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Depression can lead to inflated reports of
Physical Symptoms
Newswise — New research shows people who
feel depressed tend to recall having more
physical symptoms than they actually
experienced. The study indicates that
depression -- not neuroticism -- is the
cause of such over-reporting.
Psychologist Jerry Suls, professor and
collegiate fellow in the University of Iowa
College of Liberal Arts and Sciences,
attributes the findings to depressed
individuals recalling experiences
differently, tending to ruminate over and
exaggerate the bad.
Published electronically this month in the
journal Psychosomatic Medicine, the study was
conducted by investigators in the UI
Department of Psychology, the Center for
Research in the Implementation of Innovative
Strategies in Practice (CRIISP) at the Iowa
City VA Medical Center, and the UI College
of Nursing.
The 109 study participants, all female,
completed baseline surveys to assess their
levels of neuroticism and depression. Each
day for three weeks, they reported whether
they felt 15 common physical symptoms
including aches and pains, gastrointestinal
and upper-respiratory issues.
On the 22nd
day, they were asked to remember how often
they had experienced each physical symptom
in the preceding three weeks. People who
scored higher in depression were more likely
to overstate the frequency of their past
symptoms.
"People who felt depressed made the most
errors when asked to remember their physical
symptoms," Suls said. "They tended to
exaggerate their experience."
Past research has indicated that people high
in neuroticism, a general disposition that
includes negative affects like irritability,
sadness, anxiety and fear, are more likely
to exaggerate their physical symptom
experience. This new study indicates that
depression -- which can be one component of
neuroticism -- is more likely the reason.
"For 30 years, the hypothesis has been that
neuroticism is behind inflated reports of
symptoms. We're saying no -- depression
appears to be the big player," Suls said.
"We discovered that people high in
neuroticism but low in depression are not
likely to misremember symptoms."
Knowing depression has physical symptoms of
its own, researchers employed a key control
in the study. When looking at the accuracy
of symptom recall, they factored out the
physical symptoms associated with
depression, like changes in sleep and
appetite. They also classified participants
as depressed or non-depressed based only on
the cognitive symptoms of depression, such
as sadness and anhedonia, a lack of interest
in normally pleasurable activities.
Depressed individuals still over-reported
physical symptoms.
The topic is important, Suls said, because
inflated symptom reports skew the
information healthcare providers need to
determine the best course of action.
Perception of symptoms can also affect the
patients' decisions -- such as whether they
take time off work, use over-the-counter
medications, or see a doctor.
"Depressed individuals and their physicians
shouldn't discount common symptoms because
they can indicate serious problems," Suls
said. "However, since we now know that
depressed individuals tend to over-remember
the frequency of symptoms, it wouldn't hurt
to encourage patients to write down their
symptoms as they're happening. That way the
patient and doctor have an accurate record
of what has been going on, rather than
relying on memory."
This particular study focused on women, but
Suls and colleagues are examining results
for a mixed group of men and women.
Participants in the studies were in good
health overall. In the future, Suls would
like to investigate how depression affects
symptom reporting in individuals with
chronic illnesses.
The research was supported by a grant to
Suls from the National Institute on Aging.
Co-Authors of the paper are M. Bryant Howren,
now a post-doctoral fellow with CRIISP at
the VA Medical Center in Iowa City, and René
Martin, a research health science specialist
at CRIISP and an associate professor in the
UI College of Nursing. CRIISP is funded
through the Department of Veterans Affairs,
Veterans Health Administration, Health
Services Research and Development
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