS

Systematic literature searches were independently conducted in major databases (PubMed, EMBASE, PsycINFO and Web of Science). Data analyses were conducted using a random-effects model.

RESULTS

A total of 20 studies with 53,852 patients were included. The overall prevalence of PPS in MDD patients was 55.2% (95%CI: 47.9-62.3%), with a point prevalence of 64.2% (95%CI: 53.2-73.8%) and a 12-month prevalence of 57.0% (95%CI: 23.9-84.8%). No significant publication bias was found in this meta-analysis.

CONCLUSION

PPS are common in MDD patients. Considering the negative impact of PPS on daily functioning, effective preventive measures and routine screening should be conducted for MDD patients, and timely treatments should be offered to those in need. Registration number: CRD42020179471.

Evolution and Emerging Trends in Depression Research From 2004 to 2019: A Literature Visualization Analysis

Depression has become a major threat to human health, and researchers around the world are actively engaged in research on depression. In order to promote closer research, the study of the global depression knowledge map is significant. This study aims to map the knowledge map of depression research and show the current research distribution, hotspots, frontiers, and trends in the field of depression research, providing researchers with worthwhile information and ideas. Based on the Web of Science core collection of depression research from 2004 to 2019, this study systematically analyzed the country, journal, category, author, institution, cited article, and keyword aspects using bibliometric and data visualization methods. A relationship network of depression research was established, highlighting the highly influential countries, journals, categories, authors, institutions, cited articles, and keywords in this research field. The study identifies great research potential in the field of depression, provides scientific guidance for researchers to find potential collaborations through collaboration networks and coexistence networks, and systematically and accurately presents the hotspots, frontiers, and shortcomings of depression research through the knowledge map of global research on depression with the help of information analysis and fusion methods, which provides valuable information for researchers and institutions to determine meaningful research directions.

Loneliness and social integration as mediators between physical pain and suicidal ideation among elderly men

OBJECTIVES

Suicide in the elderly is a complex and significant public health problem. The purpose of our study was to examine the role of loneliness and social integration as potential mediators in the relationship between physical pain and suicidal ideation in the elderly.

DESIGN

Descriptive, bivariate correlations, and moderated mediation analyses were performed.

SETTING

Personal meetings were held with participants in their homes.

PARTICIPANTS

A total of 198 elderly men aged 65 and over.

MEASUREMENTS

Self-report measures: Beck Scale for Suicidal Ideation, Physical pain subscale, Multidimensional Social Integration in Later Life Scale, and University of California, Los Angeles (UCLA) Loneliness Scale (Version 3).

RESULTS

Our findings showed that the association between physical pain and suicidal ideation was mediated by loneliness and social integration. Further analyses revealed that this mediation model was significant among single, but not married, men.

CONCLUSIONS

Physical pain and social factors are both important in understanding suicidality in late life. Elderly single men who experience physical pain may be lonelier and less socially integrated, and these factors may contribute to higher risk of suicidal ideation.

Somatic symptoms and sleep quality as indicators of depression and suicide risk among Korean military conscripts

This study examined whether somatic symptoms and sleep quality can be indicators of depression and suicide risk in Korean military conscripts. In October and November of 2016, a total of 1,937 conscripts completed a survey that included the patient health questionnaire (PHQ) 9, PHQ15, the Mini International Neuropsychiatric Interview Plus suicidality module, and the Pittsburgh sleep quality index. Four groups were formed by depression and suicide risk status. Results from analyses of covariance indicated that overall, the severity of somatic symptoms and aspects of sleep quality were higher in conscripts with both depression and suicide risk, and greater associations of depression with somatic symptoms and sleep quality. The results of logistic regression analyses indicated that moderate to high levels of somatic symptoms and poorly perceived health were associated with the risk of depression and suicide, respectively. Poor sleep quality was associated with a higher risk of depression, but it was not significantly related to suicide risk after accounting for depression, which showed a greater association with suicide risk. Monitoring somatic and sleep complaints along with perceived health are needed as potential markers of depression and suicide risk among military conscripts.

