Frequency of Constipation in Major Depression: Relationship to Other C finical Variables MICHAEL GARVEY. M.D. RUSSELL NOYES. JR .. M.D. WILLIAM YATES. M.D.
A semistructured interview that evaluates 70 clinical variables. including constipation.
was administered to 170 patients with major depression. Twenty-seven percent ofthe patients had depression-associated constipation. Constipation was not associated with any other clinical variable.
A lthough constipation is often listed as one of .1""Lhe symptoms of depression,l.2 it probably does not occur in the majority of depressed patients. The reported frequency of constipation in depressed patients ranges from 28% to 60%/-5 while the reported frequency of constipation in the general population ranges from 10% to 30%.~8 However, comparisons of the rates of constipation in depressed and healthy populations are limited because previous studies of constipation in depressed patients failed to state the criteria used to define constipation. 3- 5 Moreover, if patients were asked whether they were constipated at the time of the index interview, then the frequency figures for constipation would need adjustment to account for the base rate or normal occurrence of this symptom. This study was conducted to ascertain whether the frequency or severity of constipation Received April 20. 1988; revised December 7. 1988; accepted January 4. 1989. From the Depanment of Psychiatry. Veterans Administration Medical Center, Iowa Cily: and the Depanment of Psychiatry. College of Medicine. University of Iowa. Iowa City. Iowa. Address reprint requests to Dr. Garvey. College of Medicine. University ofIowa. Psychiatric Hospital. 500 Newton Road. Iowa City. fA 52242. Copyright © 1990 The Academy of Psychosomatic Medicine.
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increases in depression and whether specific features distinguished depressed patients who were constipated from those who were not. METHODS Study participants were recruited from a university inpatient service and a private outpatient practice. All subjects met Research Diagnostic Criteria (RDC)9 for major depressive disorder and were evaluated with a semistructured interview. The interview elicited demographic data, the presence or absence of 31 depressive symptoms, a longitudinal psychiatric history, the previous medical history, the presence or absence of alcohol use, polarity of mood, data to make depression-subtype diagnoses according to ROC, and the family psychiatric history. Family history diagnoses were made with the ROC for family history. Inpatient subjects had a dexamethasone suppression test when they were hospitalized. Constipation was evaluated in the following manner: Patients were asked whether they began to experience constipation after the start of their current episode of depression. If constipation had been present before the current depression, patients were asked whether there was an unequivocal increase in the frequency or severity of the PSYCHOSOMATICS
Garvey et al.
constipation. We chose this strategy over simply comparing the frequency of constipation in patients and controls because the latter comparison would have excluded already constipated patients who experienced an unequivocal worsening of constipation when they became depressed. Constipation was defined as difficulty evacuating or straining during a bowel movement. 7 A previous study has demonstrated that patients meeting such a definition often meet alternate criteria for constipation. such as using laxatives, having a sensation of abdominal distension. or having a sensation of incomplete evacuation. 7 RESULTS A total of 177 patients met the study criteria. and all consented to the study interview. Forty-six T ABLE I.
patients had depression-related constipation, and 124 patients did not (seven patients did not give infonnation about constipation). Seventy variables were used to compare the two groups. Only two variables differed at the p
A semistructured interview that evaluates 70 clinical variables. including constipation.
was administered to 170 patients with major depression. Twenty-seven percent ofthe patients had depression-associated constipation. Constipation was not associated with any other clinical variable.
A lthough constipation is often listed as one of .1""Lhe symptoms of depression,l.2 it probably does not occur in the majority of depressed patients. The reported frequency of constipation in depressed patients ranges from 28% to 60%/-5 while the reported frequency of constipation in the general population ranges from 10% to 30%.~8 However, comparisons of the rates of constipation in depressed and healthy populations are limited because previous studies of constipation in depressed patients failed to state the criteria used to define constipation. 3- 5 Moreover, if patients were asked whether they were constipated at the time of the index interview, then the frequency figures for constipation would need adjustment to account for the base rate or normal occurrence of this symptom. This study was conducted to ascertain whether the frequency or severity of constipation Received April 20. 1988; revised December 7. 1988; accepted January 4. 1989. From the Depanment of Psychiatry. Veterans Administration Medical Center, Iowa Cily: and the Depanment of Psychiatry. College of Medicine. University of Iowa. Iowa City. Iowa. Address reprint requests to Dr. Garvey. College of Medicine. University ofIowa. Psychiatric Hospital. 500 Newton Road. Iowa City. fA 52242. Copyright © 1990 The Academy of Psychosomatic Medicine.
204
increases in depression and whether specific features distinguished depressed patients who were constipated from those who were not. METHODS Study participants were recruited from a university inpatient service and a private outpatient practice. All subjects met Research Diagnostic Criteria (RDC)9 for major depressive disorder and were evaluated with a semistructured interview. The interview elicited demographic data, the presence or absence of 31 depressive symptoms, a longitudinal psychiatric history, the previous medical history, the presence or absence of alcohol use, polarity of mood, data to make depression-subtype diagnoses according to ROC, and the family psychiatric history. Family history diagnoses were made with the ROC for family history. Inpatient subjects had a dexamethasone suppression test when they were hospitalized. Constipation was evaluated in the following manner: Patients were asked whether they began to experience constipation after the start of their current episode of depression. If constipation had been present before the current depression, patients were asked whether there was an unequivocal increase in the frequency or severity of the PSYCHOSOMATICS
Garvey et al.
constipation. We chose this strategy over simply comparing the frequency of constipation in patients and controls because the latter comparison would have excluded already constipated patients who experienced an unequivocal worsening of constipation when they became depressed. Constipation was defined as difficulty evacuating or straining during a bowel movement. 7 A previous study has demonstrated that patients meeting such a definition often meet alternate criteria for constipation. such as using laxatives, having a sensation of abdominal distension. or having a sensation of incomplete evacuation. 7 RESULTS A total of 177 patients met the study criteria. and all consented to the study interview. Forty-six T ABLE I.
patients had depression-related constipation, and 124 patients did not (seven patients did not give infonnation about constipation). Seventy variables were used to compare the two groups. Only two variables differed at the p
