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BMC Psychiatry

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Open Access 01-12-2012 | Research article

Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers

Authors: Hannes Bohman, Ulf Jonsson, Aivar Päären, Lars von Knorring, Gunilla Olsson, Anne-Liis von Knorring

Published in: BMC Psychiatry | Issue 1/2012

Abstract

Background

There is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.

Methods

The total population of 16–17-year-olds in Uppsala, Sweden, was screened for depression in 1991–1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.

Results

Somatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.

Conclusions

Somatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.

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Mumford DB, Devereux TA, Maddy PJ, Johnston JV: Factors leading to the reporting of ‘functional’ somatic symptoms by general practice attenders. Br J Gen Pract. 1991, 352: 454-458.

Peveler R, Kilkenny L, Kinmonth AL: Medically unexplained physical symptoms in primary care. A comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res. 1997, 42: 245-252. 10.1016/S0022-3999(96)00292-9.CrossRefPubMed

Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW: The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil. 2010, 20: 264-273. 10.1007/s10926-010-9239-3.CrossRefPubMedPubMedCentral

Hanel G, Henningsen P, Herzog W, Sauer N, Schaefert R, Szecsenyi J, Löwe B: Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res. 2009, 67: 189-197. 10.1016/j.jpsychores.2009.04.013.CrossRefPubMed

Dirkwager AJ, Verhaak PF: Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Fam Prac. 2007, 31: 33-42.CrossRef

Ohayon MM, Schatzberg AF: Using chronic pain to predict depressive morbidity in the general population. Arch Gen Psychiatry. 2003, 60: 39-47. 10.1001/archpsyc.60.1.39.CrossRefPubMed

Kirmayer LJ, Robbins JM, Dworkind M, Yaffe MJ: Somatization and the recognition of depression and anxiety in primary care. Am J Psychiatry. 1993, 150: 734-741.CrossRefPubMed

Stegenga BT, Kamphuis MH, King M, Nazareth I, Geerlings MI: The natural course and outcome of major depressive disorder in primary care: the PREDICT-NL study. Soc Psychiatry Psychiatr Epidemiol. 2012, 47: 87-95. 10.1007/s00127-010-0317-9.CrossRefPubMed

Huijbregts KML, van der Feltz-Cornelis CM, van Marwijk HWJ, de Jong FJ, van der Windt DAWM, Beekman ATF: Negative association of concomitant physical symptoms with the course of major depressive disorder: a systematic review. J Psychosom Res. 2010, 68: 511-519. 10.1016/j.jpsychores.2009.11.009.CrossRefPubMed

10.

Papakostas GI, Petersen T, Denninger J, Sonawalla SB, Mahal Y, Alpert JE, Nierenberg AA, Fava M: Somatic symptoms in treatment-resistant depression. Psychiatry Res. 2003, 118: 39-45. 10.1016/S0165-1781(03)00063-5.CrossRefPubMed

11.

Ang QQ, Wing YK, He Y, Sulaiman AH, Chiu NY, Shen YC, Wang G, Zhang C, Lee KH, Singh P, Granger RE, Raskin J, Dossenbach M: Association between painful physical symptoms and clinical outcomes in East Asian patients with major depressive disorder: a 3-month prospective observational study. Int J Clin Pract. 2009, 63: 1041-1049. 10.1111/j.1742-1241.2009.02107.x.CrossRefPubMed

12.

Linke SE, Rutledge T, Johnson BD, Vaccarino V, Bittner V, Cornell CE, Eteiba W, Sheps DS, Krantz DS, Parashar S, Bairey Merz CN: Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: a report from the National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation. Arch Gen Psychiatry. 2009, 66: 499-507. 10.1001/archgenpsychiatry.2009.27.CrossRefPubMedPubMedCentral

13.

Bohman H, Jonsson U, von Knorring A-L, von Knorring L, Päären A, Olsson G: Somatic symptoms as a marker for severity in adolescent depression. Acta Pediatr. 2010, 99: 1724-3170. 10.1111/j.1651-2227.2010.01906.x.CrossRef

14.

Lieb R, Meinlschmidt G, Araya R: The association between somatoform disorders and anxiety and depressive disorders: an update. Psychosom Med. 2007, 69: 860-863. 10.1097/PSY.0b013e31815b0103.CrossRefPubMed

15.

Olsson G, von Knorring A-L: Adolescent depression: prevalence in Swedish high-scholol students. Acta Psychiatr Scand. 1999, 99: 324-331.CrossRefPubMed

16.

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry. 1961, 4: 561-571. 10.1001/archpsyc.1961.01710120031004.CrossRefPubMed

17.

Schoenbach VJ, Kaplan BH, Grimson RC, Wagner EH: Use of a symptom scale to study the prevalence of a depressive syndrome in young adolescents. Am J Epidemiol. 1982, 116: 791-800.PubMed

18.

Reich W, Herjanic B, Welner Z, Gandhy PR: Development of a structured psychiatric interview for children: agreement on diagnosis comparing child and parent interviews. J Abnorm Child Psychol. 1982, 10: 325-336. 10.1007/BF00912325.CrossRefPubMed

19.

Olsson G: Adolescent depression. Epidemiology, nosology, life stress and social network. Minireview based on a doctoral thesis. Ups J Med Sci. 1998, 10: 77-145.CrossRef

20.

Larsson BS: Somatic complaints and their relationship to depressive symptoms in Swedish adolescents. J Child Psychol Psychiatry. 1991, 32: 821-832. 10.1111/j.1469-7610.1991.tb01905.x.CrossRefPubMed

21.

