Somatic symptom overlap in Beck Depression Inventory–II scores following myocardial infarction

Department of Psychiatry, McGill University, and Department of Psychiatry and Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, Québec, Canada.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 07/2010; 197(1):61-6. DOI: 10.1192/bjp.bp.109.076596
Source: PubMed


Depression measures that include somatic symptoms may inflate severity estimates among medically ill patients, including those with cardiovascular disease.
To evaluate whether people receiving in-patient treatment following acute myocardial infarction (AMI) had higher somatic symptom scores on the Beck Depression Inventory-II (BDI-II) than a non-medically ill control group matched on cognitive/affective scores.
Somatic scores on the BDI-II were compared between 209 patients admitted to hospital following an AMI and 209 psychiatry out-patients matched on gender, age and cognitive/affective scores, and between 366 post-AMI patients and 366 undergraduate students matched on gender and cognitive/affective scores.
Somatic symptoms accounted for 44.1% of total BDI-II score for the 209 post-AMI and psychiatry out-patient groups, 52.7% for the 366 post-AMI patients and 46.4% for the students. Post-AMI patients had somatic scores on average 1.1 points higher than the students (P<0.001). Across groups, somatic scores accounted for approximately 70% of low total scores (BDI-II <4) v. approximately 35% in patients with total BDI-II scores of 12 or more.
Our findings contradict assertions that self-report depressive symptom measures inflate severity scores in post-AMI patients. However, the preponderance of somatic symptoms at low score levels across groups suggests that BDI-II scores may include a small amount of somatic symptom variance not necessarily related to depression in post-AMI and non-medically ill respondents.

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    • "Although depressive symptoms are generally considered on a continuum with depressive disorder, it is not clear whether this assumption holds true. Especially lower levels of depressive symptoms in the population may be confounded by underlying somatic illnesses (Thoms et al., 2010). Although the pathophysiological mechanisms underlying the association between metabolic disturbances and depression remains to be elucidated, our study point to sex-differences as well as a specific phenotype of depression that is associated with metabolic disturbances. "
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    • "The first study reported comparable somatic symptom levels, but a lower number of cognitive/affective symptoms and depressive cognitions in a sample of 40 depressed MI patients compared to 40 depressed patients from psychiatric care [7]. Another study found comparable somatic symptom levels after adjusting for the number of cognitive/affective symptoms [14]. These results do not necessarily suggest an increase in somatic symptoms as the driving force of post-MI depression. "
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    ABSTRACT: Depression in myocardial infarction patients is often a first episode with a late age of onset. Two studies that compared depressed myocardial infarction patients to psychiatric patients found similar levels of somatic symptoms, and one study reported lower levels of cognitive/affective symptoms in myocardial infarction patients. We hypothesized that myocardial infarction patients with first depression onset at a late age would experience fewer cognitive/affective symptoms than depressed patients without cardiovascular disease. Combined data from two large multicenter depression studies resulted in a sample of 734 depressed individuals (194 myocardial infarction, 214 primary care, and 326 mental health care patients). A structured clinical interview provided information about depression diagnosis. Summed cognitive/affective and somatic symptom levels were compared between groups using analysis of covariance, with and without adjusting for the effects of recurrence and age of onset. Depressed myocardial infarction and primary care patients reported significantly lower cognitive/affective symptom levels than mental health care patients (F (2,682) = 6.043, p = 0.003). Additional analyses showed that the difference between myocardial infarction and mental health care patients disappeared after adjusting for age of onset but not recurrence of depression. These group differences were also supported by data-driven latent class analyses. There were no significant group differences in somatic symptom levels. Depression after myocardial infarction appears to have a different phenomenology than depression observed in mental health care. Future studies should investigate the etiological factors predictive of symptom dimensions in myocardial infarction and late-onset depression patients.
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