Functional impairment related to painful physical symptoms in patients with generalized anxiety disorder with or without comorbid major depressive disorder: post hoc analysis of a cross-sectional study

Abstract

Background: Generalized anxiety disorder (GAD) is the most frequent anxiety disorder in primary care patients. It is known that painful physical symptoms (PPS) are associated with GAD, regardless the presence of comorbid major depressive disorder (MDD). However the specific role of such symptoms in patients' functional impairment is not well understood. The objective of the present study is to assess functional impairment related to the presence of PPS in patients with GAD.

Methods: This is a post hoc analysis of a cross-sectional study. Functioning, in the presence (overall pain score >30; Visual Analog Scale) or absence of PPS, was assessed using the Sheehan Disability Scale (SDS) in three groups of patients; 1) GAD and comorbid MDD (GAD+MDD+), 2) GAD without comorbid MDD (GAD+MDD-), 3) controls (GAD-MDD-). ANCOVA models were used.

Results: Of those patients with GAD+MDD+ (n = 559), 436 (78.0%) had PPS, compared with GAD+MDD- (249 of 422, 59%) and controls (95 of 336, 28.3%). Functioning worsened in both GAD groups in presence of PPS (SDS least squares mean total score: 16.1 vs. 9.8, p < 0.0001, GAD+MDD+; 14.3 vs. 8.2, p < 0.0001, GAD+MDD-). The presence of PPS was significantly associated with less productivity.

Conclusions: Functional impairment related to the presence of PPS was relevant. Clinical implications should be considered.

Figure 1

Patient disposition. Abbreviations: HADS-A = Hospital Anxiety and Depression Scale-Anxiety subscale; GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms.

Figure 2

Functioning (SDS total score) by the presence of PPS in patients with GAD, with or without co-morbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms; SDS = Sheehan Disability Scale, SD = Standard deviation; LSM = Least square mean.

Figure 3

Underproductive days/weeks by the presence of PPS in patients with GAD, with or without comorbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms, SD = Standard deviation; LSM = Least square mean; ANCOVA = Analysis of covariance.

Figure 4

Quality of life (EuroQoL-5D total score) by the presence of PPS in patients with GAD, with or without comorbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms; SD = Standard deviation.