A Correlative Study On The Biopsychosocial Factors For Depression With Somatization

Objective: The aim of the present case-control study was to investigate clinical phenomenology,psychosocial related risk factors and the differences betwween depressive patients presented as emotional complains and somatoform disorder; and to find the psychosocial mechanisms and the characteristics of autonomic nervous system funtion for depression with somatization .Methods: In CCMD-3, 51 depressive patients presented as somatic complains (somatic group,DSG), 57 depressive patients presented as emotional complains (emotional group,DEG), 42 somotoform disorders patients(somotoform disorder group,SFD) and 48 normal controls(normal group,HCG)were investigated.All patients were interviewed in general condition questionnair,history questionnair, HRSD, HAMA, TAS, LES, SSRS, TCSQ, FES-CV, DSQ, GQOLI-74; and analysed the short-term heart rate variability (10 minutes) before and after stress stimulations and after relaxation training .Results: 1,Clinical phenomenology showed : (1) DSG group were older,lower educated, and had more women,longer history,more incentives,less family history(P<0.05 or P<0.01); DSG group and SFD group received more treatment in non-psychiatric;The number of hospitals,departments,medications,medical examinations and the fees of examinations were higher than DEG group(P<0.05 or P<0.01); (2) DSG group presented more stomach discomfort and neck(back or limbs)pain,sleep disorders,abdominal discomfort and chest tightness(P<0.05 or P<0.01); (3) The physical symptoms of DSG group were more centered in digestive system(P<0.05); (4) DSG group gained higher score in HRSD total score,factor anxiety/somatization,awareness barriers,sleep disorders,hopelessness,HAMA total score and factor sores (P<0.05 or P<0.01). 2,Psychosocial factors showed: (1) Patients of DSG group,DEG group and SFD group (68.93±14.71,65.67±18.19,66.26±17.70)gained higher TAS total score than the HCG group(56.62±21.85)(P<0.05 or P<0.01); (2) DSG group (20.24±6.39)gained higher score in the factorⅡof TAS than the DEG group (17.71±5.85)and SFD group(17.26±2.92)(P<0.05); (3) Patients of DSG group,DEG group and SFD group used the immature defense styles more;DSG group (7.3±2.7)had higher score on inhibition than DEG group (5.9±2.6),SFD group(4.3±2.2) and HCG group(5.3±2.7)(P<0.05或P<0.01); (4) DSG group had the more total life events and negative life events and lower score for the use of social support than DEG group and SFD group(P<0.05 or P<0.01); (5) DSG group,DEG group and SFD group all had family function deficits;the cohesion,emotional expression,control and entertainment of DSG group were lower than DEG group and SFD group(P<0.05 or P<0.01); (6) DSG group were lowest in the dimensions of physical function,psychological function,social function and the total quality of life dimebsion than DEG group,SFD group and HCG group(P<0.05 or P<0.01).3,Results of heart rate variability: (1) In resting baseline period, DSG group and SFD group ( 61.32±29.08 , 75.42±33.78 ) had lower SDSD than HCG group(106.10±45.05)(P<0.01); DSG group,DEG group and SFD group(5.14±1.39, 3.90±1.40,4.28±2.34) had higher LF?HF than HCG group(2.74±2.61)(P<0.01); (2) After the stress stimulations, DSG group,DEG group and SFD group had higher demention of changes than HCG group ( P < 0.05 or P < 0.01 ) ; DSG group (-23.25±10.59,-20.53±11.39, 341.94±207.25, 431.97±256.32,2.75±1.61)had higher demention of change on SDNN,SDSD,LF,VLF,LF?HF than DEG group(-8.69±6.68,-14.56±5.36,222.09±165.78,226.61±191.79,1.52±1.02)and SFD group(-16.42±8.33,-11.85±6.42,234.90±140.88,272.23±132.05,2.02±1.18)(P<0.05 or P<0.01); (3) After relaxation training, HRV of DSG group,DEG group and SFD group did not return to the basiline; DSG group(-101.84±84.52,-0.89±0.47) had lower degree of return demention on LF and LF?HF than DEG group(-122.21±59.25,-1.14±0.51) and SFD group(-134.63±89.08,-1.25±1.02)(P<0.05); (4) Compared with youth group, the elderly group are lower on SDNN,SDSD,RMS-SD,HF and higher on LF and LF?HF (P<0.05 or P<0.01).Conclusions: There are differences in clinical phenomenology and psychosocial intermediation between depressive patients presented as somatic complains,depressive patients presented as emotional complains and somotoform disorder patients; Depression presented as somatic complains may be a subtype of depresion; Inbalance of autonomic nervous system may be one of the mechanisms for depression with somatization.