Subjective depressive symptoms associated with pain in patients with major depressive disorder: Findings from the study on the aspect of Asian depression

PURPOSE

To examine subjective depressive symptoms associated with physical pain symptoms (PPSs) in Asian patients with major depressive disorder (MDD).

DESIGN AND METHODS

Four PPSs, including headache, chest pain, low back pain, and muscle pain, and subjective depressive symptoms were assessed using the Symptom Checklist-90-Revised.

FINDINGS

Out of 528 participants, 390 (73.9%) had at least one PPS. After adjusting for sex, depression severity, disability, fatigue, physical health status, and mental health status, PPSs were found to be associated with crying easily, blaming oneself, feeling lonely, feeling blue, and worrying too much.

PRACTICAL IMPLICATIONS

Almost three-quarters of Asian patients with MDD experience PPSs. PPSs are associated with some subjective feelings of depression.

Cognitive-affective depression and somatic symptoms clusters are differentially associated with maternal parenting and coparenting

BACKGROUND

Both depressive and somatic symptoms are significant predictors of parenting and coparenting problems. However, despite clear evidence of their co-occurrence, no study to date has examined the association between depressive-somatic symptoms clusters and parenting and coparenting. The current research sought to identify and cross-validate clusters of cognitive-affective depressive symptoms and nonspecific somatic symptoms, as well as to test whether clusters would differ on parenting and coparenting problems across three independent samples of mothers.

METHOD

Participants in Studies 1 and 3 consisted of 409 and 652 community mothers, respectively. Participants in Study 2 consisted of 162 mothers exposed to intimate partner violence. All participants prospectively completed self-report measures of depressive and nonspecific somatic symptoms and parenting (Studies 1 and 2) or coparenting (Study 3).

RESULTS

Across studies, three depression-somatic symptoms clusters were identified: no symptoms, high depression and low nonspecific somatic symptoms, and high depression and nonspecific somatic symptoms. The high depression-somatic symptoms cluster was associated with the highest levels of child physical maltreatment risk (Study 1) and overt-conflict coparenting (Study 3). No differences in perceived maternal competence (Study 2) and cooperative and undermining coparenting (Study 3) were found between the high depression and low somatic symptoms cluster and the high depression-somatic symptoms cluster.

CONCLUSIONS

The results provide novel evidence for the strong associations between clusters of depression and nonspecific somatic symptoms and specific parenting and coparenting problems. Cluster stability across three independent samples suggest that they may be generalizable. The results inform preventive approaches and evidence-based psychotherapeutic treatments.

Factors associated with and impact of pain persistence in Asian patients with depression: a 3-month, prospective observational study

OBJECTIVE

We investigated the depression outcomes and the factors associated with pain persistence in Asian patients treated for major depressive disorder (MDD).

METHODS

This observational study enrolled 909 Asian adult inpatients and outpatients. The presence or absence of painful physical symptoms and severity of depression were assessed at baseline and after three months of treatment. Factors associated with pain persistence and outcome of depression were investigated using regression methods.

RESULTS

Of the 909 patients enrolled, 684 were included in the analysis and evaluated at three months. Of them, 335 (49%) had no pain at baseline nor follow up, 198 (29%) at baseline but not at follow up and 151 (22%) in both assessments. Pain more frequently persisted in patients who were divorced/widowed/separated, with >1 comorbidity, aged <40 years, with previous MDD episodes, taking pain medications, and with greater depression severity. At three months, response/remission were 84%/73% in the no pain group, 83%/63% in the remitted pain group and 46%/25% in the persistent pain group (differences all p < .0001; all bivariate comparisons were statistically significant with p < .05 except response between no pain and remitted pain). Persistent pain was also associated with less improvement in quality of life and health state.

CONCLUSIONS

Pain should be taken into account when diagnosing MDD and when tailoring therapy.

Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management

Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.

Major depression and suicide attempts in patients with liver disease in the United States

BACKGROUND & AIMS

Depression is common in patients with liver disease. Moreover, alcohol use is intricately linked with both major depression and liver disease, and has also been linked with suicidal behaviours, suggesting that the alcohol use may have an intermediate role in the relationship between liver disease and major depression or suicidal behaviours. This study presents nationally representative data on the prevalence of major depression in patients with liver disease in the United States and its association with suicide attempts.

