ORIGINAL ARTICLE Association between painful physical symptoms and clinical outcomes in Taiwanese patients with major depressive disorder: A three-month observational study Kuang-Peng Chen 1 MD, Nan-Ying Chiu 2 MD, Yu-Chih Shen 3 MD, Yuh-Ming Hou 4 MD, Chin-Bin Yeh 5 MD, Wen-Chen Ouyang 6 MD MPH PhD, Pritibha Singh 7 MSc, Renee E. Granger 7 PhD, Joel Raskin 8 MD FRCPC & Chaucer C.H. Lin 3,9 MD PhD 1 National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan 2 Changhua Christian Hospital, Lu-Tung Branch, Changhua, Taiwan 3 Buddhist Tzu Chi General Hospital and University, Hualien, Taiwan 4 Chia-Yi Christian Hospital, Chia-Yi, Taiwan 5 Tri-Service General Hospital, Taipei, Taiwan 6 Jianan Mental Hospital, Tainan, Taiwan 7 Intercontinental Information Sciences, Eli Lilly and Company, Sydney, Australia 8 Lilly Research Laboratories, Eli Lilly Canada, Toronto, Canada 9 Eli Lilly and Company Taiwan, Taipei, Taiwan Keywords East Asia, major depressive disorder, pain assessment, quality of life, Taiwan Correspondence Chaucer C.H. Lin MD PhD, Eli Lilly and Company Taiwan, 11F, 365, Fu Hsing N. Road, Taipei, Taiwan. Tel: 1886 2 3518 2234 Fax: 1886 2 2716 3314 Email: lin_chaucer@lilly.com Received 1 February 2010 Accepted 26 June 2010 DOI:10.1111/j.1758-5872.2010.00077.x Abstract Introduction: Reports from non-Asian populations indicate that painful physical symptoms are associated with poorer clinical and functional out- comes in patients with Major Depressive Disorder (MDD). This paper shows the changes in disease characteristics and quality of life in Taiwanese MDD patients, with or without painful physical symptoms, over 3 months’ observation. Methods: Taiwanese patients from an observational study of six East Asian countries/regions were classified as painful physical symptom positive (PPS1) or negative (PPS  ) based on a mean score of Z2 or o 2, respec- tively, on the modified Somatic Symptom Inventory. Changes from base- line in outcomes were compared between the groups. Results: Of 194 patients with MDD, 69% were PPS1 at baseline. These PPS1 patients were more depressed (17-item Hamilton Depression Rating Scale total; mean [SD] 27.1 [6.26] versus 21.8 [5.94] PPS  , P o 0.001), in more pain (Visual Analog Scale overall; median [range] 73.5 [9–100] versus 40 [0 to 80] PPS  , P o 0.001) and had poorer quality of life at baseline (EuroQoL; mean [SD] 42.9 [18.26] versus 59.8 [18.21] PPS , P o 0.001). At endpoint (n = 118), PPS  patients showed greater improve- ment on depression outcomes (Clinical Global Impression of Severity; P = 0.011) and had a higher remission rate (52.8 % versus 14.6% PPS1, P = 0.007). Discussion: Painful physical symptoms were frequently observed in Tai- wanese patients with MDD. As PPS are associated with more severe depression, poorer quality of life, and poorer remission outcomes, clinical management should address both the mental and physical symptoms associated with this disorder. Introduction Major depressive disorder (MDD) is a chronic psychiatric illness that is associated with various emotional and physical symptoms and affects almost 340 million people worldwide (Greden, 2003). The lifetime prevalence rate of MDD in Taiwan, as defined by the Chinese Diagnostic Interview Schedule, is 1.1%. This is markedly lower 136 Asia-Pacific Psychiatry 2 (2010) 136–145 Copyright c  2010 Blackwell Publishing Asia Pty Ltd Asia-Pacific Psychiatry ISSN 1758-5864 Official journal of the Pacific Rim College of Psychiatrists