Similarity of depression in diabetic and psychiatric patients.

Diabetic and psychiatric out-patients were studied to determine whether the symptom profile of depression was similar in medically ill and medically well subjects. The diagnosis of major depression was determined using psychiatric interviews and DSM-IIIR criteria. The 21-item Beck Depression Inventory (BDI) was used to characterize the prevalence and severity of depression symptoms, and the measure was divided into cognitive (13 symptoms) and somatic (eight symptoms) subsets. Seventeen (81%) of 21 symptoms (including 12/13 cognitive and 5/8 somatic symptoms) were not statistically different in prevalence or severity between the depressed diabetic patients (N = 41) and the depressed psychiatric patients (N = 68). Both of these depressed groups were significantly different from a nondepressed diabetic comparison group (N = 58) in the prevalence and severity of every BDI symptom except weight loss. These data show that the symptom profile of depression in diabetic patients (in particular the cognitive symptoms) is similar to that in depressed psychiatric patients and is readily differentiated from the symptom profile in nondepressed diabetic patients. Our observations support the diagnostic validity of the DSM-IIIR criteria for major depression in this medically-ill outpatient sample.     

Medical co-morbidity and validity of DSM-IV depression criteria

BACKGROUND: Clinicians have questioned the validity of depression criteria in patients with chronic medical illness, but few empirical data address this question. METHOD: Computerized records identified two samples of managed care patients beginning depression treatment: 235 with diabetes, ischemic heart disease, or chronic obstructive lung disease and 204 without those conditions. Telephone assessments at baseline, 2 months, and 6 months included the Structured Clinical Interview for DSM-IV and other measures of depression severity and functional status. Item Response Theory analyses compared patterns of depressive symptoms across groups and specifically evaluated somatic symptoms (fatigue, change in weight or appetite, psychomotor agitation/retardation, and sleep disturbance) as indicators of depression. Logistic regression examined how change in somatic symptoms during treatment varied between patient groups. RESULTS: Overall item response analysis indicated differential item functioning between groups (chi2=33.7, df=18, p=0.017). Two of eight item-level comparisons were statistically significant; one in the predicted direction (patients with co-morbidity reported more fatigue at low levels of depression: chi2=17.9, df=1, p<0.001) and one in the opposite direction from predicted (patients with co-morbidity reported less psychomotor agitation/retardation at low levels of depression: chi2=8.0, df=1, p=0.005). Observed differences were modest: at the midpoint of the depression severity scale, patients with medical co-morbidity had a 54% probability of reporting fatigue compared to 45% in those without co-morbidity. All four somatic symptoms showed robust improvement with treatment, and this improvement did not differ significantly between patients with and without medical co-morbidity. CONCLUSIONS: We find only limited evidence that fatigue, changes in weight or appetite, psychomotor agitation/retardation, and sleep disturbance are less valid indicators of depression in patients with chronic medical illness. DSM-IV criteria for diagnosis of depression do not require significant modification for patients with medical co-morbidity.     

Prevalence and association of somatic symptoms in patients with Major Depressive Disorder

BACKGROUND: Painful and non-painful somatic symptoms are often reported in patients with depressive disorder. The proper identification of depression-relevant somatic symptoms is important for the accurate diagnosis of depression, development of treatment strategies and measurement of outcome. The objective of this study was to characterize the relationship between somatic symptoms and depression in patients diagnosed with Major Depressive Disorder (MDD), using data from randomized drug trials carried out by a pharmaceutical company. METHODS: Pooled 'blinded' data from 2191 patients enrolled in randomized, multicenter, double-blind placebo-controlled studies for the treatment of MDD were analyzed. Somatic symptoms were assessed using the Somatic Symptoms Inventory (SSI) and the Hamilton Depression Rating Scale (HAMD) was used to assess symptoms of depression. RESULTS: The most common somatic symptom reported by patients with MDD was 'feeling fatigued, weak, or tired all over', with 78% of patients reporting 'moderate' levels or above. This was followed by 'feeling that not in as good physical health as most of your friends' (59%), 'not feeling well most of the time in the past few years' (54%), and 'feeling weak in parts of body' (45%). 'Headache' was the most common pain-related symptom with 43% reporting 'moderate' or above. Pearson's product-moment correlations revealed that somatic symptoms generally increased as a function of overall depressive (r=0.43), with 'feeling fatigued, weak, or tired all over' (r=0.50), 'feeling that not in as good physical health as most of your friends' (r=0.42), 'feeling weak in parts of body' (r=0.41), 'heavy feeling in arms and legs' (r=0.34), 'not feeling well most of the time in the past few years' (r=0.32), and 'headache' (r=0.31) showing the strongest correlation with overall HAMD scores. Non-parametric item response analyses showed that many somatic symptoms demonstrate good relationship between item response and the overall severity of depression. In particular, 'feeling fatigued, weak, or tired all over' exhibited good discriminative properties across the full range of severity for depression. LIMITATIONS: The analysis utilized data from a 'restricted' patient population in drug trials sponsored by a pharmaceutical company. CONCLUSIONS: These results demonstrate a high prevalence and association of somatic symptoms in patients with MDD, including feelings of fatigue, physical malaise and pain-related symptoms, which could be potentially useful in the assessment of depression and in the evaluation of treatment strategies.     

The validity of diagnosis of melancholic depression according to different diagnostic systems.

BACKGROUND: Melancholic versus nonmelancholic depression dichotomy is perhaps the most widely accepted distinction in categorization of depression. This research aims to compare RDC, DSM-III, DSM-III-R, DSM-IV and ICD-10 melancholic/endogenous/somatic and nomelancholic/nonendogenous/nonsomatic depressive patients with regards to biological variables thyroid stimulating hormone (TSH), basal and post dexamethasone cortisol levels, age, age of onset of depression, psychosocial stressors, and severity of depression. METHODS: Sixty-five patients who had been diagnosed as having major depression according to DSM III-R, using SCID were included in this study. Patients were divided into melancholic and nonmelancholic subtypes using RDC, DSM-III, DSM III-R, DSM-IV and ICD-10 criteria and groups were compared on the basis of biological variables, as well as age, psychosocial stressors and the severity of depression. RESULTS: RDC endogenous depressives were older, more severely depressed and had higher cortisol levels then RDC nonendogenous depressives. DSM III-R melancholics were older, more severely depressed, reported fewer numbers of psychosocial stressors and had lower levels of TSH than nonmelancholics. DSM-IV melancholics were more severely depressed, had higher basal and post dexamethasone cortisol levels and lower TSH levels. The ICD 10 somatic depression group contained more severe, older depressives with lower TSH levels. CONCLUSION: The results of this research show that different criteria may identify different groups of patients as having melancholic depression. They also partly support the hypothesis that endogenous or melancholic depression have a biological basis. LIMITATIONS OF STUDY: The study involved a relatively small sample size from a single centre and the results are based on this relatively small sample.     

浏阳市农村社区重症抑郁发作患者的症状特点

目的:探讨农村社区重症抑郁发作患者的症状特点.方法:以2007年3-5月浏阳市农村抑郁症抽样调查中筛查发现并确诊的重症抑郁发作患者234例为研究对象,由培训合格的调查员按照SCID的要求调查重症抑郁发作各症状发生情况.结果:在重症抑郁发作的9条症状阳性率依次为抑郁或情绪低落(96.6%)、兴趣或愉快感缺失(85.0%)、疲倦或精力缺失(84.6%)、睡眠变化(83.3%)、饮食或体重的变化(68.4%)、思考或集中注意力障碍(64.5%)、无价值感或不适当的自罪感(62.4%)、自杀意念或行为(37.2%)和精神运动激越或迟滞(27.4%),有7.7%的患者9项症状全部阳性.男性饮食和体重变化阳性率(76.7%)最著高于女性(63.5%);女性患者自杀意念和自杀未遂的阳性率(40.2%)显著高于男性(30.2%).躯体症状中最常见的是疲倦或精力缺失,其次是睡眠变化和食欲与体重改变,患者报告的平均睡眠时间只有4.53小时.结论:农村社区人群一些症状的阳性率低于临床患者,应进一步加强社区抑郁症患者的症状特点研究,提高抑郁症的主动就医率和临床识别与诊断率.     

Depression profile in patients with and without chronic heart failure

OBJECTIVE: Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF. METHODS: Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders. RESULTS: Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p< or =.001, and p=.04, respectively). LIMITATIONS: Our study population of CHF patients may not be representative for CHF patients recruited in the general population. CONCLUSIONS: The diagnostic features discriminating between depressed patients with and without CHF are the cognitive-emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.     

