Should Unexplained Painful Physical Symptoms be Considered within the Spectrum of Depressive Symptoms?

Jihyung Hong *, 1, Diego Novick 1, William Montgomery 2, Jaume Aguado 3, Héctor Dueñas 4, Xiaomei Peng 5, Josep Maria Haro 3
1 Eli Lilly and Company, Windlesham, Surrey, UK
2 Eli Lilly Australia Pty Ltd, West Ryde, Australia
3 Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
4 Eli Lilly de Mexico, Mexico City; 5Eli Lilly and Company, Indianapolis, IN, US
5 Eli Lilly and Company, Indianapolis, IN, US

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© Hong et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Eli Lilly and Company, ErlWood Manor, Sunninghill Road, Windlesham, Surrey, GU20 6PH, UK; Tel: +44 1276 483260; Fax: +44 1276 483192; E-mail:



To examine whether painful physical symptoms (PPS) can be considered within the spectrum of depressive symptoms.


Data for this post-hoc analysis were taken from a 6-month observational study mostly conducted in East Asia, Mexico, and the Middle East of 1,549 depressed patients without sexual dysfunction at baseline. Both explanatory and confirmatory factor analyses (EFA and CFA) were performed on the combined items of the 16-item Quick Inventory of Depressive Symptomatology Self-Report and the Somatic Symptom Inventory (seven pain-related items only). An additional second-order CFA was also conducted to examine an association between retained factors and the overall “depressive symptoms” factor. In addition, Spearman’s correlation was used to assess levels of correlation between retained factors and depression severity as well as quality of life.


Both EFA and CFA suggested and validated a four-factor solution, which included a pain factor. The other three factors identified were a mood/cognitive factor, a sleep disturbance factor, and an appetite/weight disturbance factor. All four factors were significantly associated with the overall factor of depression. They were also highly correlated to depression severity and quality of life (p<0.001 for all). The levels of correlations with the pain factor were generally greater than those with the appetite/weight factor and similar to those with the sleep factor.


It may be reasonable to consider PPS within a broad spectrum of depressive symptoms. At least, they should be routinely assessed in patients with depression. Further research is warranted to validate these preliminary findings.

Keywords: Depression, factor analysis, painful physical symptoms, rating scale.