THE EVALUATION OF SOMATIC SYMPTOMS IN MAJOR DEPRESSIVE DISORDER - Evaluarea simptomelor somatice in tulburarea depresiva majora - Alina Beldie, Elena Calinescu

Alina Beldie*, Elena Calinescu**

 

Abstract

Background: Somatic symptoms are highly prevalent in major depressive disorder, presented in rates that are comparable to those of the psychological symptoms. Compared with patients with depression alone, those with depression and somatic symptoms are significantly less likely to seek mental health specialty care and are more likely to incur high health care costs with additional investigations and use alternative treatments with questionable effectiveness. Furthermore, patients suffering with Major Depressive Disorder somatic symptoms are associated with a high degree of  socio-professional disability.

Objective: To assess the relationship between somatic symptoms and severity of depression in patients diagnosed with Major Depressive Disorder.

Method: The study inclued 98 patients meeting the DSM-IV TR criteria for Major Depressive Disorder, withouth comorbid somatic disorder by the time of evalutions. Somatic symptoms were evaluated using the 26-item Somatic Symptoms Inventory (SSI) and the severity of depression was assessed using the 24-item Hamilton Depression Rating Scale (HAMD).

Results: The majority of studied patients reported somatic symptoms, the most frequent of those beeing “feeling fatigued, weak, or tired all over” with 63% of patients reporting sever level, followed by “feeling in not  as good physical health as most of your friends” and “headache” was the most common of pain-related symptoms. Pearson’s correlation indicates a strong correlation between SSI and HAM-D(r=0.660) and between some items of SSI such as feeling fatigued, weak, or tired all over” (r=0.64),feeling not in as good physical health as friends” (r=0.52), “headaches” (r=0.50).

Conclusion: The results demonstrate a significant association of somatic symptoms with depression in patients with Major Depressive Disorder. In this context, the evaluation of somatic symptomatology, could be useful in recognizing of depression, in its severity assessment and in development of treatment strategies.

Key words: Major Depressive Disorder, somatic symptoms, pain.

 

Rezumat

Context: Simptomele somatice sunt manifestari frecvent întâlnite în tulburarea depresiva majora, prevalenta lor fiind comparabila cu cea a simptomelor psihologice. În comparatie cu pacientii depresivi care prezinta doar simptome psihosociale, cei care acuza si simptome somatice, au o probabilitate mult mai mica de a consulta  serviciile de sanatate mintala si o probabilitate mult mai mare de a realiza costuri suplimentare pentru investigatii medicale sau de a utiliza tratamente alternative cu eficacitate îndoielnica.

Obiectiv: evalueze relatia dintre simptomele somatice si severitatea depresiei la pacientii diagnosticati cu tulburare depresiva majora.

Metoda: Studiu a cuprins 100 pacienti diagnosticati cu tulburare depresiva majora conform criteriilor DSM-IV TR, fara afectiuni somatice prezente la momentul evaluarilor. Simptomele somatice au fost evaluate cu ajutorul Inventarului Simptomelor Somatice (SSI) cu 26 itemi (Barsky AJ) iar severitatea depresiei a fost estimata folosind Scara de Depresie Hamilton (HAM-D) cu 24 itemi.

Rezultate: Majoritatea pacientilor studiati au raportat simptome somatice, cel mai iportant dintre acestea fiind reprezentat de „oboseala, slabiciune, epuizare cea mai mare parte a timpului” 63% dintre pacienti raportand un nivel crescut de severitate. Al doilea ca frecventa a fost „sentimentul de a nu fi într-o forma fizica la fel de buna ca majoritatea prietenilor”; iar cefaleea a fost cel mai comun dintre simptomele algice. Coeficientului Pearson indica o corelatie puternica intre scorurile SSI si HAM-D(r=0.660), dar si între anumiti itemi ai SSI si HAM-D cum ar fi: oboseala, slabiciune, epuizare” (r=0.64), „sentimentul de a nu fi într-o forma fizica la fel de buna ca majoritatea prietenilor” (r=0.52), headaches” (r=0.50).

Concluzii: Rezultatele demonstreaza o asociere semnificativa între acuzele somatice si tulburarea depreresiva majora. În acest context, evaluarea simptomatologiei somatice poate fi utila în diagnosticarea si estimarea severitatii acestei tulburari precum si în dezvoltarea de strategii terapeutice.

Cuvinte cheie: tulburarea depresiva majora, simptome somatice, durere.

 

* Fourth year resident Clinical Psychiatric Hospital “Prof. Dr. Alexandru Obregia”, Bucharest alinabeldie@yahoo.com

** Third year resident Clinical Psychiatric Hospital “Prof. Dr. Alexandru Obregia”, Bucharest

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