Do medically unexplained somatic symptoms predict depression in older Chinese?

OBJECTIVE: To identify the pattern of somatic presentation of depression among older Chinese by examining the association between medically unexplained somatic symptoms and depression.
SUBJECTS: The population comprised 1433 Chinese 65 years or older recruited from 11 older community centres distributed across the three main territory regions of Hong Kong.
METHOD: Data were collected between January and December 2008, with a response rate of 72.3%. Data on socio-demographic background, medical profile and somatic symptoms were collected. The Mental Health Inventory (five-item) was used for depression screening. Medically unexplained somatic symptoms were defined as those not explained by any known medical pathology.
RESULTS: The prevalence of depression among older Chinese was 16.5%. They reported more frequently than did the non-depressed six medically unexplained somatic symptoms. After being adjusted for age, living arrangements, social support, financial strain, major stressful life events and chronic illness, depression was found to be significantly associated with all medically unexplained somatic symptoms (odds ratio: 1.667-2.268). Indeed, depressed older people were more likely to have multiple symptoms than were the non-depressed, the odds ratio increasing from 2.64 (95%CI: 1.884-3.717) for two co-existing symptoms to 4.521 (95%CI: 1.872-10.917) for six symptoms.
CONCLUSION: Older Chinese with depression were more likely to have multiple medically unexplained somatic symptoms, particularly fatigue, insomnia, loss of appetite and gastro-intestinal problems. Health care professionals need to be aware of this pattern of somatization and take active steps to rule out any underlying psychological etiology.