Pain symptoms in Malay patients with major depression

ObjectivesThere is a strong association between depression and pain, which is influenced by various biological and psychological mechanisms. The objectives of this study were to assess the prevalence and severity of pain symptoms among patients with major depression; and to determine the correlation between pain with clinical variables, neurotic pathology and severity of depression.MethodsFifty-one Malay patients with major depressive disorder without psychotic feature enrolled for the study. They were assessed with the Hamilton Rating Scale for Depression (HAM-D), Brief Pain Inventory (BPI) and Crown Crisp Experiential Index (CCEI).ResultsThe majority (80.4%) of the subjects had experienced pain, but overall severity of the pain was mild (33.3%). There were no statistically significant differences in socio-demographic variables with the status of pain. The prevalence of pain was significantly higher in patients who were still depressed (p < 0.05), had anxious depression (p < 0.05) and those with prominent somatic symptoms of anxiety (SOM) (p < 0.05). The severity of pain was significantly correlated with neuroticism, the severity of depression (HAM-D total score) and high scores on SOM, DEP and FFA subscales of the CCEI. Among the three, the DEP subscale had the highest correlation with severity of pain.ConclusionsThe somatising patients were heterogeneous group. The pain symptoms were common in severe mixed anxiety–depression, predisposed by the underlying neurotic pathology. Neuroticism and high scores on SOM, DEP and FFA subscales of the CCEI contributed significantly to the pathogenesis of depressed Malay patients with pain symptoms.

► The socio-cultural factors play important role in determining the expression of pain and other somatic symptoms.
► The relationships between depression, neuroticism, anxiety with somatic and pain symptoms are complex.
► Severely depressed patients with neuroticism and specific neurotic pathology are at high risk for pain symptoms.
► Depressed Malay patients with pain symptoms had high scores on SOM, DEP and FFA subscales of the CCEI.