Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-19T11:01:04.125Z Has data issue: false hasContentIssue false
  • English
  • Français

Somatic Symptoms of Depression and Anxiety in the Western Pacific Region: Questions and Answers

Published online by Cambridge University Press:  07 November 2014

David M. Clarke ,
Ahmad Hatim ,
Brian Ho ,
Jiyang Pan ,
Chee Ng ,
Kang-Seob Oh ,
Wu Wenyuan  and
Mak Ki-Yan
David M. Clarke
Affiliation:
Dr. David M. Clarke, MBBS, PhD, FRANZCP, is professor in the Department of Psychological and Behavioural Medicine at Monash Medical Centre in Melbourne. Dr. Clarke is a consultant to Wyeth.
Ahmad Hatim
Affiliation:
Ahmad Hatim, MBBS, MPM, is associate professor at, the University of Malaya in Kuala Lumpur. Dr. Hatim is a consultant to Janssen-Cilag, Lundbeck, and Servier; is on the advisory board of AstraZeneca, Janssen-Cilag, and Wyeth; and has received honoraria from Eli Lilly, GlaxoSmithKline, Johnson & Johnson, and Pfizer.
Brian Ho
Affiliation:
Brian Ho, FRCPsych, MPM, MBBS, is associate professor of psychiatry at, Universiti Putra Malaysia in Kuala Lumpur. Dr. Ho is a consultant to and/or on the advisory boards of Janssen-Cilag and Wyeth; and has received honoraria from AstraZeneca and Lundbeck.
Jiyang Pan
Affiliation:
Jiyang Pan, MD, is professor of psychiatry and chairman of the Department of Psychiatry in, the First Affiliated Hospital of Jinan University in Guangzhou. Dr. Pan is a consultant to GlaxoSmithKline, Johnson & Johnson, and Wyeth.
Chee Ng
Affiliation:
Chee Ng, MBBS, MMed, MD, FRANZCP, is associate professor in the Department of Psychiatry at, the University of Melbourne. Dr. Ng is a consultant to and on the advisory boards of Eli Lilly and Wyeth; and has received honoraria from Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, and Wyeth.
Kang-Seob Oh
Affiliation:
Kang-Seob Oh, MD, PhD, is department director of the Department of Psychiatry, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan UniversityDr. Oh reports no affiliation with or relevant financial interest in any organization that may pose of conflict of interest.
Wu Wenyuan
Affiliation:
Wu Wenyuan, MD, is professor in the Department of Psychiatry at, Tongji Univiversity in Shanghai. Dr. Wu reports no affiliation with or relevant financial interest in any organization that may pose of conflict of interest.
Mak Ki-Yan
Affiliation:
Mak Ki-Yan, MBBS, DPM, MHA, MD, FRCPsych, is honorary professor in the Department of Psychiatry at, the University of Hong Kong. Dr. Mak reports no affiliation with or relevant financial interest in any organization that may pose of conflict of interest.
Get access Rights & Permissions [Opens in a new window]

Extract

It is a commonly held belief among mental health care providers that patients from the Western Pacific region with major depressive disorder (MDD) and anxiety disorders disproportionately present with somatic symptoms as opposed to emotional symptoms. Cultural norms, such as the stigma associated with psychiatric disorders, may lead members of this population to ignore the emotional aspects of these disorders or deny the presence of psychological symptoms. Empirical support is provided by the lower prevalence of these disorders in some Western Pacific nations in relation to the rest of the world. For example, MDD rates in India (9%), Japan (2%), China (2% to 4%), Malaysia (8%) and Australia (3%) are generally lower than rates in the United States (16%) and worldwide (10%). These discrepancies may be the result of missed diagnoses. Misdiagnosis is related to the increased somatization of MDD symptoms in these populations. As defined by the WHO, the Western Pacific region consists of 37 countries with a total population of 1.8 billion people (1.3 billion in China alone) with diverse cultural backgrounds and demographic profiles, which makes the issue of cultural effects on MDD diagnosis more complex.

Patients with MDD or anxiety disorders worldwide often present with somatic symptoms, which frequently accompany psychological symptoms. For example, in a recent report of pooled data from Canada, scores on the Somatic Symptoms Inventory, the 17-item Hamilton Rating Scale for Depression (HAM-D17), and the Hamilton Rating Scale for Anxiety (HAM-A) were used to evaluate the association between somatic symptoms and MDD. Of the 2,191 patients randomly enrolled in the study, 78% reported moderate-to-severe fatigue and weakness. Painful physical symptoms commonly occur in patients with anxiety disorders as well. In a European study, painful physical symptoms were reported by 28% of those without anxiety disorders and 45% of those with anxiety disorders.

