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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.
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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.
Affiliation: Clinical Research Department, Lilly SA, Avenida de la Industria 30, Alcobendas, Spain. romera_irene@lilly.com
ABSTRACT
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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. Related in: MedlinePlus |
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Figure 3: Underproductive days/weeks by the presence of PPS in patients with GAD, with or without comorbid MDD. Abbreviations: GAD = Generalized anxiety disorder; MDD = Major depressive disorder; PPS = Painful physical symptoms, SD = Standard deviation; LSM = Least square mean; ANCOVA = Analysis of covariance. Mentions: Analysis of underproductive days per week showed that patients with PPS in all the groups experienced a significantly higher number of underproductive days compared to patients without PPS (F-value = 6.1 for the combination of diagnoses and pain p < 0.0001, p = 0.0016, p = 0.0005; PPS+ vs. PPS- for GAD+MDD+, GAD+MDD-, and control groups, respectively) (Figure 3). The presence of PPS in GAD+MDD+ patients was associated with a nearly two-fold increase in the number of underproductive days (LSM [SD] = 3.5 [0.2] vs. 1.9 [0.3]; p < 0.0001, PPS+ vs. PPS-). Interestingly, in the absence of PPS, no statistically significant differences between study groups (GAD+MDD+, GAD+MDD-, control) were found regarding the number of underproductive days. Finally, other factors found to be related to more underproductive days were patients' severity measured by CGI-S scale (F-value = 12.4; p < 0.0001) and the interaction between age and diagnosis (F-value = 3.4; p = 0.0049). This means that the effect of diagnosis on the number of unproductive days varies according to age. Gender, medical comorbidity, and psychiatric comorbidity were not found to be significantly associated with underproductive days. |
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Affiliation: Clinical Research Department, Lilly SA, Avenida de la Industria 30, Alcobendas, Spain. romera_irene@lilly.com
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.
