Academic journal article Indian Journal of Psychiatry

IPS Multicentric Study: Functional Somatic Symptoms in Depression

Academic journal article Indian Journal of Psychiatry

IPS Multicentric Study: Functional Somatic Symptoms in Depression

Article excerpt

Byline: Sandeep. Grover, Ajit. Avasthi, Kamal. Kalita, P. Dalal, G. Rao, R. Chadda, Bhavesh. Lakdawala, Govind. Bang, Kaustav. Chakraborty, Sudhir. Kumar, P. Singh, Puneet. Kathuria, M. Thirunavukarasu, P. S. V. N.. Sharma, T. Harish, Nilesh. Shah, Kamla. Deka

Background: As a pilot project, Indian Psychiatric Society conducted the first multicentric study involving diverse settings from teaching institutions in public and private sectors and even privately run psychiatric clinics. Aim of the Study: To study the typology of functional somatic complaints (FSC) in patients with first episode depression. Materials and Methods: A total of 741 patients from 16 centers across the country participated in the study. They were assessed on Bradford Somatic Symptom inventory for FSC, Beck Depression Inventory for severity of depression, and Comprehensive Psychopathological Rating Scale- anxiety index (CPRS-AI) for anxiety symptoms. Results: The mean age of the study sample was 38.23 years (SD-11.52). There was equal gender distribution (male - 49.8% vs. females 50.2%). Majority of the patients were married (74.5%), Hindus (57%), and from nuclear family (68.2%). A little over half of the patients were from urban background (52.9%). The mean duration of illness at the time of assessment was 25.55 months. Most of the patients (77%) had more than 10 FSCs, with 39.7% having more than 20 FSCs as assessed on Bradford Somatic Inventory. The more common FSC as assessed on Bradford Somatic Inventory were lack of energy (weakness) much of the time (76.2%), severe headache (74%) and feeling tired when not working (71%), pain in legs (64%), aware of palpitations (59.5%), head feeling heavy (59.4%), aches and pains all over the body (55.5%), mouth or throat getting dry (55.2%), pain or tension in neck and shoulder (54%), head feeling hot or burning (54%), and darkness or mist in front of the eyes (49.1%). The prevalence and typology of FSCs is to a certain extent influenced by the sociodemographic variables and severity of depression. Conclusion: Functional somatic symptoms are highly prevalent in Indian depressed patients and hence deserve more attention while diagnosing depression in Indian setting.


Studies from the various parts of the world suggest that many patients suffering from depression manifest physical complaints which are not specifically identified by the nosological systems. It is suggested that many a times, these functional somatic complaints (FSC) dominate the clinical picture to such an extent that they exert a crucial influence on the perception of the illness. Due to the predominance of physical symptoms, many patients believe their depressive illness to be physical in origin, and consult a physician rather than mental health professionals and this may lead to misutilization of medical services. [sup][1] FSCs are known to increase the burden and disability associated with depression. Increased burden of FSCs in patients with depression also leads to increased utilization of healthcare services, greater economic burden [sup][2],[3],[4] and contributes greatly to the recurrence of another new depressive episode several years later. [sup][5],[6],[7],[8],[9],[10]

Studies done in patients with depression presenting to different treatment settings like primary care, medical outpatient, and psychiatric outpatient clinics suggest high prevalence of FSCs across various treatment setting. Studies done in primary care setting suggest that about 66 to 73% of patients with depression and anxiety have FSC. [sup][11],[12],[13] The prevalence figures of FSC in clinic-based studies have varied between 66 and 92%. [sup][14],[15],[16],[17],[18],[19]

Studies from different parts of the world have also described the typology of FSC in depression and in general suggest that painful symptoms are highly prevalent, although many studies have also described painless FSCs. [sup][20],[21],[22],[23],[24]

Very few studies from India have focused on FSC in patients with depression, [sup][25],[26] although there are few studies which have focused on the prevalence of non-organic FSC in outpatients in general. …

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