ints needs long-term out-patient surveillance after

Table 2. Mean scores for psychometric scales on admission and at discharge among psychosomatically or somatically ill adult psychiatric patients referred to the psychiatric ward of a general hospital.

Table 3. The adjusted odds ratios (OR) with 95% confidence intervals (CI) related to depression (BDI ≥ 15) (Model 1) and at least partial recoverya) (Model 2)*.

assessment of their clinical status and work ability. Poor subjective health, long-lasting bodily pains, psychosomatic symptoms and life dissatisfaction at referral predicted depression at discharge, regardless of gender. They improved during the work ability assessment, but recovery was only started at the time of discharge.

Only 13% of the patients recovered at least partially from severe depression during their hospital stay. This is not surprising, since the recovery process is time-taking in depression, and can be more difficult if somatic complaints are involved. A younger age was beneficial for recovery paralleling to a study on partial recovery from major depression among outpatients of the same area of Finland [33]. Many of the patients of the present study had been in poor health for several years, but reported having been left without care. Thus, the special nature of psychosomatic problems is challenging. Better care of both somatic and mental health after evaluation period as well as long-lasting support should be provided if needed [12,27].

A poor health status, bodily pains and psychosomatic symptoms were linked with depressive symptoms. The study subjects reported long-lasting physical pains paralleling to the study of Alvarenga et al. [8] of patients with MDD and pain. Indeed, depression complicates the treatment of patients with pain, and vice versa [12,17]. Pains, chronic physical illnesses and psychosomatic symptoms may complicate the recognition of the psychological problems of the patients. Depression may remain unnoticed. Also the dualistic tendency especially of liaison-psychiatric patients to keep the body and mind separate may increase the risk of dropping out from psychiatric treatment. This risk should be minimized to avoid seeking repeatedly new health authorities after rejections by previous ones. Also the fear of the stigma of psychiatric disorders among these patients should be alleviated [34]. This might enhance the recovery from depression and restore the personal life satisfaction and self-respect of the patients. However, also comorbid personality disorder is a challenge for a good treatment outcome [35].

Life satisfaction has shown to be lowest among subjects with hospital discharge due to mental health disorders compared to other disorders [26]. It is strongly linked with various indicators of mental health [28], but especially with depression, even in longitudinal settings [25,27]. The proportion of dissatisfied (LS > 11) among the psychosomatically or somatically ill psychiatric patients of the present study (80%) was far greater than that among overall non-healthy Finns (25%). Thus, depression with somatic complaints seems to be especially hazardous to one’s subjective well-being.

In spite of all this, the study subjects assessed their depression as being milder than the treating psychiatrist. Even though the majority of them reported clinically significant depression, only a quarter experienced their depression as severe, while according to the psychiatrist almost two-thirds of the patients suffered from major depressive disorder. This result contrasts with findings from other depression patients, but might be typical for psychosomatic patients, but it needs further research.

While several adverse life changes were correlates of depression in the women (i.e. financial difficulties, the loss of a job and breaking off of a long-term relationship) as in a previous study among the female general population from the same area [36] the only such correlate in the men was difficulties in their sexual life. How psychosomatic tendency or possible alexithymia in men might play role in this? This finding emphasizes, however, the assessment of sexual difficulties particularly among men with psychosomatic complaints.

The strength of the present study was the homogeneous and fairly large sample (n = 146). The results obtained may be generalized to depressive patients with chronic somatic symptoms seeking help from non-psychiatric specialists. In the present sample, the chronic psychiatric, somatic and psychosomatic problems were leading them towards permanent disability. Since the recovery process had only started among the sample during the inpatient evaluation, further follow-up studies in the out-patient setting are especially warranted.


The findings emphasized the need for long-term outpatient surveillance of rehabilitation of psychiatric patients with somatic and psychosomatic problems after evaluation of their clinical status and work ability. Both their somatic and psychiatric needs, and especially their underreported depression and their psychosocial distresses due the long course of their illness should be recognized.


