The level of recognition of physical symptoms in patients with a major depression episode in the outpatient psychiatric practice in Puerto Rico: an observational study

Abstract

Background: This study was designed to evaluate the psychiatrists' level of recognition of somatic symptoms associated to a major depressive episode (MDE) (DSM-IV-TR criteria) and the impact of those somatic symptoms on the treatment effectiveness.

Methods: This non-interventional study was conducted in 25 medical offices in Puerto Rico from February to December 2003. It had 2 visits separated by 8 weeks. The level of recognition was determined by: the correlation between the physician clinical evaluation and their patients' self-evaluations through different validated instruments using kappa statistics. Chi-square test was used to evaluate the impact of somatic symptoms on treatment antidepressants' effectiveness.

Results: All the 145 recruited patients reported the presence of at least one somatic symptom associated with their current MDE. In the two visits covered by the study, a fair agreement between the psychiatrists' and the patients' reports was noted for headache, abdominal pain and upper limb pains (0.4003 <or= kappa >or= 0.6594). For other painful symptoms and painless somatic symptoms, the Kappa values obtained were non-significant. Slight but significant reductions in depression and painful symptoms severity were observed after 8 weeks of treatment. A proportional relationship between the pain and depression severity was observed (p < 0.0001).

Conclusion: The study results show that somatic symptoms: are very common in depressed Puerto Rican patients; are significant under-reported by psychiatrists; and have a significant impact on the antidepressant effectiveness.

Figure 1

Analysis of the SSI total score related to the mean CGI-S score. The patients were divided into two groups according to their degree of discomfort with their somatic symptoms: minimum (≤ 52) (n = 29) and moderate/high (>52) (n = 50). CGI-S is measured from 1 to 7, where "1" corresponds to the absence of depressive symptoms and "7" to the greatest possible severity of depressive symptoms. Abbreviations: SSI – Somatic Symptom Inventory; CGI-S – Clinical Global Impression of Severity. *p < .001

Figure 2

Relationship between pain severity and depression improvement (patient report). Regression analysis shows an inversely proportionate relationship between the severity of the pain reported by the patients and the level of improvement from the major depressive episode according to the patients' global impression (PGI-I) (n = 87). Abbreviations: VAS – Visual Analogue Scale; PGI-I – Patient Global Impression of Improvement.