Background: Evidence suggests substantial comorbidity between symptoms of somatization and depression in clinical as well as nonclinical populations. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship. In particular, it is unclear whether somatic complaints may heighten the risk for the subsequent development of depressive symptoms. Methods: We report findings on the link between symptoms of somatization (assessed using the SCL-90-R) and depression 5 years later (assessed using the CES-D) in an initially healthy cohort of community adults, based on prospective data from the RENO Diet-Heart Study. Results: Gender-stratified multiple regression analyses revealed that baseline CES-D scores were the best predictors of subsequent depressive symptoms for men and women. Baseline scores on the SCL-90-R somatization subscale significantly predicted subsequent self-reported symptoms of depressed mood 5 years later, but only in women. However, somatic complaints were a somewhat less powerful predictor than income and age. Conclusions: Our findings suggest that somatic complaints may represent one, but not necessarily the most important, risk factor for the subsequent development of depressive symptoms in women in nonclinical populations. The results also highlight the importance of including social variables in studies on women’s depression as well as conducting additional research to further examine predictors of depressive symptoms in men.

Allen L, Gara, M, Escobar J, Waitkin H, Silver R: Somatization: A debilitating syndrome in primary care. Psychosomatics 2001;42:63–67.
Escobar J, Golding J, Hough R, Karno M, Burnam M, Wells K: Somatization in the community: Relationship to disability and use of services. Am J Public Health 1987;77:837–840.
Gureje O, Simon G: The natural history of somatization in primary care. Psychol Med 1999;29:669–676.
Kaplan C, Lipki M, Gordon G: Somatization in primary care. J Gen Intern Med 1988;3:177–190.
Nezu A, Nezu C, Lombardo E: Cognitive-behavior therapy for medically unexplained symptoms: A critical review of the treatment literature. Behav Ther 2001;32:537–583.
Piccinelli M, Rucci P, Ustun B, Simon G: Typologies of anxiety, depression and somatization symptoms among primary care attenders with no formal mental disorder. Psychol Med 1999;29:677–688.
Robbins J, Kirmayer L: Transient and persistent hypochondriacal worry in primary care. Psychol Med 1996;26:575–590.
Kroenke K, Spitzer R, deGruy VF 3rd, Hahn S, Linzer M, Williams J, Brody D, Davies M: Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry 1997;54:352–358.
Katon W, Lin E, VonKorff M, Russo J, Lipscomb P, Bush T: Somatization: A spectrum of severity. Am J Psychiatry 1991;148:34–40.
Terre L, Ghiselli W: Do somatic complaints mask negative affect in youth? J Am Coll Health 1995;44:91–96.
Simon G, VonKorff M: Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area Study. Am J Psychiatry 1991;148:1494–1500.
Piccinelli M, Simon G: Gender and cross-cultural differences in somatic symptoms associated with emotional distress: An international study in primary care. Psychol Med 1997;27:433–444.
Couvee J, Bakker A, Zitman F: The relevance of psychiatric and somatic comorbidity in depressed chronic benzodiazepine users. Psychother Psychosom 2002;71:263–268.
Fava G, Mangelli L, Ruini C: Assessment of psychological distress in the setting of medical disease. Psychother Psychosom 2001;70:171–175.
Petersen T, Hughes J, Papakostas G, Kant A, Fava M, Rosenbaum J, Nierenberg A: Treatment-resistant depression and Axis II comorbidity. Psychother Psychosom 2002;71:269–274.
Simon G, VonKorff M, Piccinelli M, Fullerton C, Ormel J: An international study of the relation between somatic symptoms and depression. New Engl J Med 1999;341:1329–1335.
Zwaigenbaum L, Szatmari P, Boyle M, Offord D: Highly somatizing young adolescents and the risk of depression. Pediatrics 1999;103:1203–1209.
Judd L, Paulus M, Wells K, Rapaport M: Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. Am J Psychiatry 1996;153:1411–1417.
Coyne J, Thompson R, Palmer S, Kagee A, Maunsell E: Should we screen for depression? Caveats and potential pitfalls. Appl Prev Psychol 2000;2:101–121.
Johnson J, Weissman M, Klerman G: Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 1992;267:1478–1483.
Olfson M, Broadhead E, Weissman M, Leon A, Farber L, Hoven C, Kathol R: Subthreshold psychiatric symptoms in a primary care group practice. Arch Gen Psychiatry 1996;53:880–886.