METHODS

Data were drawn from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43 093 adults aged 18 years and older in the United States. Medically recognized liver diseases were self-reported, and diagnoses of major depression were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version.

RESULT

The prevalence of liver disease was estimated at 0.7%. Respondents with a liver disease reported 12-month rates of major depression (17.2%) that were significantly higher than among respondents without liver disease (7.0%; Adjusted OR:2.2; CI: 1.2-4.1). Lifetime rates of suicide attempts among participants with a major depression were also higher in participants with a liver disease (33.2%) than among respondents without liver disease (13.7%; OR: 3.1; CI: 1.3-7.6).

CONCLUSIONS

Liver diseases are associated with major depression and suicide attempts among adults in the community. Adjustment for the amount of alcohol used or sociodemographical factors did not explain the observed association of liver disease with both major depression and suicide attempts.

Chinese patients with major depression: Do concomitant pain symptoms affect quality of life independently of severity of depression?

OBJECTIVE

This study investigated whether painful physical symptoms (PPSs) influenced quality of life (QoL) when adjusting for severity of depression.

METHODS

Severity of depression, QoL and PPSs were assessed at baseline and 3 months among the Chinese cohort (n = 300) of a 3-month observational study of major depressive disorder (MDD) in East Asia. The presence of PPS was defined as 'a mean score of ≥2 on the Somatic Symptom Inventory pain-related items'. Regression analyses determined predictors of QoL at 3 months, adjusting for age, sex, depressive symptoms, overall severity and QoL at baseline.

RESULTS

PPSs were present (PPS+) at baseline in 35.3% of patients. Over 3 months, in the whole sample, EuroQoL visual analogue scale (EQ-VAS) score improved from 45.5 (standard deviation [SD]: 20.9) to 81 (SD: 16.7), and EuroQoL 5-Dimension Questionnaire (EQ-5D) score improved from 0.52 (SD: 0.31) to 0.89 (0.16). At 3 months, mean EQ-VAS was 75.9 (SD: 17.7) for PPS+ versus 83.7 (SD: 15.6) for PPS-, and mean EQ-5D was 0.83 (SD: 0.17) versus 0.92 (SD: 0.14). PPS+ at baseline was a significant predictor of QoL at 3 months after adjusting for socio-demographic and baseline clinical variables.

CONCLUSIONS

PPSs were associated with less improvement in QoL in patients receiving treatment for MDD, independent of severity of depression.

Importance of remission and residual somatic symptoms in health-related quality of life among outpatients with major depressive disorder: a cross-sectional study

BACKGROUND

Major depressive disorder (MDD) is strongly associated with an impaired quality of life (QoL), which is itself affected by various factors. Symptom-oriented ratings poorly reflect the impact of disease on the QoL and level of functioning of the mental health of subjects. The purpose of this study was to assess health-related QoL (HRQoL) using preference-based measures in outpatients with MDD with regard to their remission achievement and clinical factors affecting the HRQoL.

METHODS

This was a cross-sectional observational study. We recruited 811 patients with MDD from 14 psychiatric outpatient clinics in Korea. They were divided into three groups as follows: a new visit group (n = 287), a remitted group (n = 235), and a non-remitted group (n = 289). The 17-item Hamilton Depression Rating Scale was used to assign patients to the remitted or non-remitted group. The general HRQoL was assessed with the EuroQol 5D (EQ-5D), using both the EQ-5D index score and the EuroQol Visual Analog Scale (EQ-VAS). The disease-specific HRQoL was assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF).

RESULTS

The non-remitted group showed a significant impairment of HRQoL in view of the subscales of EQ-5D index scores, EQ-VAS, and Q-LES-Q-SF. The EQ-5D index score in the remitted group was 0.77 ± 0.10, while it was 0.57 ± 0.23 in the non-remitted group and 0.58 ± 0.24 in the new visit group (p < 0.0001). The EQ-VAS scores for the remitted and non-remitted groups were 72.5 ± 16.6 and 50.9 ± 20.3, respectively (p < 0.0001). Likewise, patients with remission had the Q-LES-Q-SF total score of 46.5 ± 8.8, whereas those with non-remission reported 36.7 ± 7.7 (p < 0.0001). The symptom severity measured by the Depression and Somatic Symptoms Scale was significantly correlated with the HRQoL. Furthermore, patients with severe somatic symptoms showed a significantly lower EQ-5D index score (0.54 ± 0.24) than those with mild/moderate somatic symptoms (0.75 ± 0.12; p = 0.002).

