title: Unexplained somatic symptoms during major depression: prevalence and clinical impact in a national sample of Italian psychiatric outpatients.
abstract: BACKGROUND
  The aim of this study was to explore the prevalence and impact of unexplained somatic symptoms during major depression.
  
  
  METHODS
  A total of 560 consecutive outpatients with a major depressive episode according to the DSM-IV (text revision) were evaluated in 30 psychiatric facilities throughout Italy. 'Unexplained' somatic symptoms were evaluated using the 30-item Somatic Symptoms Checklist (SSCL-30). Somatic symptoms were considered explained if they were best accounted for as coming from a concomitant physical illness or side effects. Patients evaluated their own mood symptomatology using the Zung questionnaires for depression and anxiety and the Hypomania Checklist-32.
  
  
  RESULTS
  According to the SSCL-30, only 90 subjects (16.1%) had no unexplained somatic symptoms, while 231 (41.3%) had 1-5 unexplained symptoms and 239 (42.7%) had more than 5. Asthenia was the most commonly observed unexplained somatic symptom (53% of patients). Unexplained somatic symptoms were more common in females and among those suffering from major depression and depression not otherwise specified rather than in patients with recurrent major depression and bipolar disorders. No relationship between unexplained somatic symptoms and hypomanic features was observed.
  
  
  CONCLUSIONS
  The presence of a large number of unexplained somatic symptoms is associated with more severe depression and higher rates of misdiagnosis and inappropriate treatment.
authors.affiliation: Dipartimento di Psichiatria, Università di Pisa, Institute of Behavioural Sciences G. De Lisio, Pisa, Italy. gperugi@med.unipi.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Canonico
authors.forename: Paolo
authors.initials: P
authors.lastname: Carbonato
authors.forename: Claudio
authors.initials: C
authors.lastname: Mencacci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muscettola
authors.forename: Luca
authors.initials: L
authors.lastname: Pani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Torta
authors.forename: Claudio
authors.initials: C
authors.lastname: Vampini
authors.forename: Michele
authors.initials: M
authors.lastname: Fornaro
authors.forename: Fabio
authors.initials: F
authors.lastname: Parazzini
authors.forename: Arina
authors.initials: A
authors.lastname: Dumitriu
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013001:Somatoform Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires