Depression and Anxiety in Multisomatoform Disorder: Prevalence and Clinical Predictors in Primary Care

Abstract

Objective

Multisomatoform disorder (MSD) is characterized by ≥3 medically unexplained, bothersome physical symptoms together with a ≥2-year history of somatization. The aim of this study was to evaluate the prevalence of depressive and anxiety disorders in a South African sample with MSD, and compare demographic and clinical outcomes in those with and without comorbidity.

Methods

Fifty-one adult outpatients with MSD were recruited from primary care clinics in the Cape Town metropole. Participants were assessed for the presence of co-morbid anxiety and depressive disorders using the Mini Neuropsychiatric Interview-Plus (MINI-Plus). Outcomes included somatic symptom severity; disability; reported sick days and health care visits; pain experience; patient satisfaction with health services; and clinician experienced difficulty.

Results

A current comorbid depressive disorder was present in 29.4% (n=15) of patients, and a current comorbid anxiety disorder in 52.9% (n=27). MSD patients with a comorbid depressive disorder (current or lifetime) had significantly higher physical symptom counts, greater functional impairment, higher unemployment rates, more clinician reported difficulties, and more dissatisfaction with health care services than those without. A larger number of comorbid disorders was associated with greater overall disability.

Conclusion

High rates of comorbid major depression and anxiety disorders were present in a South African sample of primary care patients with MSD. Not all patients had comorbidity, consistent with the view that MSD should be conceptualised as an independent disorders. Furthermore, comorbid depression was associated with increased symptom severity and functional impairment, consistent with previous reports from developing countries, emphasizing the importance of comorbidity in MSD.