CONCLUSION

Non-remitted MDD patients, especially those with more severe somatic symptoms, show a distinct impairment of HRQoL and more clinical symptoms, suggesting the importance of achieving remission in the treatment of MDD.

The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder

Background

No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue.

Methods

This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS.

Results

Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs.

Conclusion

Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.

Impact of painful physical symptoms on depression outcomes in elderly Asian patients

ABSTRACT Background: Painful physical symptoms (PPS) are prevalent among elderly patients with depression. We describe the impact of PPS on depression outcomes and quality of life (QOL) of elderly Asian patients with major depressive disorder (MDD). Methods: This post hoc analysis of data from a three-month prospective observational study of East Asian MDD in- or out-patients focused on elderly patients aged ≥60 years. Depression severity was evaluated using the Hamilton depression (HAMD-17) and clinical global impression of severity (CGI-S) scales, while QOL was measured using EuroQOL (EQ-5D and EQ-VAS) instruments. PPS were rated using the modified somatic symptom inventory (SSI). Results: At baseline, depression was moderate to severe and 49% of the 146 elderly patients were painful physical symptom positive (PPS+). Bivariate analysis showed significant correlations between PPS and depression severity and QOL at baseline. Linear regression models showed the baseline factor most significantly associated with depression severity at three months was baseline PPS status. PPS+ patients had a mean increase of 2.87 points in their HAMD-17 rating and 0.77 points in their CGI-S score. Response and remission were significantly lower in PPS+ patients; response was 60% and remission was 40% in PPS+ patients while 82% and 66% in painful physical symptom negative (PPS-) patients. QOL at endpoint was lower in PPS+ patients. Conclusions: PPS are common in elderly Asian patients with MDD and negatively influence depression outcomes and QOL. Patients with PPS had lower QOL at baseline, lower response and remission rates, higher severity of depression, and lower QOL after three months of treatment.

Influence of the number and severity of somatic symptoms on the severity of depression and suicidality in community-dwelling elders

INTRODUCTION

Older adults commonly experience somatic symptoms, and those who do are more likely to have depressive disorders as well. Our goal in this study is to examine the influence of the number and severity of somatic symptoms on the severity of depressive symptoms, including suicidality, in elderly adults.

METHODS

This study was conducted as part of the Ansan Geriatric (AGE) Study, a community-based cohort study in Ansan City, South Korea. A total of 3,210 elderly adults aged 60 years or over (1,388 males and 1,770 females) participated in this study. The Korean version of the Beck Depression Inventory (BDI) was used to measure depressive symptoms and suicidality. Somatic symptoms were assessed by the Patient Health Questionnaire-15 (PHQ-15).

RESULTS

Both mild and severe somatic symptoms significantly increased the risk for severe depression and high suicidality. Severe somatic symptoms doubled the risk for severe depression and suicidal intent.

DISCUSSION

Somatic symptoms not fully explained as medical illnesses are closely associated with late-life depression, even after adjustments for comorbid physical illnesses and other confounding factors. The presence of somatic symptoms concurrent with, but not fully explained by comorbid physical illness or disability, seems to be an independent marker for predicting the severity of late-life depression and suicidality.

Risk factors for suicidal ideations in patients with bipolar disorder

OBJECTIVE

To identify the risk factors for suicidal ideation in subjects with bipolar depression.

METHODS

One-hundred and thirty subjects diagnosed with bipolar depression were evaluated on the following scales: Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Patient Health Questionnaire-15 (PHQ-15), Barrat's Impulsivity Scale (BIS), Irritability, Anxiety, and Depression (IDA) Scale, Young Mania Rating Scale (YMRS), Buss-Durke Hostile Inventory (BDHI), and Brief Psychiatric Rating Scale (BPRS).

