International Journal of Social Psychiatry 58(1)
psychiatrists (Corruble and Guelfi, 2000; Muñoz et al., 2005;Sayar et al., 2003; Vaccarino et al., 2009).With regard to the typology of functional somatic com- plaints in depression, the most common symptoms reportedacross many studies are those of pain (Corruble and Guelfi,2000; Muñoz
et al., 2005; Sugahara et al., 2004). Previousstudies from India have reported headache as the most com-mon functional somatic complaint among those who werefound depressed, followed by tiredness, palpitations, sleep-lessness, weakness, and pain in whole body (Banerjee et al.,1987; Gautam and Kapur, 1977; Srinivasan et al., 1986).Studies have shown that a tendency to perceive and reportdistress in somatic terms is influenced by various social andcultural factors, including the degree of stigma attached toemotional symptoms (Raguram et al., 1996). Further, studiesconducted in psychiatric outpatient (Muñoz et al., 2005; Sayaret al., 2003; Vaccarino et al., 2009) and inpatient (Corrubleand Guelfi, 2000)
settings have reported a positive correlation between severity of depression and painful somatic symp-toms. Similarly, studies using various measures of anxietyacross cultures have reported a positive correlation betweenanxiety levels in depressed patients and functional somaticcomplaints (Fink et al., 1999; Haug et al., 2004; Kroenke andPrice, 1993; Simon and Vonkorff, 1991). There are studies,often with contradictory findings, that have investigated therelationship of functional somatic complaints in depressionwith the concept of alexithymia, increased somato-sensoryamplification and hypochondriacal worry (Bach et al., 1996;Kooiman et al., 2000; Sayar et al., 2003; Wise and Mann,1994).
Sayar et al. (2003) specifically addressed the relation-ship between functional somatic complaints and alexithymiain depressed patients and found that alexithymia predictedfunctional somatic complaints in depressed outpatients inde- pendent of the level of anxiety and depression.
Moreover,functional somatic complaints also showed a positive correla-tion with the first two factors (difficulty in identifying feel-ings and difficulty in describing feelings) of the TorontoAlexithymia Scale. However, other studies that have studiedalexithymia in primary care patients did not find a correla-tion between alexithymia and functional somatic complaintsand concluded that both were separate and independentconstructs (Bach et al., 1996; Kooiman et al., 2000).However, none of the studies have attempted to examinethe relationship between all these variables put together andthe presence of functional somatic complaints in patientssuffering from depression.Very few studies have assessed the functional somaticcomplaints using the Bradford Somatic Inventory (BSI) in patients presenting to psychiatrists; hence, it is difficult tocompare the present study with others. However, the find-ings are similar to the type and frequency of functionalsomatic complaints reported by other researchers who haveassessed functional somatic complaints in patients attendingthe psychiatry outpatient department using instruments likethe Somatic Symptom Inventory (SSI). Muñoz
et al. (2005)found that for patients of first-episode depression attendingthe psychiatry outpatient services, muscle soreness (82.3%),neck pain (78.0%), headache (77.6%) and heart and chest pain (61.5%) were the most common functional somaticcomplaints. In their study of depressed patients, Corrubleand Guelfi (2000) found that pain complaints were reportedin 92% of the patients as measured on the self-report 90-itemSymptom Checklist.
A recent study (Vaccarino et al., 2009)assessed the functional somatic complaints using SSI andreported feeling fatigued, weak or tired all over to be themost common functional somatic complaints (78%), fol-lowed by feeling not in as good physical health as friends(59%), not feeling well most of the time in past few years(54%), feeling weak in parts of body (45%) and headaches(43%). A study from Japan reported headache and loss of interest among the most commonly reported functionalsomatic complaints (Sugahara et al., 2004).
The aim of this study was to examine the clinical and psychological correlates of functional somatic complaints in patients with first episode depression. It was hypothesizedthat severity of depression, anxiety, alexithymia, hypochon-driacal worry and somato-sensory amplification would havea positive correlation with presence of functional somaticcomplaints.
This study was carried out in the Department of Psychia-try at the Postgraduate Institute of Medical Educationand Research (PGIMER), Chandigarh, India. PGIMER isa multi-speciality teaching tertiary care hospital, provid-ing services to a major area of North India. The depart-ment is a general hospital psychiatric unit with inpatientand outpatient facilities.
The people eligible for the study were all consecutive out- patients receiving a ICD-10 diagnosis by a consultant psy-chiatrist of first-episode unipolar depression except forsevere depression with psychotic symptoms, which has been confirmed the by Mini International NeuropsychiatricInterview (MINI) (English version 5.0.0) (Lecrubier et al.,1997),
during a period of two months; they were aged 18 to50 years, had been formally educated for at least five yearswith proficiency in reading either English or Hindi, andhad a duration of depression of more than one month withno comorbid psychiatric disorders (including substancedependence) or comorbid medical illnesses.
The following instruments, as required, were used.