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Functional impairment related to painful physical symptoms in patients with generalized anxiety disorder with or without comorbid major depressive disorder: post hoc analysis of a cross-sectional study.

Romera I, Montejo AL, Caballero F, Caballero L, ArbesĂș J, Polavieja P, Desaiah D, Gilaberte I - BMC Psychiatry (2011)

Bottom Line: It is known that painful physical symptoms (PPS) are associated with GAD, regardless the presence of comorbid major depressive disorder (MDD).Of those patients with GAD+MDD+ (n = 559), 436 (78.0%) had PPS, compared with GAD+MDD- (249 of 422, 59%) and controls (95 of 336, 28.3%).The presence of PPS was significantly associated with less productivity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinical Research Department, Lilly SA, Avenida de la Industria 30, Alcobendas, Spain. romera_irene@lilly.com

ABSTRACT

Background: Generalized anxiety disorder (GAD) is the most frequent anxiety disorder in primary care patients. It is known that painful physical symptoms (PPS) are associated with GAD, regardless the presence of comorbid major depressive disorder (MDD). However the specific role of such symptoms in patients' functional impairment is not well understood. The objective of the present study is to assess functional impairment related to the presence of PPS in patients with GAD.

Methods: This is a post hoc analysis of a cross-sectional study. Functioning, in the presence (overall pain score >30; Visual Analog Scale) or absence of PPS, was assessed using the Sheehan Disability Scale (SDS) in three groups of patients; 1) GAD and comorbid MDD (GAD+MDD+), 2) GAD without comorbid MDD (GAD+MDD-), 3) controls (GAD-MDD-). ANCOVA models were used.

Results: Of those patients with GAD+MDD+ (n = 559), 436 (78.0%) had PPS, compared with GAD+MDD- (249 of 422, 59%) and controls (95 of 336, 28.3%). Functioning worsened in both GAD groups in presence of PPS (SDS least squares mean total score: 16.1 vs. 9.8, p < 0.0001, GAD+MDD+; 14.3 vs. 8.2, p < 0.0001, GAD+MDD-). The presence of PPS was significantly associated with less productivity.

Conclusions: Functional impairment related to the presence of PPS was relevant. Clinical implications should be considered.

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Functioning (SDS total score) by the presence of PPS in patients with GAD, with or without co-morbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms; SDS = Sheehan Disability Scale, SD = Standard deviation; LSM = Least square mean.
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Figure 2: Functioning (SDS total score) by the presence of PPS in patients with GAD, with or without co-morbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms; SDS = Sheehan Disability Scale, SD = Standard deviation; LSM = Least square mean.

Mentions: Patients with PPS in all groups exhibited significantly worse functional impairment compared to patients without PPS, as expressed by a significantly higher SDS total score (F-value = 52.8 for the combination of diagnoses and pain; p < 0.0001, PPS+ vs. PPS- for GAD+MDD+, GAD+MDD-, and control groups). This result indicates that the presence of PPS contributes to worse functional impairment in work, social, and family life, when adjusted by patients' severity (CGI-S scale), age, gender, or comorbidity, (Figure 2). As expected, functional impairment was worst in patients suffering from GAD and comorbid MDD and PPS (SDS total score least squares means [LSM] [SD] = 16.1 [0.5] p < 0.0001 vs. GAD+MDD- and vs. control groups, regardless of the presence of PPS). Interestingly, the magnitude of the functioning impairment related to the presence of PPS was relevant as it was >1.5 fold worse when PPS was present (SDS total score LSM [SD] in GAD+MDD+ patients = 16.1 [0.5] vs. 9.8 [0.6]; p < 0.0001, PPS+ vs. PPS-; SDS total score LSM [SD] in GAD+MDD- patients = 14.3 [0.5] vs. 8.2 [0.6]; p < 0.0001, PPS+ vs. PPS- ; SDS total score LSM [SD] in controls = 12.1 [0.8] vs. 7.7 [0.7]; p < 0.0001, PPS+ vs. PPS-). Other factors that significantly contributed to patients' functional impairment were: age (F-value = 21.9; p < 0.0001), being female (F-value = 5.0; p = 0.0253), medical comorbidity (F-value = 5.6; p = 0.0180), and patients' severity as measured by the CGI-S scale (F-value = 33.6; p < 0.0001).


Functional impairment related to painful physical symptoms in patients with generalized anxiety disorder with or without comorbid major depressive disorder: post hoc analysis of a cross-sectional study.

Romera I, Montejo AL, Caballero F, Caballero L, ArbesĂș J, Polavieja P, Desaiah D, Gilaberte I - BMC Psychiatry (2011)

Functioning (SDS total score) by the presence of PPS in patients with GAD, with or without co-morbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms; SDS = Sheehan Disability Scale, SD = Standard deviation; LSM = Least square mean.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108915&req=5

Figure 2: Functioning (SDS total score) by the presence of PPS in patients with GAD, with or without co-morbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms; SDS = Sheehan Disability Scale, SD = Standard deviation; LSM = Least square mean.
Mentions: Patients with PPS in all groups exhibited significantly worse functional impairment compared to patients without PPS, as expressed by a significantly higher SDS total score (F-value = 52.8 for the combination of diagnoses and pain; p < 0.0001, PPS+ vs. PPS- for GAD+MDD+, GAD+MDD-, and control groups). This result indicates that the presence of PPS contributes to worse functional impairment in work, social, and family life, when adjusted by patients' severity (CGI-S scale), age, gender, or comorbidity, (Figure 2). As expected, functional impairment was worst in patients suffering from GAD and comorbid MDD and PPS (SDS total score least squares means [LSM] [SD] = 16.1 [0.5] p < 0.0001 vs. GAD+MDD- and vs. control groups, regardless of the presence of PPS). Interestingly, the magnitude of the functioning impairment related to the presence of PPS was relevant as it was >1.5 fold worse when PPS was present (SDS total score LSM [SD] in GAD+MDD+ patients = 16.1 [0.5] vs. 9.8 [0.6]; p < 0.0001, PPS+ vs. PPS-; SDS total score LSM [SD] in GAD+MDD- patients = 14.3 [0.5] vs. 8.2 [0.6]; p < 0.0001, PPS+ vs. PPS- ; SDS total score LSM [SD] in controls = 12.1 [0.8] vs. 7.7 [0.7]; p < 0.0001, PPS+ vs. PPS-). Other factors that significantly contributed to patients' functional impairment were: age (F-value = 21.9; p < 0.0001), being female (F-value = 5.0; p = 0.0253), medical comorbidity (F-value = 5.6; p = 0.0180), and patients' severity as measured by the CGI-S scale (F-value = 33.6; p < 0.0001).

Bottom Line: It is known that painful physical symptoms (PPS) are associated with GAD, regardless the presence of comorbid major depressive disorder (MDD).Of those patients with GAD+MDD+ (n = 559), 436 (78.0%) had PPS, compared with GAD+MDD- (249 of 422, 59%) and controls (95 of 336, 28.3%).The presence of PPS was significantly associated with less productivity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Clinical Research Department, Lilly SA, Avenida de la Industria 30, Alcobendas, Spain. romera_irene@lilly.com

ABSTRACT

Background: Generalized anxiety disorder (GAD) is the most frequent anxiety disorder in primary care patients. It is known that painful physical symptoms (PPS) are associated with GAD, regardless the presence of comorbid major depressive disorder (MDD). However the specific role of such symptoms in patients' functional impairment is not well understood. The objective of the present study is to assess functional impairment related to the presence of PPS in patients with GAD.

Methods: This is a post hoc analysis of a cross-sectional study. Functioning, in the presence (overall pain score >30; Visual Analog Scale) or absence of PPS, was assessed using the Sheehan Disability Scale (SDS) in three groups of patients; 1) GAD and comorbid MDD (GAD+MDD+), 2) GAD without comorbid MDD (GAD+MDD-), 3) controls (GAD-MDD-). ANCOVA models were used.

Results: Of those patients with GAD+MDD+ (n = 559), 436 (78.0%) had PPS, compared with GAD+MDD- (249 of 422, 59%) and controls (95 of 336, 28.3%). Functioning worsened in both GAD groups in presence of PPS (SDS least squares mean total score: 16.1 vs. 9.8, p < 0.0001, GAD+MDD+; 14.3 vs. 8.2, p < 0.0001, GAD+MDD-). The presence of PPS was significantly associated with less productivity.

Conclusions: Functional impairment related to the presence of PPS was relevant. Clinical implications should be considered.

Show MeSH
Related in: MedlinePlus