  1. Balon, R. (2006) Mood, anxiety and physical illness: Body and mind, or mind and body? Depression and Anxiety, 23, 377-387. doi:10.1002/da.20217
  2. Halaris, A. (2009) Comorbidity between depression and cardiovascular disease. International Angiology, 28, 92- 99.
  3. Frasure-Smith, N. and Lespérance, F. (2006) Recent evidence linking coronary heart disease and depression. The Canadian Journal of Psychiatry, 51, 730-737.
  4. Engum, A. (2007) The role of depression and anxiety in onset of diabetes in a large population-based study. Journal of Psychosomatic Research, 62, 31-38. doi:10.1016/j.jpsychores.2006.07.009
  5. Wilson, D. and Warise, L. (2008) Cytokines and their role in depression. Perspectives in Psychiatric Care, 44, 285-289. doi:10.1111/j.1744-6163.2008.00188.x
  6. Zhang, J., Ye, M., Huang, H., Li, L. and Yang, A. (2008) Depression of chronic medical inpatients in China. Archives of Psychiatric Nursing, 22, 39-49. doi:10.1016/j.apnu.2007.04.007
  7. Viinamäki, H., Heiskanen, T., Lehto, S., Niskanen, L., Koivumaa-Honkanen, H., Tolmunen, T., Honkalampi, K., Saharinen, T., Haatainen, K. and Hintikka, J. (2009) Association of depressive symptoms and metabolic syndrome in men. Acta Psychiatrica Scandinavica, 120, 23-29. doi:10.1111/j.1600-0447.2008.01333.x
  8. Alvarenga, M.E., Caniato, R.N., Mauritz, A., Braun, A., Aljeesh, Y. and Braune, B. (2008) Health service utilization in patients with major depression and co-morbid pain. Psychiatry and Clinical Neurosciences, 63, 101-106. doi:10.1111/j.1440-1819.2008.01898.x
  9. Lewandowski, W. (2004) Psychological Factors in chronic pain: A worthwhile undertaking for nursing. Archives of Psychiatric Nursing, 18, 97-105. doi:10.1016/j.apnu.2004.03.005
  10. Pincus, T., Burton, A.K., Vogel, S. and Field, A. (2002) Systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine, 27, E109-E120. doi:10.1097/00007632-200203010-00017
  11. Mok, L.C. and Lee, I.F.-K. (2008) Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals. Journal of Clinical Nursing, 17, 1471-1480. doi:10.1111/j.1365-2702.2007.02037.x
  12. Bair, M.J., Robinson, R.L., Katon, W. and Kroenke, K. (2003) Depression and pain comorbidity. Archives of Internal Medicine, 163, 2433-2445. doi:10.1001/archinte.163.20.2433
  13. Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V. and Ustun, B. (2007) Depression, chronic diseases, and decrements in health: Results from the World Health Surveys. The Lancet, 370, 851-858. doi:10.1016/S0140-6736(07)61415-9
  14. Sinikallio, S., Aalto, T., Airaksinen, O., Herno, A., Kröger, H, Savolainen, S., Turunen, V. and Viinamäki, H. (2006) Depression and associated factors in patients with lumbar spinal stenosis. Disability & Rehabilitation, 28, 415-422. doi:10.1080/09638280500192462
  15. Sinikallio, S., Aalto, T., Airaksinen, O., Herno, A., Kröger, H. and Viinamäki, H. (2009) Depressive burden in the preoperative and early recovery phase predicts poorer surgery outcome among lumbar spinal stenosis patients: A one-year prospective follow-up study. Spine, 34, 2573-2578. doi:10.1097/BRS.0b013e3181b317bd
  16. Romanov, K., Varjonen, J., Kaprio, J. and Koskenvuo, M. (2003) Life events and depressiveness—The effect of adjustment for psychosocial factors, somatic health and genetic liability. Acta Psychiatrica Scandinavica, 107, 25-33. doi:10.1034/j.1600-0447.2003.01419.x
  17. Aro, R., Nyberg, N., Absetz, P., Henriksson, M. and Lönnqvist, J. (2001) Depressive symptoms in middleaged women are more strongly associated with physical health and social support than socioeconomic factors. Nordic Journal of Psychiatry, 55, 191-198. doi:10.1080/08039480152036074
  18. Chong, J., Reinschmidt, K.M. and Moreno, F.A. (2010) Symptoms of depression in a Hispanic primary care population with and without chronic medical illnesses. The Primary Care Companion to the Journal of Clinical Psychiatry, 12, e1-e9.
  19. Escobar, J.I., Interian, A., Diaz-Martinez, A. and Gara, M. (2006) Idiopathic physical symptoms: A common manifestation of psychiatric disorders in primary care. The International Journal of Neuropsychiatric Medicine, 11, 201-210.