Are there any gender differences in frequency of self-reported somatic symptoms of depression?

BACKGROUND: The purpose of this study was to evaluate whether self-reported somatic symptoms of depression, as measured by the Beck Depression Inventory-II (BDI-II), are more frequent in women than in men with major depressive disorder. METHODS: A sample of 105 male and 105 female adult psychiatric outpatients diagnosed with major depressive disorder was classified according to endorsed changes in appetite, changes in sleeping pattern, and fatigue (i.e., "somatic depression") symptoms on the BDI-II. RESULTS: The female to male ratio of somatic symptoms was approximately 2:1. Subsequent analyses found that change in appetite robustly distinguished between women and men and that fatigue partially distinguished between women and men. LIMITATIONS: The sample was largely Caucasian and composed of patients with high rates of comorbidity who presented to a service known for specializing in cognitive therapy. CONCLUSIONS: In outpatients with major depressive disorder, the higher prevalence of "somatic depression" in women is largely attributable to changes in appetite.     

Prediction of major depression in Japanese adults: somatic manifestation of depression in annual health examinations

BACKGROUND: The present study examined whether somatic symptoms found in annual health examinations, could be predictive of major depression in the ensuing year. METHOD: Subjects analyzed were 1027 non-major-depressive workers (706 men, mean age 35) attending annual health examinations at a research institute. All were Japanese and found not to be suffering from major depression when interviewed, according to the semi-structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A self-administered questionnaire containing items relating to twelve major somatic symptoms was completed by all the subjects. The same DSM-IV interviews for the diagnosis of major depression were conducted to calculate the odds ratio of baseline variables for depressive and somatic symptoms, physical examination items, and health-related life-styles for the prediction of major depression in the ensuing year. RESULTS: The prevalence of major depression in the ensuing year was 2.5%. For four somatic symptoms (fatigue, lower back pain, dizziness, and nausea), the prevalence was higher (all p < 0.05) in those who complained of each somatic symptom at baseline than in those who did not. Furthermore, the multiple logistic regression analysis indicated that lower back pain and dizziness at baseline were independent risk factors of major depression in the ensuing year [odds ratio (95% confidence intervals), 3.2 (1.1, 8.9) and 6.0 (1.8, 20.1), respectively]. LIMITATIONS: It is possible that somatic manifestations of depression are culturally bound phenomena and results might be generalizable only to Japanese workers. CONCLUSION: Somatic symptoms reported at annual health examinations may be useful indicators for predicting major depression.     

Somatic symptom severity among primary care patients who are obese: examining the unique contributions of anxiety sensitivity,discomfort intolerance,and health anxiety

Prior research indicates the common presentation of somatic symptoms and obesity in primary care settings, as well as links between obesity and somatic symptoms. Anxiety sensitivity, discomfort intolerance, and health anxiety are three variables relevant to somatic symptoms. How those three variables relate to somatic symptom severity among individuals who are obese and the unique variance accounted for by each variable in somatic symptom severity remains unexamined. Among a large sample of primary care patients who are obese (N = 342), anxiety sensitivity, discomfort intolerance, and health anxiety collectively accounted for 35% of variance in somatic symptom severity beyond the effects of sociodemographic variables, body mass index, medical morbidity, and depression severity. Health anxiety accounted for the largest amount of unique variance in somatic symptom severity, potentially supporting the relevance of health anxiety to the presentation of increased somatic symptoms among patients who are obese.     

