Somatization as a core symptom of melancholic type depression. Evidence from a cross-cultural study

doi:10.1016/0165-0327(94)90089-2

Journal of Affective Disorders

Volume 32, Issue 4, December 1994, Pages 253-256

https://doi.org/10.1016/0165-0327(94)90089-2 Get rights and content

Abstract

The study questions whether different types of somatization may be a core symptom of melancholia, thus, being invariable across cultures and being a candidate for neurobiological research and diagnostic criteria. 51 Turkish patients and 51 education-matched German patients with melancholic depression were compared for two types of somatization. Turkish patients had higher frequencies of somatic preoccupation and hypochondriasis but they were not different in the perception and experience of somatic symptoms. It is concluded that: (1) somatization has to be differentiated psychopathologically; (2) it may be a neurobiological core symptom of melancholia in the well-defined sense of ‘perceiving abnormal somatic symptoms’; and (3) it may be a culture-bound symptom in the sense of ‘being abnormally concerned with somatic symptoms or hypochondical fears’.

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Cited by (41)

Cultural and developmental factors affecting the presentation of somatic symptoms in depression: The case of turkish patients
2012, Neurology Psychiatry and Brain Research
Citation Excerpt :
Three studies compared Turkish patients with depression with European patients (i.e. German and English). All of those reported that somatic concerns and hypocondriasis are commoner in Turkish patients.17,35,39 The prevalence of somatic symptoms reported by Turkish patients and its comparison with other Asian populations diagnosed with MDD were summarized in Table 1.
Major Depressive Disorder is a frequent cause of morbidity worldwide. Depression and pain disorders/symptoms are common co-morbidities. The current definitions of depression mention pain but they describe it as a secondary or uncommon symptom. This emphasis on affective symptoms may contribute to under-recognition of pain and other physical symptoms in patients with depression. The differing patterns of symptoms of depression, both over life time and within different cultures may reflect various mechanisms, cultural and economical. Therefore, we aimed to focus on painful/somatic symptoms of depression in studies reported from Turkey both in native and in migrant populations and compare the results with studies reported from other Asian and European countries. As a result, we have found that somatic symptoms are a prominent feature of Asian populations with depression, including Turkey, but that the latter also tend to report cognitive symptoms similar to Western populations with depression. The relationship of pain and somatic symptoms with depression may be complex. Further studies are needed to explain the co-morbidity of pain and depression.
Severe depression: Cultural and social factors
2009, Encephale
Après avoir proposé un cadre théorique permettant d’intégrer les contributions des approches du constructivisme social et de la biologie dans la compréhension des maladies mentales en général et de la maladie dépressive en particulier, les auteurs soulignent le faible nombre de publications mentionnant un lien direct entre les facteurs socio-culturels et la sévérité de la dépression. Par contre, des arguments indirects existent qui sont regroupés en deux entités, les modifications selon les cultures de l’expression clinique (somatisation, idées délirantes) d’une part, le poids des représentations sociales et individuelles de la maladie dépressive et ses conséquences en termes de stigmatisation d’autre part. Ces variations transculturelles modulent le processus de recherche de soins et donc l’évolution de la maladie dans le sens d’une gravité plus importante. Les auteurs font remarquer pour conclure que la proposition initiale pourrait être inversée puisque certains avancent que la place centrale occupée par le diagnostic de dépression est un fait de civilisation, voire le symptôme de la sévérité du malaise de la société occidentale.
After first providing a theoretical framework including the contributions of social constructivist and biological approaches to the comprehension of mental diseases in general and depression in particular, the authors stress the small number of publications mentioning a direct link between sociocultural factors and the severity of depression. However, there are indirect arguments that are classified into two groups : modifications based on the cultures of clinical expression (somatisation, delirious ideas) on one hand and the weight of social and individual views of depression and of its consequences in terms of stigmatisation on the other. These transcultural variations modify the process of seeking care and, thus, the progression of the disease towards increased severity. The authors point out, in conclusion, that the initial proposition could be reversed as some have postulated that the central role occupied by the diagnosis of depression is a phenomenon of civilisation or even the symptom of the severity of the uneasiness of western society.
Depression and generalised anxiety in the general population in Belgium: A comparison between native and immigrant groups
2007, Journal of Affective Disorders
Knowledge of the mental health status of the general population in Belgium is limited. Only recently have prevalence rates and risk factors for depression and generalised anxiety been identified. However, the question remains whether there are statistically significant differences between foreign origin groups and the native population.
Basing our study on data from the Belgian Health Interview Survey 2001 and focusing on the adult population aged 18–65 (N = 7224), we consider eight risk factors for depression and generalised anxiety as assessed by the Symptom Checklist 90-subscales. The risk factors are region of origin, gender, age, household type, labour market position, educational level, household income and home ownership. Our approach involves weighted logistic regression.