  20. Antikainen, R. and Hintikka, J. (1996) Somatic comorbidity in personality disorder inpatients. Effect on treatment outcome in a 3-year follow-up study. Nordic Journal of Psychiatry, 50, 469-476. doi:10.3109/08039489609082515
  21. Viinamäki, H., Hintikka, J., Haatainen, K., Antikainen, R., Honkalampi, K., Haatainen, K., Koivumaa-Honkanen, H., Saarinen, P. and Lehtonen, J. (2000) Effect of somatic comorbidity on alleviation of depressive symptoms. The Australian and New Zealand Journal of Psychiatry, 34, 755-761.
  22. Beck, A., Ward, C., Mendelson, M., Mock, J. and Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571. doi:10.1001/archpsyc.1961.01710120031004
  23. Viinamäki, H., Tanskanen, A., Honkalampi, K., Koivumaa-Honkanen, H., Haatainen, K., Kaustio, O. and Hintikka, J. (2004) Is the beck depression inventory suitable for screening major depression in different phases of the disease? Nordic Journal of Psychiatry, 58, 49-53. doi:10.1080/08039480310000798
  24. Allardt, E. (1973) About dimensions of welfare: Explanatory analysis of the comparative Scandinavian survey. Research Group of Comparative Sociology. Research Reports, University of Helsinki, Helsinki.
  25. Koivumaa-Honkanen, H., Honkanen, R., Viinamäki, H., Heikkilä, K., Kaprio, J. and Koskenvuo, M. (2000) Selfreported life satisfaction and 20-year mortality in healthy Finnish adults. American Journal of Epidemiology, 152, 983-991. doi:10.1093/aje/152.10.983
  26. Koivumaa-Honkanen, H. (1998) Life satisfaction as a health predictor. Kuopio University Printing Office, Kuopio.
  27. Koivumaa-Honkanen, H., Kaprio, J., Honkanen, R., Viinamäki, H. and Koskenvuo, M. (2004) Life satisfaction and depression in a 15-year follow-up. Social Psychiatry and Psychiatric Epidemiology, 39, 994-999. doi:10.1007/s00127-004-0833-6
  28. Koivumaa-Honkanen, H., Huovinen, T.K., Honkalampi, K., Antikainen, R., Hintikka, J., Haatainen, K. and Viinamäki, H. (2008) Mental health and well-being in a 6-year follow-up of patients with depression: Assessments of patients and clinicians. Social Psychiatry and Psychiatric Epidemiology, 43, 688-696. doi:10.1007/s00127-008-0353-x
  29. Derogatis, L.R. and Cleary, P.A. (1977) Confirmation of the dimensional structure of the SCL-90: Study in construct validation. Journal of Clinical Psychology, 33, 981-989. doi:10.1002/1097-4679(197710)33:4<981::AID-JCLP2270330412>3.0.CO;2-0
  30. World Health Organization (1992) International statistical classification of diseases and related health problems (ICD-10). World Health Organization, Geneva.
  31. First, M.B., Spitzer, R.L., Gibbon, M. and Williams, J.B.W. (1997) User’s guide for the structured clinical interview for DSM-IV Axis I disorders (SCID-I)—Clinician Version. American Psychiatric Press, Washington DC.
  32. First, M.B., Gibbon, M., Spitzer, R.L. and Williams, J.B.W. (1997) Structured clinical interview for DSM-IV Axis II personality disorders (SCID-II). American Psychiatric Press, Washington DC.
  33. Viinamäki, V., Hintikka, J., Tanskanen, A., Honkalampi, K., Antikainen, R., Koivumaa-Honkanen, H., Haatainen, K., Saarinen, P. and Lehtonen, J. (2002) Partial remission in major depression: A two-phase, 12-month prospective study. Nordic Journal of Psychiatry, 56, 33-37. doi:10.1080/08039480252803891
  34. Givens, J.L., Katz, I.R., Bellamy, S. and Holmes, W.C. (2007) Stigma and the acceptability of depression treatments among african americans and whites. Journal of General Internal Medicine, 22, 1292-1297. doi:10.1007/s11606-007-0276-3
  35. Viinamäki, H., Haatainen, K., Honkalampi, K., Tanskanen, A., Koivumaa-Honkanen, H., Antikainen, R., Valkonen-Korhonen, M. and Hintikka, J. (2006) Which factors are important predictors of non-recovery from major depression? A 2-year prospective observational study. Nordic Journal of Psychiatry, 60, 410-416. doi:10.1080/08039480600937801
  36. Honkalampi, K., Hintikka, J., Haatainen, K., KoivumaaHonkanen, H., Tanskanen, A. and Viinamäki, H. (2005) Adverse childhood experiences, stressful life events or demographic factors: Which are important in women’s depression? A 2-year follow-up population study. Australian and New Zealand Journal of Psychiatry, 39, 627-632. doi:10.1080/j.1440-1614.2005.01636.x

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