Relationship between painful physical symptoms and severity of depressive symptomatology and suicidality

We examined the prevalence of painful physical symptoms in patients with major depressive disorder (MDD), clinical correlations therewith, and associations between painful symptoms and depression severity, quality of life, and suicidality, in a clinical sample in Korea. A total of 414 psychiatric outpatients at least 18years of age, with a primary diagnosis of MDD based on the DSM-IV-TR, were enrolled at the discretion of their treating psychiatrist. Patients were assessed for the presence or absence of painful physical symptoms (PPS+ and PPS-, respectively), defined by a total score ≥5 on the pain subscale (PS) of the Depression and Somatic Symptoms Scale (DSSS). DSSS and the Clinical Global Impressions-Severity of Illness scale (CGI-S) determined depression severity, and the EuroQoL Questionnaire-5 dimensions (EQ-5D) determined perceived quality of life. Questions about suicidality during current depressive episode were also asked to the participants. Overall, 30.4% of patients were classified as PPS+. PPS+ patients were older, less educated, less frequently unmarried, and more frequently widowed/divorced/separated compared to PPS- patients. PPS+ patients showed a significantly greater depression severity (CGI-S mean difference 0.92; 95% CI=0.68 to 1.16; DSSS mean difference 18.39; 95% CI=16.28 to 20.50), a significantly lower quality of life (EQ-5D VAS mean difference -18.15; 95% CI=-22.68 to -13.62), and significantly higher suicidal ideation (OR 1.73; 95% CI 1.04-2.86) during the current depressive episode. This study suggests that assessment of depressive patients should include detailed questions about painful physical symptoms, and treatment of MDD should involve management targeting painful physical symptoms as well as emotional and non-painful physical symptoms.