Study On Characteristics Of Comorbid Depression And Somatoform Disorders

Objective: Aims of this study are (1) to explore clinical picture, personality, defense mechanism, and social support of inpatients with comorbid depression and somatoform disorders;(2) to explore the relationships between Comorbid Depression and Somatoform disorders and major depression;(3) to investigate risk factors of comorbid Depression and Somatoform disorders; and (4) to provide scientific proves for clinical treatments.Methods: Subjects were inpatients in the No7 people's hospital of Dalian during June to December in 2008. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used as the diagnostic instrument. 60 patients with comorbid depression and somatoform disorders(comorbid group) and 63 major depression patients (non-comorbid group) accepted the investigation. The general state of health ques- tionnaire, case history questionnaire, Hamilton depression scale (HAMD). Hamilton anxiety scale(HAMA),Minnesota Multiphasic Personality Inventory(MMPI), Defense style questionnaire (DSQ), and social support rating scale (SSRS) were used as the instruments. Results were analyzed with t test, chi square test and Logistic regression analysis.Results:1. Clinical phenomenology: (1) Comorbid group had less education degree and income than non-comorbid group; (2) Comorbid group had earlier onset age and longer duration than non-comorbid group;(3) Features of psychological symptoms: comorbid group had more self-blame, suicidal idea and behavior, and psychomotor agitation than non-comorbid group;(4) Features of biological symptoms: comorbid group had more changes of biological rhythm, loss of weight and genital symptoms than non-comorbid group.2. Results of HAMD and HAMA: Higher scores of HAMD and HAMA, and higher scores on anxiety/ somatization, weight, diurnal variation, hopelessness, somatic anxiety and psychic anxiety were found in comorbid group compared with non- comorbid group.3. Results of MMPI: (1) Comorbid group had lower scores on L scale and scores on F scale than non-comorbid group; the curve of validity declined from F, K to L in comorbid group, while it was from L, F to K in non-comorbid group. (2) Comorbid group had higher on Hs,Hy,Pd,Pt,Sc than non-comorbid group (3) code type of co-morbid group were M312 and code type of non-comorbid group were M273.4. Result of DSQ: Defense styles such as projection, passive aggression, complain, somatiztion, and consuming were more common in comorbid group, while denial, suppress, and anticipation were more common in non-comorbid group.5. Result of SSRS: Comorbid had higher scores on social support, objective support and subjective support than non-comorbid group.6. Result of Logistic regression analysis: Projection, passive aggression, complain and consuming of defense style, Hy of personality and subjective support were risk factors of comorbid depression and somatoform disorders. Suppress and denial of defense style were protective factors of comorbid depression and somatoform disorders.Conclusions:1. Comorbid depression and somatoform disorders are associated with educational level, income, personality and defense mechanisms. The abuse of social support may be the important internal factor .2. There are differences on psychosocial factors between comorbid depression and somatoform disorders and pure major depression. So it can't be considered as a new independent disease entity. It just was manifestation of somatization of depression.3. Comorbidity with somatoform disorders often makes depression patients more severe symptoms, more chronicity and dysfunction.