Suicidal ideation and the subjective aspects of depression

BackgroundSuicidal ideation is common in depression, but only moderately related to depression severity — in part because certain clusters of symptoms, such as those related to core mood disturbance, have a differential relationship to suicidal thinking.Methods400 medication free participants with current major depression were assessed with either or both the Hamilton Depression Rating Scale (HDRS, n = 396) and Beck Depression Inventory (BDI, n = 366), and the Scale for Suicide Ideation (SSI). Depression rating scales were decomposed into symptoms clusters previously reported (Grunebaum et al., 2005), in order to evaluate their association to suicidal thinking.ResultsCorrelations between overall depression severity ratings and the measure of suicidal ideation were modest, and reduced when specific items assessing suicidal thinking on these depression scales were removed. Symptom clusters assessing Psychic Depression (HDRS), Subjective Depression (BDI), and Self-Blame (BDI) were the strongest correlates of suicidal ideation; other somatic and vegetative symptoms had little or no association to suicidal ideation. Severity of these symptom clusters effectively discriminated those with (SSI > 0) and without (SSI = 0) ideation; severity of these symptom clusters was less strongly associated with the severity of ideation once ideation was present.LimitationsThis is a cross-sectional study, and the dynamic relationship between changes in the severity of various depressive symptoms and change in suicidal thinking remains to be explored.ConclusionsDepression severity is moderately associated with suicidal ideation, and accounted for primarily by core mood disturbance symptoms and self-punitive thinking. These associations may explain why suicide risk might remain high during treatment even though somatic and vegetative symptoms improve.     

Depression symptoms during pregnancy

Summary Pregnancy impacts common symptoms of major depressive disorder (MDD), such as energy, appetite, weight change, and sleep and somatic complaints. However, it is not known whether the presentation of depression during pregnancy is different from that at other times in women’s lives. This study compares the severity of symptoms of depression in 61 pregnant women with MDD (PD), 50 nonpregnant women with MDD (D), and 41 pregnant women without MDD (P). Despite equivalent overall depression severity, PD women had lower scores on suicidality, guilt, and early insomnia and higher scores on psychomotor retardation than D women. The severity of other depressive symptoms was similar in the two depressed groups. As expected on the basis of the selection criteria, overall depression severity and the severity of individual symptoms were significantly higher in the PD group than in the P group but effect sizes for somatic symptoms were smaller than for psychological symptoms. The results suggest that the profile of depression symptoms of women with MDD who are pregnant does not differ much from that of depressed nonpregnant women. Depressive symptoms, particularly psychological symptoms of depression, during pregnancy should be taken seriously and not be dismissed as a normal part of the pregnancy experience. Correspondence: Rachel Manber, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road Suite 3301, Stanford, CA 94305, USA     

躯体化障碍患者抑郁症状的对照研究

目的:了解躯体化障碍患者伴发抑郁症状的临床特征.方法:选取44例符合CCMD-3躯体化障碍诊断标准的患者(研究组)和 92例不伴躯体症状的抑郁症患者(对照组),分别用HAMD、SDS、SCL-90进行评定.结果:研究组HAMD认知障碍因子分及SCL-90人际关系、恐怖及偏执因子分低于对照组,临床以躯体性焦虑、胃肠道及疑病等症状为主,自罪、自杀、工作和兴趣减退、激越等症状较轻.结论:躯体化障碍的抑郁症状因躯体症状的掩盖而更易被忽视.     

Somatic symptoms in outpatients with major depressive disorder treated with fluoxetine

Among patients with major depressive disorder (MDD), physical and somatic symptoms are associated with a high degree of disability and healthcare utilization. However, little is known regarding the treatment of these symptoms with standard pharmacotherapy. To measure somatic symptoms of depression, the authors administered The Symptom Questionnaire (Kellner) before and after 8 weeks of open-label treatment with fluoxetine, 20 mg/day, in 170 MDD outpatients (mean age: 40.4 years). Somatic symptom scores decreased significantly after fluoxetine treatment. The degree of reduction in somatic symptoms was significantly and positively correlated with the degree of improvement in depressive symptoms as measured by the 17-item Hamilton Rating Scale for Depression (Ham-D). Somatic symptom scores at baseline did not predict the degree of reduction in Ham-D scores during treatment. However, fluoxetine-remitters had significantly lower somatic symptom scores at end-point than responders who did not remit. Taken together, these findings suggest that developing treatment strategies that successfully target somatic symptoms of depression may further improve the ability to treat depression to remission.     

