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.

5. CONCLUSION

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.

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