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Li X, Zhang H, Han X, Guo L, Ceban F, Liao Y, Shi J, Wang W, Liu Y, Song W, Zhu D, Wang H, Li L, Fan B, Lu C, McIntyre RS. Predictive potential of somatic symptoms for the identification of subthreshold depression and major depressive disorder in primary care settings. Front Psychiatry 2023; 14:999047. [PMID: 36865073 PMCID: PMC9971499 DOI: 10.3389/fpsyt.2023.999047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
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.
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Affiliation(s)
- Xiuwen Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Huimin Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China.,Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Felicia Ceban
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Braxia Health, Mississauga, ON, Canada
| | - Yuhua Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China.,Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Weidong Song
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Dongjian Zhu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Hongqiong Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.,Department of Nutrition, Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Braxia Health, Mississauga, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
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Pérez V, Martínez-Navarro R, Pérez-Aranda A, Martínez-Sadurní L, Arranz-Estévez FJ, Colom F, Pujol J, Toll A, Iniesta-Terré M, Elices M. A multicenter, observational study of pain and functional impairment in individuals with major depressive disorder in partial remission: the DESIRE study. J Affect Disord 2021; 281:657-660. [PMID: 33246652 DOI: 10.1016/j.jad.2020.11.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The study explores the association between pain and functional impairment in patients with partially remitted MDD, considering both clinician and patient reported outcomes. METHODS Multicenter, observational, and cross-sectional study, with 583 outpatients with partially remitted MDD. Measures of pain intensity (VAS), functional impairment (SOFAS), depressive symptomatology (HAM-D6), and remission from MDD and functional status from a patient-centered perspective (RDQ) were collected. VAS scores (cut-off: 30) were used to divide the sample in two groups: no pain (n = 274) and pain (n = 309). Descriptive data, correlation and regression analyses were obtained. RESULTS Functional impairment (SOFAS) and pain (VAS) were negatively and significantly correlated in the total sample, and in the group with pain. Lower pain predicted higher functioning. The pain sub-sample was older, less educated, with higher medical comorbidities, higher HAM-D6 scores, and lower functionality (SOFAS). In the RDQ, the pain group showed significantly higher scores in the symptom-related subscales, and lower scores in the subscales related to positive mental health, functioning and wellbeing. LIMITATIONS Correlational and observational design. The criteria and instruments used to measure pain and to define a threshold might limit the generalizability of findings. CONCLUSIONS Pain and functionality should be assessed and treated in patients with MDD in partial remission. Our results indicate that functionality should be assessed with a broader perspective, that also considers positive mental health features.
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Affiliation(s)
- Víctor Pérez
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain. Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Institute Mar of Medical Research, IMIM, Barcelona, Spain; Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Raúl Martínez-Navarro
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain. Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Adrián Pérez-Aranda
- Institute Mar of Medical Research, IMIM, Barcelona, Spain; Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain; Department of Basic Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain.
| | - Laura Martínez-Sadurní
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain. Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Francesc Colom
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain. Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Institute Mar of Medical Research, IMIM, Barcelona, Spain; Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Jesús Pujol
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain. Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Institute Mar of Medical Research, IMIM, Barcelona, Spain; Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Alba Toll
- Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain. Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain; Institute Mar of Medical Research, IMIM, Barcelona, Spain; Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Matilde Elices
- Institute Mar of Medical Research, IMIM, Barcelona, Spain; Centro de Investigación en Red de Salud Mental, CIBERSAM, Madrid, Spain
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Oon-Arom A, Likhitsathian S, Maneeton B, Sulaiman AH, Shih-Yen EC, Udomratn P, Chen CH, Srisurapanont M. Subjective depressive symptoms associated with pain in patients with major depressive disorder: Findings from the study on the aspect of Asian depression. Perspect Psychiatr Care 2020; 56:188-193. [PMID: 31148197 DOI: 10.1111/ppc.12403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/04/2019] [Accepted: 05/14/2019] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Awirut Oon-Arom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Edwin Chan Shih-Yen
- Singapore Clinical Research Institute, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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