Association between painful physical symptoms and clinical outcomes in Chinese patients with major depressive disorder: a three-month observational study.

Background: Painful physical symptoms (PPS) may present as a component of major depressive disorder (MDD). Their effect in Chinese patients has not been investigated. This analysis reports the changes in disease severity, treatment patterns, quality of life and outcomes in a Chinese cohort according to the presence (PPS+) or absence (PPS-) of painful physical symptoms.

Methods: A subgroup of Chinese patients from a large observational 3-month study of patients from Asian countries and regions of China were classified using the modified Somatic Symptom Inventory (SSI) as PPS+ (mean score >or= 2) or PPS- (mean score < 2). Depression severity was assessed with the Clinical Global Impression of Severity (CGI-S) scale and 17-item Hamilton depression rating scale (HAMD(17)). Pain severity was measured using a visual analogue scale (VAS), while the EuroQoL (EQ-5D) assessed patient well-being. Antidepressants were compared with regard to their efficacy.

Results: Of the 299 Chinese patients enrolled in the study, 105 were classified as PPS+ (73/105, 70% women). At baseline, PPS+ patients reported greater pain severity (VAS, mean (SD): 49.56 (26.49) vs. 16.60 (20.99) for PPS-, P < 0.01), were more depressed (HAMD(17), mean (SD): 25.32 (5.47) vs. 23.33 (5.24) for PPS-, P = 0.002) and had poorer quality of life (EQ-5D Health State, mean (SD): 38.48 (22.38) vs. 49.57 (18.54) for PPS-, P < 0.001). PPS+ patients showed less overall improvement in depressive symptom severity (HAMD(17), change from baseline (95%CI): -17.38 (-18.65, -16.12) vs. -19.20 (-20.05, -18.35) for PPS-, P = 0.032; CGI-S, change from baseline (95%CI): -2.85 (-3.11, -2.58) vs. -3.20 (-3.38, -3.02) for PPS-, P = 0.044).

Conclusions: PPS were less frequent than expected compared with previous studies of Asian populations. PPS+ were associated with greater MDD severity and less improvement than PPS- when antidepressants were given.