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Volume 341:1329-1335 October 28, 1999 Number 18 Next

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ABSTRACT

Background Patients with depression, particularly those seen by primary care physicians, may report somatic symptoms, such as headache, constipation, weakness, or back pain. Some previous studies have suggested that patients in non-Western countries are more likely to report somatic symptoms than are patients in Western countries.

Methods We used data from the World Health Organization's study of psychological problems in general health care to examine the relation between somatic symptoms and depression. The study, conducted in 1991 and 1992, screened 25,916 patients at 15 primary care centers in 14 countries on 5 continents. A total of 5447 of the patients underwent a structured assessment of depressive and somatoform disorders.

Results A total of 1146 patients (weighted prevalence, 10.1 percent) met the criteria for major depression. The range of patients with depression who reported only somatic symptoms was 45 to 95 percent (overall prevalence, 69 percent; P=0.002 for the comparison among centers). A somatic presentation was more common at centers where patients lacked an ongoing relationship with a primary care physician than at centers where most patients had a personal physician (odds ratio, 1.8; 95 percent confidence interval, 1.2 to 2.7). Half the depressed patients reported multiple unexplained somatic symptoms, and 11 percent denied psychological symptoms of depression on direct questioning. Neither of these proportions varied significantly among the centers. Although the overall prevalence of depressive symptoms varied markedly among the centers, the frequencies of psychological and physical symptoms were similar.

Conclusions Somatic symptoms of depression are common in many countries, but their frequency varies depending on how somatization is defined. There is substantial variation in how frequently patients with depression present with strictly somatic symptoms. In part, this variation may reflect characteristics of physicians and health care systems, as well as cultural differences among patients.

Source Information

From the Center for Health Studies, Group Health Cooperative, Seattle (G.E.S., M.V.); Azienda Ospedaliera Ospedale de Circolo e Fondazione Macchi, Varese, and Dipartimento di Medicina e Sanita Pubblica, Servizio di Psicologia Medica, Istituto di Psichiatria, Universita de Verona, Verona — both in Italy (M.P.); Departamento de Psiquiatria y Salud Mental, Universidad de Chile, Santiago, Chile (C.F.); the Departments of Psychiatry and Health Sciences, University of Groningen, Groningen, the Netherlands (J.O.); and the Institute of Psychiatry, King's College, London (J.O.). The investigators who participated in the study are listed in the Appendix.

Address reprint requests to Dr. Simon at the Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101-1448, or at simon.g{at}ghc.org.

Full Text of this Article

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