J Korean Med Sci.  2016 Dec;31(12):2002-2009. 10.3346/jkms.2016.31.12.2002.

Do Somatic Symptoms Predict the Severity of Depression? A Validation Study of the Korean Version of the Depression and Somatic Symptoms Scale

• Jeon SW
• Yoon SY
• Ko YH
• Joe SH
• Kim YK
• Han C
• Yoon HK
• Liu CY

• KMID: 2355632
• DOI: http://doi.org/10.3346/jkms.2016.31.12.2002

Abstract

This study aimed at exploring the psychometric characteristics of the Korean Version of the Depression and Somatic Symptoms Scale (DSSS) in a clinical sample, and investigating the impact of somatic symptoms on the severity of depression. Participants were 203 consecutive outpatients with current major depressive disorders (MDD) or lifetime diagnosis of MDD. The DSSS was compared with the Montgomery-Ã…sberg Depression Rating Scale (MADRS) and the 17-items Hamilton Depression Rating Scale (HAMD). The DSSS showed a two-factor structure that accounted for 56.8% of the variance, as well as excellent internal consistency (Cronbach's alpha = 0.95), concurrent validity (r = 0.44-0.82), and temporal stability (intraclass correlation coefficient = 0.79). The DSSS had a high ability to identify patients in non-remission (area under receiver operating characteristic [ROC] curve = 0.887). Maximal discrimination between remission and non-full remission was obtained at a cut-off score of 22 (sensitivity = 82.1%, specificity = 81.4%). The number of somatic symptoms (the range of somatic symptoms) and the scores on the somatic subscale (SS, the severity of somatic symptoms) in non-remission patients were greater than those in remission patients. The number of somatic symptoms (slope = 0.148) and the SS score (slope = 0.472) were confirmed as excellent predictors of the depression severity as indicated by the MADRS scores. The findings indicate that the DSSS is a useful tool for simultaneously, rapidly, and accurately measuring depression and somatic symptoms in clinical practice settings and in consultation fields.

Keyword

Depression and Somatic Symptoms Scale; Depression; Somatic Symptoms; Psychometrics; Validation; Cut-off Score

MeSH Terms

Depression*
Depressive Disorder, Major
Diagnosis
Discrimination (Psychology)
Humans
Outpatients
Psychometrics
ROC Curve
Sensitivity and Specificity

Figure

• 

  Fig. 1 Receiver operating characteristic curve for the DSSS and the MADRS to detect patients with depressed state. DSSS = Depression and Somatic Symptoms Scale, MADRS = Montgomery-Åsberg Depression Rating Scale.

• 

  Fig. 2 The SS scores and number of somatic symptoms evaluated using the DSSS in subjects with non-remission (n = 106) and in subjects with full remission (n = 97). (A) Frequencies of number of subjects depending on SS score in non-remission and in remission. (B) Frequencies of number of subjects depending on number of somatic symptoms in non-remission and in remission. DSSS = Depression and Somatic Symptoms Scale, SS = somatic subscale.

• 

  Fig. 3 Simple linear regression (n = 203) for evaluating whether the number of somatic symptoms or the SS scores predict the MADRS scores. These findings reach statistical significance in linear regression analysis (both P < 0.001). (A) Linear regression of the number of somatic symptoms on the MADRS scores. (B) Linear regression of the SS scores on the MADRS scores. MADRS = Montgomery-Åsberg depression rating scale, SS = somatic subscale.

Reference

1. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999; 341:1329–1335.

2. Park SC, Sakong J, Koo BH, Kim JM, Jun TY, Lee MS, Kim JB, Yim HW, Park YC. Clinical significance of the number of depressive symptoms in major depressive disorder: results from the CRESCEND study. J Korean Med Sci. 2016; 31:617–622.

3. Greden JF. Physical symptoms of depression: unmet needs. J Clin Psychiatry. 2003; 64:Suppl 7. 5–11.

4. Leuchter AF, Husain MM, Cook IA, Trivedi MH, Wisniewski SR, Gilmer WS, Luther JF, Fava M, Rush AJ. Painful physical symptoms and treatment outcome in major depressive disorder: a STAR*D (sequenced treatment alternatives to relieve depression) report. Psychol Med. 2010; 40:239–251.

5. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, et al. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord. 1998; 50:97–108.

6. Tylee A, Gandhi P. The importance of somatic symptoms in depression in primary care. Prim Care Companion J Clin Psychiatry. 2005; 7:167–176.

7. Fava M. Depression with physical symptoms: treating to remission. J Clin Psychiatry. 2003; 64:Suppl 7. 24–28.

8. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974; 19:1–15.

9. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002; 64:258–266.

10. Hung CI, Weng LJ, Su YJ, Liu CY. Preliminary study of a scale measuring depression and somatic symptoms. Psychol Rep. 2006; 99:379–389.

11. Hung CI, Weng LJ, Su YJ, Liu CY. Depression and somatic symptoms scale: a new scale with both depression and somatic symptoms emphasized. Psychiatry Clin Neurosci. 2006; 60:700–708.

12. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134:382–389.

13. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967; 6:278–296.

14. Ahn YM, Lee KY, Yi JS, Kang MH, Kim DH, Kim JL, Shin J, Shin HK, Yeon BK, Lee JH, et al. A validation study of the Korean-version of the Montgomery-Asberg depression rating scale. J Korean Neuropsychiatr Assoc. 2005; 44:466–476.

15. Yi JS, Bae SO, Ahn YM, Park DB, Noh KS, Shin HK, Woo HW, Lee HS, Han SI, Kim YS. Validity and reliability of the Korean version of the Hamilton depression rating scale (K-HDRS). J Korean Neuropsychiatr Assoc. 2005; 44:456–465.

16. Zimmerman M, Chelminski I, Posternak M. A review of studies of the Hamilton depression rating scale in healthy controls: implications for the definition of remission in treatment studies of depression. J Nerv Ment Dis. 2004; 192:595–601.

17. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44:837–845.

18. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington, D.C.: American Psychiatric Association;1995.

19. Khan A, Brodhead AE, Kolts RL. Relative sensitivity of the Montgomery-Asberg depression rating scale, the Hamilton depression rating scale and the clinical global impressions rating scale in antidepressant clinical trials: a replication analysis. Int Clin Psychopharmacol. 2004; 19:157–160.

20. Carmody TJ, Rush AJ, Bernstein I, Warden D, Brannan S, Burnham D, Woo A, Trivedi MH. The Montgomery Asberg and the Hamilton ratings of depression: a comparison of measures. Eur Neuropsychopharmacol. 2006; 16:601–611.

21. Pancheri P, Picardi A, Pasquini M, Gaetano P, Biondi M. Psychopathological dimensions of depression: a factor study of the 17-item Hamilton depression rating scale in unipolar depressed outpatients. J Affect Disord. 2002; 68:41–47.

22. Zimmerman M, McGlinchey JB. Depressed patients’ acceptability of the use of self-administered scales to measure outcome in clinical practice. Ann Clin Psychiatry. 2008; 20:125–129.

23. Zimmerman M, McGlinchey JB, Posternak MA, Friedman M, Attiullah N, Boerescu D. How should remission from depression be defined? The depressed patient’s perspective. Am J Psychiatry. 2006; 163:148–150.

24. Karp JF, Scott J, Houck P, Reynolds CF 3rd, Kupfer DJ, Frank E. Pain predicts longer time to remission during treatment of recurrent depression. J Clin Psychiatry. 2005; 66:591–597.

25. Zimmerman M, Posternak MA, Chelminski I. Is the cutoff to define remission on the Hamilton rating scale for depression too high? J Nerv Ment Dis. 2005; 193:170–175.

26. Romera I, Pérez V, Menchón JM, Polavieja P, Gilaberte I. Optimal cutoff point of the Hamilton rating scale for depression according to normal levels of social and occupational functioning. Psychiatry Res. 2011; 186:133–137.