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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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Related in: MedlinePlus

Quality of life (EuroQoL-5D total score) 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.
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Figure 4: Quality of life (EuroQoL-5D total score) 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.

Mentions: The quality of life as assessed by the EQ-5D score showed that patients with PPS in all studied groups (viz. GAD with comorbid MDD, GAD without MDD, and control groups) experienced a significantly decreased quality of life as compared to patients without PPS (F-value = 30.3 for the combination of diagnoses and pain, p < 0.0001; PPS+ vs. PPS- for GAD+MDD+, GAD+MDD-, and control groups) (Figure 4). Similarly to functionality, the poorest quality of life was found in PPS positive GAD patients with comorbid MDD (LSM [SD] = 0.3 [0.0], p < 0.0001 vs. GAD+MDD- and control groups, with or without PPS). Results suggest that the presence of PPS alone contributes to additional decrease in quality of life. Other factors found to be significantly related to a lower quality of life were age (F-value = 8.1; p = 0.0044), medical comorbidity (F-value = 6.0; p = 0.0147), and patients' severity assessed by the CGI-S scale (F-value = 44.3; p < 0.0001). Gender and psychiatric comorbidity were not significantly related (p = 0.1925 and p = 0.6363, respectively).


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)

Quality of life (EuroQoL-5D total score) 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.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Quality of life (EuroQoL-5D total score) 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.
Mentions: The quality of life as assessed by the EQ-5D score showed that patients with PPS in all studied groups (viz. GAD with comorbid MDD, GAD without MDD, and control groups) experienced a significantly decreased quality of life as compared to patients without PPS (F-value = 30.3 for the combination of diagnoses and pain, p < 0.0001; PPS+ vs. PPS- for GAD+MDD+, GAD+MDD-, and control groups) (Figure 4). Similarly to functionality, the poorest quality of life was found in PPS positive GAD patients with comorbid MDD (LSM [SD] = 0.3 [0.0], p < 0.0001 vs. GAD+MDD- and control groups, with or without PPS). Results suggest that the presence of PPS alone contributes to additional decrease in quality of life. Other factors found to be significantly related to a lower quality of life were age (F-value = 8.1; p = 0.0044), medical comorbidity (F-value = 6.0; p = 0.0147), and patients' severity assessed by the CGI-S scale (F-value = 44.3; p < 0.0001). Gender and psychiatric comorbidity were not significantly related (p = 0.1925 and p = 0.6363, respectively).

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