Association between Painful Physical Symptoms and Clinical Outcomes in Korean Patients with Major Depressive Disorder: A Three-Month Observational Study

Abstract

Objective: This paper aims to examine the association between painful physical symptoms (PPS) and major depressive disorder (MDD) in a naturalistic clinical practice setting within a Korean population.

Methods: Patients with acute MDD that joined a multicountry, observational, three-month study in six Asian countries and regions were classified as PPS+ (mean score >/=2) and PPS- (mean score <2) using the modified Somatic Symptom Inventory. In this analysis, we report the results from the Korean subset, where depression severity was assessed using the Clinical Global Impression of Severity (CGI-S) scale and 17-item Hamilton Depression Rating Scale (HAMD(17)). Pain severity was measured using a visual analogue scale (VAS), while the EuroQoL (EQ-5D) assessed patient well-being.

Results: Of 198 patients, 45.96% (91/198) of patients were classified as PPS+, of which 78.02% (71/91) were women. PPS+ patients had significantly more severe depression at baseline {CGI-S score, mean [standard deviation (SD)], PPS+: 5.09 [0.79]; PPS-: 4.63 [0.76]; p<0.001; HAMD(17) total score, mean [SD], PPS+: 24.34 [5.24]; PPS-: 20.76 [5.12]; p<0.001} and poorer quality of life [EQ-5D overall health state, mean (SD), PPS+: 39.37 (20.52); PPS-: 51.27 [20.78]; p<0.001] than PPS- patients. Both groups improved significantly (p<0.001) in depression and pain severity outcomes, as well as quality of life by endpoint, but no significant within-group baseline-to-endpoint change wase observed.

Conclusion: The frequency of PPS was common in Korean patients with MDD, and was associated with more severe depression, poorer quality of life, and a trend towards poorer clinical outcome.

Keywords: Culture; Depression; Depressive disorder; Korea; Major; Pain; Quality of life.

FIGURE 1

Adjusted mean change from baseline to endpoint in CGI-S total score. ^ap-value for adjusted mean difference [0.15, 95% CI (-0.21, 0.51)] using Type III Sums of Squares from analysis of covariance (ANCOVA) model: change=PPS group, propensity score and baseline. ^*Within group p-value (p<0.001) from ANCOVA model: change=PPS group, propensity score and baseline. PPS+: painful physical symptom positive group, PPS-: remainder of study population, CGI-S: Clinical Global Impressions of Severity Scale, n: number of patients in each group, CI: confidence interval.

FIGURE 2

Adjusted mean change from baseline to endpoint in HAMD₁₇ total score, anxiety/somatization and core mood. ^ap-values for adjusted mean differences [HAMD₁₇ total score=0.41, 95% CI (-1.69, 2.51); Anxiety/somatization subscore=0.28, 95% CI (-0.59, 1.16); Core mood subscore=0.36, 95% CI (-0.47, 1.19)] using Type III Sums Of Squares from analysis of covariance (ANCOVA) model: change=PPS group, propensity score and baseline. ^*Within group p-value (p<0.001) from ANCOVA model: change=PPS group, propensity score and baseline, and is the same for HAMD₁₇ total score and both subscores that are presented here. PPS+: painful physical symptom positive group, PPS-: remainder of study population, HAMD₁₇: 17-item Hamilton Depression Rating Scale, CI: confidence interval.

FIGURE 3

Adjusted mean change from baseline to endpoint in VAS overall and subscales. ^ap-values for adjusted mean difference using Type III Sums Of Squares from analysis of covariance (ANCOVA) model: change=PPS group, propensity score and baseline. ^*Within group p-value from ANCOVA model: change=PPS group, propensity score and baseline. PPS+: painful physical symptom positive group, PPS-: remainder of study population, VAS: Visual Analog Scale, CI: confidence interval.