Sartorius N, Ustun T, Silva J, Goldberg D, Lecrubier Y, Ormel J, VonKorff M, Wittchen H: An international study of psychological problems in primary care: Preliminary report from the World Health Organization Collaborative Project on ‘Psychological Problems in General Health Care.’ Arch Gen Psychiatry 1993;50:819–824.
Broadhead W, Blazer D, George L, Tse C: Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 1990;264:2524–2528.
Sherbourne C, Wells K, Hays R, Rogers W, Burnam A, Judd L: Subthreshold depression and depressive disorder: Clinical characteristics of general medical and mental health specialty outpatients. Am J Psychiatry 1994;151:1777–1784.
Tiemens B, Ormel J, Simon G: Occurrence, recognition, and outcome of psychological disorders in primary care. Am J Psychiatry 1996;153:636–644.
St. Jeor ST, Dyer A: Study design: The RENO Diet-Heart Study; in St. Jeor S (ed): Obesity Assessment Tools, Methods, Interpretations. New York, Chapman & Hall, 1997, pp 3–18.
St. Jeor ST (ed): Obesity Assessment Tools, Methods, Interpretations. New York, Chapman & Hall, 1997.
Shinn E, Poston W, Kimball K, St. Jeor ST, Foreyt J: Blood pressure and symptoms of depression and anxiety: A prospective study. Am J Hypertens 2001;14:660–664.
St. Jeor ST, Simpson M, Daugherty S: Subject recruitment and retention; in St. Jeor S (ed): Obesity Assessment Tools, Methods, Interpretations. New York, Chapman & Hall, 1997, pp 19–29.
Harlow S, Linet M: Agreement between questionnaire data and medical records: The evidence for accuracy of recall. Am J Epidemiol 1989;129:233–248.
Radloff L: The center for epidemiologic studies-depression scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977;3:385–401.
Radloff L, Locke B: The community mental health assessment survey and the CES-D scale; in Weissman M, Myers J, Ross C (eds): Community Surveys of Psychiatric Disorders. New Brunswick, Rutgers University Press, 1986, pp 177–189.
Miller G, Harrington M: Center for Epidemiologic Studies Depression Scale; in St. Jeor ST (ed): Obesity Assessment Tools, Methods, Interpretations. New York, Chapman & Hall, 1997, pp 457–464.
Coyne J, Kagee A: More may not be better in psychosocial interventions for cancer patients. Health Psychol 2001;20:458.
Derogatis L: SCL-90-R Administration, Scoring and Procedures Manual-II. Baltimore, Clinical Psychometric Research, 1983.
Golding J: Gender differences in depressive symptoms: Statistical considerations. Psychol Women Q 1988;12:61–74.
Antoni M, Carver C: Reply to Coyne and Kagee (2001). Health Psychol 2001;20:458–459.
Rauste-von Wright M, von Wright J: A longitudinal study of psychosomatic symptoms in healthy 11–18 year old girls and boys. J Psychosom Res 1981;25:525–534.
Terre L, Ghiselli W: A developmental perspective on family risk factors in somatization. J Psychosom Res 1997;42:197–206.
Nolen-Hoeksema S, Larson J, Grayson C: Explaining the gender difference in depressive symptoms. J Pers Soc Psychol 1999;77:1061–1072.
Barsky A, Klerman G: Overview: Hypochondriasis, bodily complaints, and somatic styles. Am J Psychiatry 1983;140:273–283.
Hansell S, Mechanic D: Introspectiveness and adolescent symptom reporting. J Human Stress 1985;11:165–176.
Mechanic D: The experience and reporting of common physical complaints. J Health Soc Behav 1980;21:146–155.
Turner R, Lloyd D: The stress process and the social distribution of depression. J Health Soc Behav 1999;40:374–404.
Craighead E, Vajk F: Depression and co-morbid disorders; in Blechman E, Brownell K (eds): Behavioral Medicine and Women: A Comprehensive Handbook. New York, Guilford, 1998, pp 757–763.
Gramling L, Lambert V, Pursley-Crotteau S: Coping in young women: Theoretical retroduction. J Adv Nurs 1998;28:1082–1091.
Rehm L, Wagner A, Ivens-Tyndal C: Mood disorders: Unipolar and bipolar; in Sutker P, Adams H (eds): Comprehensive Handbook of Psychopathology. New York, Kluwer, 2001, pp 277–308.
Kroenke K, Spitzer R: Gender differences in the reporting of physical and somatoform symptoms. Psychosom Med 1998;60:150–155.
Bardwell W, Ancoli-Israel S, Dimsdale J: Response bias influences mental health symptom reporting in patients with obstructive sleep apnea. Ann Behav Med 2001;23:313–317.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.