RESULTS

Based on the BDI suicidal thoughts and wishes item (score of ≥ 1), the study sample was divided into those with and those without suicidal ideation. Compared to those without suicidal ideations, patients with bipolar depression with suicidal ideation had significantly higher scores on the BDI, YMRS, BPRS total score, IDA total score, PHQ-15, BHS total score, and most of the hostility subscales of the BHI. [corrected]. On binary logistic regression analysis, the odds ratio (OR) for [corrected] presence of suicidal ideations was more than one and was significant for the BHS [OR = 1.53, [corrected] 95% confidence interval (CI): 1.24-1.99], the IDA-irritability directed inwards (OR = 1.48, 95% CI: 1.03-2.13), and the total hostility score (OR = 1.10, 95% CI: 1.02-1.20). Other factors for which the OR was more than one but the difference was not statistically significant were: Hindu religion (OR = 3.13, 95% CI: 0.76-12.99), lifetime mean duration of depressive episodes (OR = 1.08, 95% CI: 0.74-1.57), past history of hospitalization (OR = 1.10, 95% CI: 0.24-6.16), any preceding life events (OR = 1.45, 95% CI: 0.28-7.52), subsyndromal manic symptoms (OR = 1.01, 95% CI:0.53-1.92), presence of psychotic symptoms (OR = 1.06, 95% CI: 0.92-1.22), and irritability directed outwards (OR = 1.14, 95% CI: 0.92-1.41). [corrected].

CONCLUSION

Among the various predictors of suicidal ideations, the severity of hopelessness, irritability directed inwards, and hostility are the most important risk factors for suicidal ideations in patients with bipolar disorder. [corrected]. Hence, patients with these risk factors should be closely monitored to prevent suicide attempts and completed suicides.

The pain suicidality association: a narrative review

OBJECTIVES

The objective of this narrative review was to examine recent evidence and, when necessary, past evidence on the association between pain and suicidality.

DESIGN

Fifty-eight research reports were found on this topic, which had not previously been reviewed. These reports were divided into groups by whether they addressed suicide ideation (SI), suicide attempts (SAs), or suicide completion (SC), and what population they represented (acute pain patients [APPs], chronic pain patients [CPPs], other than APPs/CPPs) and whether they controlled for relevant confounders. Information as to whether the results of these studies supported/did not support the association of pain and suicidality was abstracted. For each group of studies (above), a vote counting method was utilized to determine the overall percentage of studies supporting/not supporting the association of pain and suicidality. According to this percentage, the consistency of the data supporting this association was rated according to Agency for Healthcare Research and Quality guidelines.

RESULTS

The following groups of studies received an A consistency rating (consistent evidence from multiple studies): SI, SA, and SC for other than APPs/CPPs; and SI, SA, and SC for CPP prevalence greater than an appropriate control group. Also, a subgroup of the SI, SA, and SC studies for other than APPs/CPPs had controlled for behavioral issues (potential confounders). These three subgroups also received an A consistency rating. The 58 studies also identified a number of new predictor variables for SI, SA, and SC in CPPs.

CONCLUSIONS

These studies solidify the evidence for an association between pain and SI, SA, and SC in both CPPs and other than APPs/CPPs.

Assessment and management of chronic pain in patients with depression and anxiety

This article will review the role of the pharmacist in the management of chronic pain in patients with comorbid mood disorders.

Possible involvement of oxido-nitrosative stress induced neuro-inflammatory cascade and monoaminergic pathway: underpinning the correlation between nociceptive and depressive behaviour in a rodent model

BACKGROUND

Pain and depression are frequent co-morbid disorders. The prevalence rate of depression is several times higher in patients with chronic pain than in the general population but the mechanism underlying this association is unknown. A combination of interactions between neurotransmitters, neuropeptides, oxidative and nitrosative stress and cytokines are thought to take part in pathogenesis of pain as well as depression. Thus, the aim of the present study was two-fold, first to investigate the interplay between nociception and associated depression and second to investigate the protective potential of berberine against the reserpine-induced nociceptive and depressive behaviour and further to explore the role of oxidative-nitrosative stress mediated inflammatory cascade and apoptotic signalling pathway in this dyad.

