Somatoform symptoms and treatment nonadherence in depressed family medicine outpatients.
OBJECTIVE
To examine whether somatoform symptoms, specifically symptoms of conversion, somatization, and hypochondriasis, are associated with side-effect reporting and treatment nonadherence in depressed family medicine outpatients, and to measure whether symptoms improve with pharmacotherapy.


METHODS
Inception cohort study with 14-week follow-up.


METHODS
Inner-city family medicine residency clinic.


METHODS
Thirty-nine consecutive adults with major depressive disorder were asked to participate, and 30 consented.


METHODS
Antidepressants for 14 weeks.


METHODS
The Personality Assessment Inventory (PAI) was administered before treatment. The PAI is a self-reported inventory compatible with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, designed to measure a broad range of personality characteristics. After 14 weeks, the side-effect incidence and treatment nonadherence rates were determined, and 12 patients were readministered the PAI.


RESULTS
Depressed family medicine patients demonstrated trends toward elevated Somatic Complaints scale and conversion subscale scores and a lower Suicidal Ideation scale score relative to those of a standardized depressed psychiatric patient profile. Conversion and hypochondriacal symptoms were associated with side-effect reporting and treatment nonadherence. Somatization and hypochondriacal symptoms improved clinically and statistically during treatment for depression.


CONCLUSIONS
Somatoform distress is a complex, common, and understudied phenomenon in primary care that can adversely affect the treatment of depression. Somatoform symptoms of conversion and hypochondriasis, but not somatization, were found to be risk factors for treatment nonadherence. Somatization and hypochondriacal symptoms may represent personality states that improve with pharmacotherapy, and conversion symptoms may be a personality trait resistant to medical treatment for depression.
Keeley
R
R
St Anthony Central Hospital, Denver, Colo., USA.
Smith
M
M
Miller
J
J
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003291:Conversion Disorder / Q000453:epidemiology; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D005194:Family Practice; D005260:Female; D006801:Humans; D006998:Hypochondriasis / Q000453:epidemiology; D008297:Male; D010555:Personality Inventory; D013001:Somatoform Disorders / Q000453:epidemiology / Q000523:psychology*; D016312:Treatment Refusal
D000928:Antidepressive Agents