Delineating psychopathologic clusters within dysthymia: a study of 512 out-patients without major depression

BACKGROUND: The literature indicates that emotional-cognitive symptoms are much more characteristic of dysthymia than the vegetative and psychomotor symptoms of major depression, yet this is insufficiently emphasized in the official criteria listed in the criteria of the American Psychiatric Association. Furthermore, as previous studies have examined these symptoms more in relation to prevalence than to possible symptom aggregation, in the present analyses we address both aspects. METHODS: In two multicenter collaborative trials, 512 out-patients meeting the symptom criteria of DSM-III-R dysthymia but without major depression were recruited. In this respect they conformed to the conceptual framework of ICD-10 which tends to restrict dysthymia to a subthreshold depression without excursion into severe depressive episodes. The Montgomery Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale (HAM-A) were used to assess depressive and anxiety symptoms. RESULTS: Symptoms most frequently observed, besides depressed mood (100% by definition), were 'low energy or fatigue' (96%) and 'poor concentration or indecisiveness' (88%), followed by 'low self-esteem' (80%), 'insomnia or hypersomnia' (77%), 'poor appetite or overeating' (69%) and 'feeling of hopelessness' (42%). Interestingly, in the subjects with fewer than five symptoms, the most frequent were low energy or fatigue (93%), poor concentration or indecisiveness (79%) and low self-esteem (77%), the other symptoms being present in no more than half the sample. MADRS factor analysis identified two main factors: the first consisting of apparent and reported sadness, and the second concentration difficulties and lassitude. HAM-A factor analysis identified two factors clearly differentiating somatic and psychic symptoms. LIMITATIONS: Because suicidal patients were excluded on the ground of human subject concerns, our sample is representative of the milder range of symptomatology within the spectrum of dysthymia. This may in part explain the low prevalence of neurovegetative symptoms. CONCLUSION: Despite this, the present study involves the largest sample of pure dysthymia ever studied. Our results indicate that dysthymic disorder appears to primarily involve psychologic symptoms. The psychological symptoms themselves seem to cluster into sadness versus mental fatigue; as for anxiety symptoms, they appear divisible into somatic and psychic clusters, with the latter prevailing in dysthymia. Dysthymia proper, dominated by negative affectivity, might be distinguishable from a 'neurasthenic' subform dominated by low energy or 'deficit' symptoms at mental and physical levels.     

Do Somatic Symptoms Predict the Severity of Depression? A Validation Study of the Korean Version of the Depression and Somatic Symptoms Scale

This study aimed at exploring the psychometric characteristics of the Korean Version of the Depression and Somatic Symptoms Scale (DSSS) in a clinical sample, and investigating the impact of somatic symptoms on the severity of depression. Participants were 203 consecutive outpatients with current major depressive disorders (MDD) or lifetime diagnosis of MDD. The DSSS was compared with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the 17-items Hamilton Depression Rating Scale (HAMD). The DSSS showed a two-factor structure that accounted for 56.8% of the variance, as well as excellent internal consistency (Cronbach’s alpha = 0.95), concurrent validity (r = 0.44–0.82), and temporal stability (intraclass correlation coefficient = 0.79). The DSSS had a high ability to identify patients in non-remission (area under receiver operating characteristic [ROC] curve = 0.887). Maximal discrimination between remission and non-full remission was obtained at a cut-off score of 22 (sensitivity = 82.1%, specificity = 81.4%). The number of somatic symptoms (the range of somatic symptoms) and the scores on the somatic subscale (SS, the severity of somatic symptoms) in non-remission patients were greater than those in remission patients. The number of somatic symptoms (slope = 0.148) and the SS score (slope = 0.472) were confirmed as excellent predictors of the depression severity as indicated by the MADRS scores. The findings indicate that the DSSS is a useful tool for simultaneously, rapidly, and accurately measuring depression and somatic symptoms in clinical practice settings and in consultation fields.     

抑郁症躯体疼痛症状与述情障碍的研究

目的 研究抑郁症躯体疼痛症状与述情障碍之间的关系,进一步探讨影响躯体疼痛症状的因素.方法 将56例抑郁症患者分为无躯体症状组(单纯组),非疼痛躯体症状组(躯体症状组),疼痛躯体组(疼痛组),采用自编基本资料调查表、SCL-90症状自评量表、汉密尔顿抑郁量表(HAMD)、多伦多述情障碍量表(TAS-20)、疼痛等级评价量...     

