In primary care, difficulty to distinguish somatic syndromes from depression with somatic symptoms is recognised. In somatoform disorders co-morbid depression and anxiety have an additive detrimental effect on level of functioning.

To investigate role of depressive symptoms in somatic presentations and elucidate its impact on level of functioning.

Cohort is 106 consecutive patients referred to a specialist somatoform disorder clinic as part of a naturalistic follow- up study. Tools used included Hamilton rating scale for depression (HAMD), Patient Health Questioner (PHQ-15), Global Assessment of Functioning (GAF).

26% of cohort had only depressive disorder (ICD-10 F32-34, 38), 44% had a somatic syndrome (F 44-45, 48), 10% with anxiety or psychotic disorders and 20% had no mental disorders. 34% of somatic syndrome had co-morbidities, mainly depressive disorder. No significant difference in HAMD, PHQ-15 and GAF, seen between diagnostic groups. In the somatic syndrome group, HAMD and PHQ-15 scores negatively correlated with GAF (functioning) (t = -4.5, df = 1, p = 0.0001 and t = -2.3, df = 1, p = 0.04). When HAMD along with PHQ-15, age, gender, co-morbidity and medication-use entered in a multiple regression model, HAMD score was the only significant parameter (F = 17, t-4.2, df = 1, p = 0.001).

A considerable number of patients with severe somatic symptoms and functional impairment have depressive disorder. In patients with somatic syndrome, depressive symptoms (even sub-syndromal) appear to influence the level of functioning and mediate the effect of somatic symptoms on level of functioning. This finding may have implication in treatment and needs establishing.