METHODS AND RESULTS

Nociception and associated depression were induced by administration of reserpine (1mg/kg subcutaneous daily) for three consecutive days. This behavioural deficit was integrated with decrease in the biogenic amine (dopamine, norepinephrine and serotonin) levels along with increased substance P concentration, oxidative-nitrosative stress, inflammatory cytokines, NF-κβ and caspase-3 levels in different brain regions (cortex and hippocampus) of the reserpinised rats.

LIMITATION

More studies are still warranted in similar rodent models of pain and depression, so, that the present findings can be further substantiated to establish the clinical effectiveness of berberine in a subset of patients suffering from pain as well as depression.

CONCLUSION

The findings from the current study suggested that reserpine-induced neurochemical alterations and dysregulation of oxidative-nitrosative stress induced inflammatory cascade underlies the co-morbidity of nociceptive behaviour and associated depression in rats.

Which somatic symptoms are associated with an unfavorable course in Asian patients with major depressive disorder?

OBJECTIVE

To investigate the impact of somatic symptoms on the severity and course of depression in Asian patients treated for an acute episode of major depressive disorder (MDD).

METHODS

Three-month prospective observational study of 917 patients with MDD in psychiatric care settings of which 909 had complete main baseline data. Depression severity was assessed using the physician-rated Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD17), and somatic symptoms were assessed using the patient-rated 28-item Somatic Symptom Inventory (SSI). Cluster analysis using baseline SSI scores grouped patients into 3 clusters with no/few, moderate or severe somatic symptoms. Four factors of SSI (pain, autonomic symptoms, energy, and central nervous system) were defined and regression analyses identified which factors were associated with remission and response at 3 months follow-up.

RESULTS

Baseline depression severity (HAMD17 and CGI-S scores) was associated with more severe somatic symptoms. Remission rates differed between clusters of patients: 68.4%, 54.7% and 29.3% for no/few, moderate and severe somatic symptoms, respectively (p<0.0001). Corresponding response rates were 81.8%, 72.1% and 55.2% (p<0.0001). Pain symptoms were the somatic symptoms most associated with these clinical outcomes at 3 months.

LIMITATIONS

Only patients diagnosed with MDD in psychiatric care were assessed.

CONCLUSIONS

Somatic symptoms are frequent among Asian patients in psychiatric care for MDD and are associated with greater clinical severity and lower response and remission rates. Among somatic symptoms, pain symptoms have the greatest prognostic value and should be taken into account when treating patients with depression.

A greater number of somatic pain sites is associated with poor mental health in adolescents: a cross-sectional study

BACKGROUND

Identifying indicators of poor mental health during adolescence is a significant public health issue. Previous studies which suggested an association between the number of somatic pains and depression have mainly focused on adults or have employed samples with a narrow age range. To date, results from previous studies have been inconsistent regarding the association between somatic pain and academic impairment. Therefore, the main aims of the present study were to 1) investigate the association between the number of somatic pain sites and poor mental health using a community sample of adolescents aged 12 to 18 years and employing a simple method of assessment, and 2) examine the association between the number of somatic pain sites and perceived academic impairment.

METHODS

Data analysis was conducted using a large cross-sectional survey of adolescents in grades 7 to 12. The one-month prevalence rates for three sites of somatic pain including head, neck and shoulders, and abdomen were examined. Poor mental health was evaluated using the General Health Questionnaire, and perceived academic impairment was measured using a self-report questionnaire.

RESULTS

A total of 18,104 adolescents participated in the survey. A greater number of pain sites was associated with poor mental health, and this association was consistent across age and gender. There was no difference in effect on mental health between any of the pain sites. Although there was an association between the number of somatic pain sites and perceived academic impairment, the results suggested that the association was mediated by poor mental health.

CONCLUSIONS

Simple reporting methods for assessing the number of pain sites may be a feasible indicator of poor mental health in adolescents. Professionals working with adolescents should consider the possibility of poor mental health, especially when students report multiple somatic pains.

Do concomitant pain symptoms in patients with major depression affect quality of life even when taking into account baseline depression severity?