Type
Research Article
Information
CNS Spectrums , Volume 14 , Issue S4 , March 2009 , pp. 1 - 8
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Simon, GE, VonKorff, M, Piccinelli, M, et al.An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999;341(18):1329–1335.CrossRefGoogle Scholar
2.Xiao, S, Yan, HQ, Lu, YF, et al.World Health Organization collaborative study on psychological disorders in primary health care: the results from Shangai. Chin J Psychiatry. 1997;30(2):90–94.Google Scholar
3.Sherina, MS, Rampal, L, Mustaqim, A. The prevalence of depression among the elderly in Sepang, Selangor. Med J Malaysia. 2004;59(1):45–49.Google ScholarPubMed
4.Wilhelm, K, Mitchell, P, Slade, T, et al.Prevalence and correlates of DSM-IV major depression in an Australian national survey. J Affect Disord. 2003;75(2):155–162.CrossRefGoogle Scholar
5.Kessler, RC, Berglund, P, Demler, O, et, al, and the National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–3105.Google Scholar
6.World Health Organization Regional Office for the Western Pacific. Countries and areas. Available at: www.wpro.who.int/countries/countries.htm. Accessed March 25, 2009.Google Scholar
7.Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.Google Scholar
8.Hamilton, M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50–55.CrossRefGoogle ScholarPubMed
9.Vaccarino, AL, Sills, TL, Evans, KR, Kalali, AH. Prevalence and association of somatic symptoms in patients with Major Depressive Disorder. J Affect Disord. 2008;110(3):270–276.CrossRefGoogle ScholarPubMed
10.Demyttenaere, K, Bonnewyn, A, Bruffaerts, R, et al.Comorbid painful physical symptoms and anxiety: Prevalence, work loss and help-seeking. J Affect Disord. 2008;109(3):264–272.Google Scholar
11.Yen, S, Robins, CJ, Lin, N. A cross-cultural comparison of depressive symptom manifestation: China and the United States. J Consult Clin Psychol. 2000;68(6):993–999.CrossRefGoogle ScholarPubMed
12.Parker, G, Gladstone, G, Chee, KT. Depression in the planet's largest ethnic group: the Chinese. Am J Psychiatry. 2001;158(6):857–864.Google Scholar
13.Beard, GM. Neurasthenia or nervous exhaustion. Boston Med Surg J. 1869;3:217–221.Google Scholar
14.Kleinman, A. Neurasthenia and depression: a study of somatization and culture in China. Cult Med Psychiatry. 1982;6(2):117–190.Google Scholar
15.Li, C, Tang, W, Wang, W, et al.The proportion of pain symptoms among patients with depression in Shanghai, China: A pilot survey and from some cultural understanding. Paper presented at: Chinese-German Congress on Psychotherapy; May 20-23, 2007; Shanghai, China.Google Scholar
16.Cheung, FM, Lau, BW, Waldmann, E. Somatization among Chinese depressives in general practice. Int J Psychiatry Med. 1980;10(4):361–374.CrossRefGoogle ScholarPubMed
17.Wu, W, Ji, J. Mental Health Care in General Hospital. Shanghai, China: Shanghai Scientific and Technological Literature Publishing House; 2001.Google Scholar
18.Ma, H, Sun, S, Wang, F, et al.An investigation of health care-seeking behavior in nonpsychiatric departments in 200 patients with mental disorders. J Clin Psychol Med. 2002;12(5):280–281.Google Scholar
19.Chen, P, Chen, C. Diagnosis and treatment of 153 cases of neurosis in endocardial department in general hospital. Guangdong Med J. 2001;22(7):610–611.Google Scholar
20.Ma, L, Xu, L, Zhang, Z, et al.Analysis of diagnosis and misdiagnosis of depression in out-patient department in general hospital. Chinese J Behavioral Med Sci. 2001;10(4):348–349.Google Scholar
21.Zhang, J. Elevating the reconcilability of depression in general hospital is imperative. Chinese J Psychiatry. 1997;30(4):195.Google Scholar
22.Kirmayer, LJ, Young, A. Culture and somatization: clinical, epidemiological, and ethnographic perspectives. Psychosom Med. 1998;60(4):420–430.Google Scholar
23.Gureje, O, Simon, GE, Ustun, TB, Goldberg, DP. Somatization in cross-cultural perspective: a World Health Organization study in primary care. Am J Psychiatry. 1997;154(7):989–995.Google ScholarPubMed
24.Mak, WW, Zane, NW. The phenomenon of somatization among community Chinese Americans. Soc Psychiatry Psychiatr Epidemiol. 2004;39(12):967–974.Google Scholar
25.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
26.Emptage, NP, Sturm, R, Robinson, RL. Depression and comorbid pain as predictors of disability, employment, insurance status, and health care costs. Psychiatr Serv. 2005;56(4):468–474.Google Scholar
27.Ng, C, Klimidis, S. Cultural factors and the use of psychotropic medications. In: Ng, CH, Lin, KM, Singh, B, Chiu, E, eds. Ethno-psychopharmacology: Advances in Current Practice. New York, NY: Cambridge University Press; 2008:123–134.Google Scholar
28.Salmon, P, Humphris, GM, Ring, A, et al.Primary care consultations about medically unexplained symptoms: patient presentations and doctor responses that influence the probability of somatic intervention. Psychosom Med. 2007;69(6):571–577.Google Scholar
29.Parker, G, Chan, B, Tully, L. Depression and help-seeking in a western sample of ‘highly acculturated’ Chinese and controls. J Affect Disord. 2006;94(1-3):239–242.CrossRefGoogle Scholar
30.Yates, WR, Mitchell, J, Rush, AJ, et al.Clinical features of depressed outpatients with and without co-occurring general medical conditions in STAR*D. Gen Hosp Psychiatry. 2004;26(6):421–429.CrossRefGoogle ScholarPubMed
31.Halbreich, U, Kahn, LS. Atypical depression, somatic depression and anxious depression in women: are they gender-preferred phenotypes? J Affect Disord. 2007;102(1-3):245–258.CrossRefGoogle ScholarPubMed
32.Piccinelli, M, Simon, G. Gender and cross-cultural differences in somatic symptoms associated with emotional distress. An international study in primary care. Psychol Med. 1997;27(2):433–444.Google Scholar
33.Clarke, DM, Piterman, L, Byrne, C, Austin, D. Somatic symptoms, hypochondriasis and psychological distress: a study of somatisation in Australian general practice. Med J Aust. 2008;189(10):560–564.Google Scholar
34.Adelman, LC, Adelman, JU, Von Seggern, R, Mannix, LK. Venlafaxine extended release (XR) for the prophylaxis of migraine and tension-type headache: A retrospective study in a clinical setting. Headache. 2000;40(7):572–580.Google Scholar
35.Joffe, H, Soares, CN, Petrillo, LF, et al.Treatment of depression and menopause-related symptoms with the serotonin-norepinephrine reuptake inhibitor duloxetine. J Clin Psychiatry. 2007;68(6):943–950.Google Scholar
36.Biglia, N, Torta, R, Roagna, R, et al.Evaluation of low-dose venlafaxine hydrochloride for the therapy of hot flushes in breast cancer survivors. Maturitas. 2005;52(1):78–85.Google Scholar
37.Raskin, J, Pritchett, YL, Wang, F, et al.A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med. 2005;6(5):346–356.CrossRefGoogle ScholarPubMed
38.Durand, JP, Goldwasser, F. Dramatic recovery of paclitaxel-disabling neurosensory toxicity following treatment with venlafaxine. Anticancer Drugs. 2002;13(7):777–780.Google Scholar
39.Durand, JP, Brezault, C, Goldwasser, F. Protection against oxaliplatin acute neurosensory toxicity by venlafaxine. Anticancer Drugs. 2003;14(6):423–425.CrossRefGoogle ScholarPubMed
40.Durand, JP, Alexandre, J, Guillevin, L, Goldwasser, F. Clinical activity of venlafaxine and topiramate against oxaliplatin-induced disabling permanent neuropathy. Anticancer Drugs. 2005;16(5):587–591.Google Scholar
41.Thase, ME, Entsuah, AR, Rudolph, RL. Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry. 2001;178:234–241.CrossRefGoogle ScholarPubMed
42.Anderson, IM. SSRIS versus tricyclic antidepressants in depressed inpatients: a meta-analysis of efficacy and tolerability. Depress Anxiety. 1998;7(suppl 1):11–17.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
43.Fishbain, D, Cutler, R, Rosomoff, HL, Rosomoff, RS. Evidence-based data from animal and human experimental studies on pain relief with antidepressants: a structured review. Pain Med. 2000;1(4):310–316.Google Scholar
44.Greco, T, Eckert, G, Kroenke, K. The outcome of physical symptoms with treatment of depression. J Gen Intern Med. 2004;19(8):813–818.Google Scholar
45.Fishbain, DA, Detke, MJ, Wernicke, J, et al.The relationship between antidepressant and analgesic responses: findings from six placebo-controlled trials assessing the efficacy of duloxetine in patients with major depressive disorder. Curr Med Res Opin. 2008;24(11):3105–3115.Google Scholar
46.Papakostas, GI, Petersen, TJ, Iosifescu, DV, et al.Somatic symptoms as predictors of time to onset of response to fluoxetine in major depressive disorder. J Clin Psychiatry. 2004;65(4):543–546.Google Scholar
47.Karp, JF, Weiner, D, Seligman, K, et al.Body pain and treatment response in late-life depression. Am J Geriatr Psychiatry. 2005;13(3):188–194.CrossRefGoogle ScholarPubMed
48.Karp, JF, Scott, J, Houck, P, et al.Pain predicts longer time to remission during treatment of recurrent depression. J Clin Psychiatry. 2005;66(5):591–597.CrossRefGoogle ScholarPubMed
49.Howland, RH, Wilson, MG, Kornstein, SG, et al.Factors predicting reduced antidepressant response: experience with the SNRI duloxetine in patients with major depression. Ann Clin Psychiatry. 2008;20(4):209–218.Google Scholar
50.Fava, M, Mallinckrodt, CH, Detke, MJ, et al.The effect of duloxetine on painful physical symptoms in depressed patients: do improvements in these symptoms result in higher remission rates? J Clin Psychiatry. 2004;65(4):521–530.CrossRefGoogle ScholarPubMed