Coddington RD: The significance of life events as etiologic factors in the diseases of children. II. A study of a normal population. J Psychosom Res. 1972, 16: 205-213. 10.1016/0022-3999(72)90045-1.CrossRefPubMed

22.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59 (suppl 20): 22-33.PubMed

23.

Jonsson U, Bohman H, von Knorring L, Olsson G, Päären A, von Knorring A-L: Mental health outcome of a long-term and episodic adolescent depression: 15-year follow-up of a community sample. J Affect Disord. 2011, 130: 395-404. 10.1016/j.jad.2010.10.046.CrossRefPubMed

24.

Fichter MM, Kohlboeck G, Quadflied N, Wyschkon A, Esser G: From childhood to adult age: 18-year longitudinal results and prediction of the course of mental disorders in the community. Soc Psychiatry Psychiatr Epidemiol. 2009, 44: 792-803. 10.1007/s00127-009-0501-y.CrossRefPubMed

25.

van Lang ND, Ferdinand RF, Verhulst FC: Predictors of future depression in early and late adolescence. J Affect Disord. 2007, 97: 137-144. 10.1016/j.jad.2006.06.007.CrossRefPubMed

26.

Nakao M, Yano E: Somatic symptoms for predicting depression: one-year follow-up study in annual health examinations. Psychiatry Clin Neurosci. 2006, 60: 219-225. 10.1111/j.1440-1819.2006.01489.x.CrossRefPubMed

27.

Hotopf M, Mayou R, Wadsworth M, Wessely S: Temporal relationships between physical symptoms and psychiatric disorder. Results from a national birth cohort. Br J Psychiatry. 1998, 173: 255-261. 10.1192/bjp.173.3.255.CrossRefPubMed

28.

Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M: Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry. 2005, 162: 847-855. 10.1176/appi.ajp.162.5.847.CrossRefPubMed

29.

Sourander A, Helsta L: Childhood predictors of externalizing and internalizing problems in adolescence. A prospective follow-up study from age 8 to 16. Eur Child Adolesc Psychiatry. 2005, 14: 415-423. 10.1007/s00787-005-0475-6.CrossRefPubMed

30.

Lewinsohn PM, Rohde P, Klein DN, Seeley JR: Natural course of adolescent major depressive disorder: I. Continuity into young adulthood. J Am Acad Child Adolesc Psychiatry. 1999, 38: 56-63. 10.1097/00004583-199901000-00020.CrossRefPubMed

31.

Hotopf M, Carr S, Mayou R, Wadsworth M, Wessely S: Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. BMJ. 1998, 316: 1196-1200. 10.1136/bmj.316.7139.1196.CrossRefPubMedPubMedCentral

32.

Gorwood P, Corruble E, Falissard B, Goodwing GM: Toxic effects of depression on brain function: impairment of delayed recall and the cumulative length of depressive disorder in a large sample of depressed outpatients. Am J Psychiatry. 2008, 165: 731-739. 10.1176/appi.ajp.2008.07040574.CrossRefPubMed

33.

Bahk WM, Park S, Jon DI, Yoon BH, Min KJ, Hong JP: Relationship between painful physical symptoms and severity of depressive symptomatology and suicidality. Psychiatry Res. 2011, 189: 357-361. 10.1016/j.psychres.2011.01.009.CrossRefPubMed

34.

Nakao M, Yamanhaka G, Kuboki T: Suicidal ideation and somatic symptoms of patients with mind/body distress in a Japanese psychosomatic clinic. Suicide Life Threat Behav. 2002, 32: 80-90. 10.1521/suli.32.1.80.22179.CrossRefPubMed

35.

Maes M: Inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms. Curr Opin Psychiatry. 2008, 22: 75-83.CrossRef

36.

Bob P, Raboch J, Maes M, Susta M, Pavlat J, Jasova D, Vevera J, Uhrova J, Benakova H, Zima T: Depression, traumatic stress and interleukin-6. J Affect Disord. 2010, 120: 231-234. 10.1016/j.jad.2009.03.017.CrossRefPubMed

37.

Lindqvist D, Janelidze S, Hagell P, Erhardt S, Samuelsson M, Minthon L, Hansson O, Björkqvist M, Träskman-Bendz L, Brundin L: Interleukin-6 is elevated in the cerebrospinal fluid of suicide attempters and related to symptom severity. Biol Psychiatry. 2009, 66: 287-292. 10.1016/j.biopsych.2009.01.030.CrossRefPubMed

38.

Capuron L, Schroecker S, Feart C, Aubert A, Higueret D, Barberger-Gateau P, Laye D: Chronic low-grade inflammation in elderly persons is associated with altered tryptophan and tyrosine metabolism. Role in neuropsychiatric symptoms. Biol Psychiatry. 2011, 70: 175-182. 10.1016/j.biopsych.2010.12.006.CrossRefPubMed

39.

Träskman L, Asberg M, Bertilsson L, Sjöstrand L: Monoamine metabolites in CSF and suicidal behavior. Arch Gen Psychiatry. 1981, 38: 631-636. 10.1001/archpsyc.1981.01780310031002.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/12/90/prepub

Title: Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers
Authors: Hannes Bohman
Ulf Jonsson
Aivar Päären
Lars von Knorring
Gunilla Olsson
Anne-Liis von Knorring
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/1471-244X-12-90

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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