Experiences and coping strategies of somatic symptoms in patients with depressive disorder: A qualitative study

Abstract

Background: Depressive disorder is the most prevalent mental illness and is characterised by the presence of mental and somatic symptoms, with the latter affecting 65.0% to 98.2% of patients with their general function and quality of life. Purpose: The purpose of this study aimed to explore the experiences and coping strategies of somatic symptoms in Chinese patients with depressive disorder, and to gain new insight into the illness and the health care provided to patients. Methods: Semi-structured, in-depth interviews were conducted with 15 patients diagnosed with depressive disorder according to international classification of diseases 10th revision. The interviews were transcribed verbatim and the thematic analysis was adapted to the data. MAXQDA10 software was used to organise, encode, classify, induce, and extract themes. Results: Four major themes were extracted from the interviews: (1) descriptions of symptoms; (2) perceptions of the symptoms; (3) symptom disturbance; and (4) coping strategies of symptoms. Within the first theme, patients identified the following sub-themes: complex experiences of somatic symptoms, which were mainly in the neuromuscular system, circulatory respiratory system, gastrointestinal system and some symptoms without obvious systemic classification; difficulty in locating symptoms accurately; and being not consistent with examination results. The second theme included patient's inadequate understanding of somatic symptoms; and denial of the link between physical discomfort and depression. Disturbance of somatic symptoms embraced three sub-themes: (1) Uncertainty about somatic symptoms; (2) Struggling with daily life; (3) Impact on social activities; (4) feeling a decrease in family support. Lastly, coping strategies taken by patients in the face of various symptoms mainly included relying on drug treatment, avoiding stressors, diverting attention, and compromise or acceptance. Conclusions: Patients with depressive disorder experience a variety of somatic symptoms that have a negative impact on social function and reduce their quality of life. Patients did not have an adequate understanding of their physical discomfort and lacked effective coping strategies for these somatic symptoms. Professional staff should pay more attention to patients' somatic symptoms and focus on targeted symptom management to facilitate patient recovery.

Network analysis of somatic symptoms in Chinese patients with depressive disorder

“…This may be related to the high mental stress caused by somatic symptoms and hyperthermia of the hypothalamus-pituitary-adrenal axis (HPA) caused by depressive symptoms ( 30 ). Hyperfunction of the HPA axis leads to feeling one's heart pound or race (heart palpitations) and shortness of breath (chest tightness), which are some of the most easily perceived and worrying physical manifestations among Chinese patients ( 31 ). Patients regard these two symptoms as manifestations of heart disease, so they use more medical services (such as repeating visits to a cardiology department or conducting various cardiac examinations) and avoid daily activities, which will cause patients' health anxiety – that is, causing them to pay too much attention to physical symptoms and promoting the emergence of other symptoms ( 32 ).…”

“…Hyperfunction of the HPA axis leads to feeling one's heart pound or race (heart palpitations) and shortness of breath (chest tightness), which are some of the most easily perceived and worrying physical manifestations among Chinese patients ( 31 ). Patients regard these two symptoms as manifestations of heart disease, so they use more medical services (such as repeating visits to a cardiology department or conducting various cardiac examinations) and avoid daily activities, which will cause patients' health anxiety – that is, causing them to pay too much attention to physical symptoms and promoting the emergence of other symptoms ( 32 ). In clinical practice, more attention should be focused on palpitations and chest tightness in patients with depressive disorder, and efforts increased toward early identification and targeted model management to ensure improvement in the somatic symptoms and treatment outcomes ( 7 , 32 ).…”

“…Back pain is also considered one of the most common causes of patients seeking medical care in primary care and emergency settings, costing $200 billion annually in the United States ( 33 ). Influenced by Chinese culture, patients with depressive disorders tend to pay more attention to pain than emotional problems ( 32 ). Suicidal ideation in patients with low back pain was significantly greater than that in patients without comorbid conditions ( 31 , 34 ).…”

“…Influenced by Chinese culture, patients with depressive disorders tend to pay more attention to pain than emotional problems ( 32 ). Suicidal ideation in patients with low back pain was significantly greater than that in patients without comorbid conditions ( 31 , 34 ). In a single patient, pain and depression can be attributed to one or more factors in various ways.…”

Sex differences in residual somatic symptoms in patients with first-episode depression after acute-phase treatment

“…As we know, there is also a correlation between quality of life, social functioning, and somatic symptoms. Most studies show that people with depression experience various somatic symptoms that negatively affect social functioning and reduce their quality of life [ 31 ]. However, whether the quality of life and social functioning affect the appearance of residual somatic symptoms is rarely explored.…”