BACKGROUND

Patients with major depressive disorder (MDD) may suffer from concomitant pain symptoms. The aim of this study is to determine whether the presence of painful physical symptoms (PPS) influences quality of life when taking into account baseline depression severity.

METHODS

Patients with a new or first episode of MDD (n = 909) were enrolled in a 3-month prospective observational study in East Asia. The Hamilton Depression Rating Scale, Clinical Global Impression-Severity score, Somatic Symptom Inventory, and EuroQoL questionnaire-5 Dimensions (EQ-5D) and EQ-Visual Analogue Scale (EQ-VAS) were assessed at baseline and 3 months' follow-up. The presence of PPS was defined as a mean score of ≥2 on the Somatic Symptom Inventory pain-related items. Regression analyses determined predictors of quality of life at 3 months, adjusting for age, sex, depressive symptoms, overall severity, and quality of life at baseline.

RESULTS

PPS were present (PPS+) at baseline in 52% of patients. During the 3-month follow-up, EQ-VAS scores improved from 47.7 (standard deviation [SD] 20.6) to 72.5 (SD 20.4), and EQ-5D improved from 0.48 (SD 0.34) to 0.80 (SD 0.26). At 3 months, mean EQ-VAS was 66.4 (SD 21.2) for baseline PPS+ patients versus 78.5 (SD 17.6) for baseline PPS- patients, and mean EQ-5D was 0.71 (SD 0.29) versus 0.89 (SD 0.18). PPS+ at baseline was a significant predictor of quality of life at 3 months after adjusting for sociodemographic and baseline clinical variables.

CONCLUSION

The presence of painful physical symptoms is associated with less improvement in quality of life in patients receiving treatment for major depression, even when adjusting for depression severity.

Major depressive disorder severity and the frequency of painful physical symptoms: a pooled analysis of observational studies

OBJECTIVE

This retrospective post-hoc analysis of observational studies assesses the frequency of painful physical symptoms (PPS) in patients with major depressive disorder (MDD) of varied severity as may be seen in clinical practice.

METHODS

Observational studies of MDD that collected a clinician-reported measure of depression severity and included assessment of PPS were screened for this individual patient-level analysis. Six observational studies were included that enrolled outpatients with a diagnosis of MDD (assessed using the 17-item Hamilton depression scale, Hospital Anxiety and Depression Scale-Depression, or Inventory of Depressive Symptomatology). Measures of PPS were based on the original study assessment (modified Somatic Symptom Inventory [SSI] and Visual Analogue Scale [VAS]). Patients were divided into analysis cohorts based on the presence or absence of PPS. To model PPS status, odds ratios were calculated from logistic regression for cross-sectional analysis (main analysis) and generalized linear mixed models for longitudinal models (exploratory longitudinal analysis).

RESULTS

For the main analysis, four studies (N = 2943, 71.6% female, mean age 45.3 years) were identified. Of 2901 eligible patients, 61.7% were classified as having painful physical symptoms (PPS+). At study entry, 73.1% (957/1309) of patients in the severe category of depression, 56.8% (537/945) of those with moderate depression, and 45.6% (295/647) of those with mild depression were PPS+. The exploratory longitudinal analysis was performed using a subset (N = 2430) from the studies used in the main analysis plus two others (an additional 7984 patients, 6742 of which were modeled). The likelihood of patients that were PPS- at baseline later developing PPS was 5% to 13% greater for patients with increased depression severity (P < 0.001) and the likelihood of PPS+ patients later not having PPS was 9% to 17% less for patients with increased depression severity (P < 0.0001).

CONCLUSIONS

Since this is a retrospective aggregate analysis of several observational studies, and due to missing data, care should be taken in the interpretation of these results. Despite the use of adjustment techniques, selection bias and unmeasured confounding may still be an issue for comparative analysis as not all variables were collected for all studies. For patients treated in typical care settings, PPS were associated with depression severity. However, patients with mild and moderate depression also exhibited PPS. Clinicians should be aware that PPS are present, and may warrant treatment, across depression severities.

