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Prevalence, Characteristics, and Attribution of Somatic Symptoms in Spanish Patients With Major Depressive Disorder Seeking Primary Health Care

Received December 12, 2006; revised March 16, 2007; accepted March 20, 2007. From the Psychiatry Department, Hospital Puerta de Hierro, Madrid; Centro de Atención Primaria Constanté, Tarragona; the Psychiatry Dept, Hospital Miguel Servet, Zaragoza, the Dept. of Preventive Medicine and Public Health, School of Medicine, Universidad Autonóma de Madrid; the Dept. of Psychiatry. Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid; and the Clinical Research Department, Lilly, SA, Madrid, Spain. Dr. Eduardo Gómez Utrero is currently affiliated with the Dept. of Neurophysiology, Hospital de Móstoles, Madrid, Spain. Send correspondence and reprint requests to Irene Romera, M.D., Clinical Research Department, Lilly, SA, Avenida de la Industria, 30, Alcobendas E-28108, Madrid, Spain. e-mail: romerai{at}lilly.com
© 2008 The Academy of Psychosomatic Medicine

BACKGROUND: Somatic symptoms (SS) tend to dominate clinical symptomatology in patients with depression in primary care. OBJECTIVE: The authors performed a cross-sectional nationwide epidemiological study on 1,150 primary-care patients with major depression and evaluated the prevalence of SS and physicians’ attribution of their origin. METHOD: Patients were administered the Structured Polyvalent Psychiatric Interview. RESULTS: Ninety-three percent of patients had at least one SS fully or partially attributed to depression, and 45% of patients had four to nine. Painful symptoms, despite being the most frequent, were the least often attributed to depression (fewer than 25% of patients with pain) and significantly more often attributed to a combined origin. CONCLUSION: Results suggest that primary-care physicians tend to associate pain with depression to a significantly lesser extent than any other somatic symptom (e.g., cardiopulmonary or gastrointestinal). Therefore, special attention should be given to painful symptoms in order to ensure efficient management of depression in primary care.

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