Masked Depression: Profile and Severity of Symptoms and Impulsivity in Patients with Generalized Anxiety Disorder

Major depressive disorder may remain underdiagnosed as it can be hidden behind somatic complaints or behavioral problems such as impulsivity, making other symptoms difficult to be recognized. The aim of the study was to determine the presence of depression in a sample of patients first-time diagnosed with generalized anxiety disorder that do not refer symptoms related to depression and to compare anxiety symptoms profile and impulsivity features between depressed and non-depressed patients. A total of 86 patients with DSM-IV diagnosis of GAD were recruited from the outpatient psychiatric services of the General Hospital of Comalcalco, Tabasco. Anxiety symptom severity and impulsivity were assessed with previously validated instruments. Depression was rated with the Hamilton Depression Rating Scale and the sample was categorized in depressed and non-depressed patients. More than half of the patients (54.7%) were identified as clinically depressed. These patients reported more severe anxiety symptomatology and more impulsivity than non-depressed patients; depressed patients also reported more somatic symptoms (e.g., gastrointestinal and hypochondriasis) which patients might identify as anxiety symptoms. In Latin-America, it is very common to use somatic symptoms as idioms of expression of emotional distress. Therefore, in patients with GAD with high levels of somatic complaints and impulsivity, depression should be evaluated.