Post-hospitalization course and predictive signs of suicidal behavior of suicidal patients admitted to a psychiatric hospital: a 2-year prospective follow-up study

BACKGROUND

Suicidal patients admitted to a psychiatric hospital are considered to be at risk of suicidal behavior (SB) and suicide. The present study aimed to seek predictors of SB recurrence of the high-risk patients by examining their post-hospitalization course.

METHOD

The design was 2-year prospective follow-up study of patients consecutively admitted with SB to a psychiatric center in Tokyo. The DSM-IV diagnoses and SB-related features of subjects were determined in structured interviews. Subsequently, the subjects underwent a series of follow-up assessments at 6-month intervals. The assessment included inquiries into SB recurrence, its accompanying suicidal intent (SI) and SF-8 health survey. Analyses of serial change over time in the follow-up data and Cox proportional hazards regression analyses of SB recurrence were performed.

RESULTS

106 patients participated in this study. The dropout rate during the follow-up was 9%. Within 2 years, incidences of SB as a whole, SB with certain SI (suicide attempt) and suicide were 67% (95% CI 58 - 75%), 38% (95% CI 29 - 47%) and 6% (95% CI 3 - 12%), respectively. Younger age, number of lifetime SBs and maltreatment in the developmental period were predictive of SB as a whole, and younger age and hopelessness prior to index admission were predictive of suicide attempt. Regarding diagnostic variables, anxiety disorders and personality disorders appeared to have predictive value for SB. Additionally, poor physical health assessed during the follow-up was indicated as a possible short-term predictor of SB recurrence.

CONCLUSIONS

This study demonstrated a high incidence of SB and suicide and possible predictors of SB recurrence in the post-hospitalization period of psychiatric suicidal patients. Specialized interventions should be developed to reduce the suicide risk of this patient population.

The impact of health-related quality of life on suicidal ideation and suicide attempts among Korean older adults

The purpose of this study was to examine the risk factors for suicidal ideation and suicide attempts among Korean older adults and to provide evidence for nursing intervention with respect to health-related quality of life (HRQoL). Data from adults 60 and older obtained through the Fourth Korean National Health and Nutrition Examination Survey (2007-2009) were used. Self-report questionnaires assessed suicidal ideation, suicide attempts, and EuroQoL 5D (EQ-5D) scores. Survey logistic regression was used to reflect the complex survey design. Among the sample of 4,506 individuals, 27.3% had thought about and 1.7% had attempted suicide. Older adults with EQ-5D index scores <0.7 had a 9.1-fold greater odds ratio for suicidal ideation than those with scores of 1 (denotes completely healthy status) (95% confidence interval [CI] [5.3, 15.8]). For suicide attempts, older adults with EQ-5D index scores <0.7 had a 3.4-fold greater odds ratio (95% CI [1.3, 8.9]) than those with index scores of 0.8 to 1. Decreased HRQoL strongly affected suicidal ideation, regardless of disease status. Due to its comprehensiveness and simplicity, the EQ-5D may be useful for identifying older individuals in nursing homes at risk of attempting suicide.

Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers

BACKGROUND

There is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.

METHODS

The total population of 16-17-year-olds in Uppsala, Sweden, was screened for depression in 1991-1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.

RESULTS

Somatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.

CONCLUSIONS

Somatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.

Comparison of treated and untreated major depressive disorder in a nationwide sample of Korean adults

We examined factors associated with lifetime treatment of major depressive disorder (MDD) in a nationwide sample of Korean adults. Of the 6,510 subjects aged 18-64 years who participated in the Korean Epidemiologic Catchment Area study, 362 (5.6%) with a lifetime diagnosis of MDD were analyzed. Diagnostic assessments were based on the Korean version of the Composite International Diagnostic Interview administered by lay interviewers. Of the 362 respondents with a lifetime diagnosis of MDD, 117 (32.3%) had been treated for psychiatric problems. Treated individuals with MDD were more likely to have chronic episode(s), more symptoms of depression, insomnia, and suicidal ideation, and were less likely to have feelings of guilt. In addition, treated individuals were more likely to have comorbid anxiety disorders, especially obsessive-compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder. Treatment-seeking by individuals with MDD is affected by socio-cultural factors such as misconception and stigma of mental illness, as well as severity of depression and comorbid conditions.