Analysis shows that most depressive symptoms are more prevalent among persons of Turkish or Moroccan origin than among Belgians or people from other EU Member States. This is not the case, though, for anxiety symptoms. However, if we consider depression and generalised anxiety as a syndrome, we find significantly more of the 10% highest SCL-scores in Turkish and Moroccan immigrants. Multivariate analysis indicates that their higher prevalence rate of anxiety is entirely attributable to their lower socioeconomic position. In the case of depression, the risk decreases only partly, leaving a significant association with Turkish or Moroccan origin.
In Belgium, depression and generalised anxiety are more prevalent in the population originating from Turkey and Morocco than in population groups originating from within the European Union.
Prediction of major depression in Japanese adults: Somatic manifestation of depression in annual health examinations
2006, Journal of Affective Disorders
The present study examined whether somatic symptoms found in annual health examinations, could be predictive of major depression in the ensuing year.
Subjects analyzed were 1027 non-major-depressive workers (706 men, mean age 35) attending annual health examinations at a research institute. All were Japanese and found not to be suffering from major depression when interviewed, according to the semi-structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). A self-administered questionnaire containing items relating to twelve major somatic symptoms was completed by all the subjects. The same DSM-IV interviews for the diagnosis of major depression were conducted to calculate the odds ratio of baseline variables for depressive and somatic symptoms, physical examination items, and health-related life-styles for the prediction of major depression in the ensuing year.
The prevalence of major depression in the ensuing year was 2.5%. For four somatic symptoms (fatigue, lower back pain, dizziness, and nausea), the prevalence was higher (all p < 0.05) in those who complained of each somatic symptom at baseline than in those who did not. Furthermore, the multiple logistic regression analysis indicated that lower back pain and dizziness at baseline were independent risk factors of major depression in the ensuing year [odds ratio (95% confidence intervals), 3.2 (1.1, 8.9) and 6.0 (1.8, 20.1), respectively].
It is possible that somatic manifestations of depression are culturally bound phenomena and results might be generalizable only to Japanese workers.
Somatic symptoms reported at annual health examinations may be useful indicators for predicting major depression.
Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands
2004, Journal of Affective Disorders
Western societies host increasing number of elderly labour migrants from Turkey and Morocco. The article studied the prevalence of clinically significant depressive symptoms among elderly Turkish and Moroccan migrants compared with native Dutch elderly and if differences in prevalence rates were explained by known risk factors for depression and/or ethnic, migration-related factors.
330 Turkish, 299 Moroccan, and 304 Dutch elderly (55–74 years) were interviewed (cross-sectionally) using the Center for Epidemiologic Depression Scale (CES-D). Potential risk factors included sex, income level, marital status, ethnic origin, chronic physical illnesses, limitations in daily functioning, migration and acculturation questions.
The prevalence of self-reported depressive symptoms (CES-D ≥16) was very high in elderly migrants, 33.6% for Moroccan and 61.5% for Turkish elderly. The prevalence of depressive symptoms in the native Dutch sample was similar to earlier studies in the Netherlands and abroad: 14.5%. Among migrants education and income level was very low and they had a high number of physical limitations and chronic medical illnesses. This only explained part of the ethnic differences found. In all three samples, depressive symptoms were associated with sex, chronic physical illness and physical limitations. In multivariate analysis, ethnic origin was uniquely associated with the presence of clinically significant depressive symptoms. Only a small number of remigration and acculturation items were associated with depressive symptoms in bivariate analysis.
The prevalence of clinically significant depressive symptoms among elderly migrants from Turkey and Morocco in the Netherlands is very high. Ethnicity was a strong independent risk factor.
Reporting of somatic symptoms as a screening marker for detecting major depression in a population of Japanese white-collar workers
2003, Journal of Clinical Epidemiology
The objective of this study was to assess screening practices for detecting major depression in workers complaining of somatic symptoms.
A total of 1443 Japanese white-collar workers (991 men and 452 women, mean age 34 years) completed a medical symptom checklist (major 12 somatic symptoms) and were diagnosed using the structured clinical interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
There were 42 cases (2.9%) with major depression in the total sample. Of the 902 subjects without somatic symptoms, only one (0.1%) was identified as having major depression. The prevalence of the disorder was positively associated (P<.001) with the total number of somatic symptoms, and the area under the receiver operator characteristic curve was 0.92 for men and 0.81 for women, which showed the sensitivity and specificity of the total number of somatic symptoms for detecting major depression.
The number of reported somatic symptoms is a simple and useful predictor of major depression.

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Somatization as a core symptom of melancholic type depression. Evidence from a cross-cultural study

Abstract

J. Affect. Disord.

Dysthymic disorder: psychopathology of proposed chronic depressive subtypes

Am. J. Psychiatry

Psychiatrie der Gastarbeiter

Cross-cultural aspects of the somatization trait

Hosp. Community Psychiatry

Culture, affect, and somatization

Transcult. Psychiatry Res. Rev.

Culture, affect, and somatization

Transcult. Psychiatry Res. Rev.