42例肿瘤患者术后焦虑和抑郁障碍的临床分析

目的探讨肿瘤患者术后焦虑和抑郁障碍的临床特征,为正确诊断和及时治疗焦虑和抑郁症提供临床依据。方法用前瞻性方法对42例恶性肿瘤并发焦虑及抑郁障碍患者进行临床特点和相关因素的分析;治疗前后焦虑量表（HAMA）和抑郁量表（ZUNG）评分分析。结果肿瘤患者中,发生焦虑和抑郁障碍最主要的躯体症状为睡眠障碍,其次为乏力、出汗、心慌、心悸、头痛、胃肠不适。结论以失眠为突出表现的躯体症状发病是肿瘤患者发病特点;乳腺癌及术后发病率较其他肿瘤患者高。抗焦虑及抑郁治疗疗效显著。     

Daily Fluctuation in Chronic Fatigue Syndrome Severity and Symptoms

The present study characterized 46 chronic fatigue syndrome (CFS) patients' experiences of CFS and compared these patients with 11 healthy control participants. Chronic fatigue syndrome patients reported more symptoms of CFS, distress, and functional impairment than the controls. These heightened symptoms remained relatively stable over time within the patient group. However, within individual patients, there were daily fluctuations in symptom reporting, indicating that some days were better than others. Additionally, there was a close association between CFS symptoms and reports of perceived stress and negative affect in the patient group. These results demonstrate the usefulness of the Daily Record Form for assessing symptom severity in CFS patients.     

Comparison of the effects of depressive symptoms and apnea severity on fatigue in patients with obstructive sleep apnea: a replication study

BACKGROUND: Links between fatigue and depressive symptoms in medically ill patients are well-documented; however, few studies controlled for illness severity. Obstructive sleep apnea (OSA) is a common, frequently devastating disease that often includes daytime sleepiness and fatigue. Fatigue is also a hallmark depressive symptom. We previously reported that depressive symptoms explained ten times the variance in fatigue in OSA patients as did OSA severity itself (respiratory disturbance index, oxyhemoglobin saturation). OSA severity explained 4.2% of variance in fatigue while depressive symptoms explained an additional 42.3%. Here, we report a replication of these findings in a new, independent sample. METHODS: 56 untreated OSA patients had their sleep monitored with polysomnography on the UCSD GCRC. Participants completed the Center for Epidemiologic Studies-Depression (CESD), Profile of Mood States (POMS) and Medical Outcomes Studies (MOS) surveys. Data were analyzed using hierarchical linear regression. RESULTS: OSA severity explained 13.4% (p=0.022) of variance in POMS fatigue while CESD scores explained an additional 24.5% (p<0.001). Results were robust to changes in the scales used to measure these constructs. LIMITATIONS: Cross-sectional design precludes determination of direction of causality. Assessment of depressive symptoms and fatigue was based on validated self-report measures. CONCLUSIONS: These results reaffirm that depressive symptoms are dramatically and independently associated with worse fatigue in OSA patients. While the independent contribution of OSA severity varied between studies, depressive symptoms were the strongest predictor of fatigue in both studies. Assessment and treatment of mood symptoms-not just treatment of OSA itself-might reduce fatigue in these patients.     

The relation between anger management style and organ system-related somatic symptoms in patients with depressive disorders and somatoform disorders

PURPOSE: The objective of this study was to examine the relation between anger management style and organ system- related somatic symptoms in depressive disorder and somatoform disorder patients. MATERIALS AND METHODS: The subjects included 73 patients with depressive disorders and 47 with somatoform disorders. Anger management styles were assessed by the Anger Expression Scale, while the severity of organ system-related somatic symptoms was evaluated using the Somatic Stress Response Scale (SSRS). The severity of depression and hostility was assessed by the Symptom Checklist-90-Revised (SCL-90-R) depression and hostility subscales. RESULTS: The results of multiple regression analyses showed that, in depressive disorder patients, the level of anger expression was significantly associated with the severity of somatic symptoms related to neuromuscular, cardiorespiratory and gastrointestinal systems. However, in these patients, the level of anger suppression was not significantly associated with the severity of somatic symptoms related to any specific organ systems. In patients with somatoform disorders, there was no significant association between the level of anger suppression or anger expression and the severity of the somatic symptoms related to any specific organ systems. CONCLUSION: These results suggest that, in depressive disorder patients, anger expression is likely to be predominantly involved in the neuromuscular, cardiorespiratory and gastrointestinal organ systems. However, in each of depressive disorder and somatoform disorder patients, anger suppression is not likely to be associated with any specific organ systems.