Psychiatria Danubina, 2011; Vol. 23, No.

4, pp 347-354 Original paper

© Medicinska naklada - Zagreb, Croatia

THE MMPI-2 NEUROTIC TRIAD SUBSCALES AND DEPRESSION

LEVELS AFTER PHARMACOLOGICAL TREATMENT
IN PATIENTS WITH DEPRESSIVE DISORDERS - CLINICAL STUDY
Monika Talarowska, Krzysztof Zboralski, Marcelina Chamielec & Piotr Gałecki
Department of Adult Psychiatry, Medical University of Lodz, Lodz, Poland

received: 16.12.2010; revised: 11.7.2011; accepted: 13.10.2011

SUMMARY
Background: Affective disorders provide for one third of the main causes of psychiatric inpatient care, both in male and female
subjects. An early diagnosis of the disease with precise identification of the character of its particular symptoms are key important
factors for the efficacy of treatment. The goal of the study was an identification of possible associations between scores of the
neurotic triad in the MMPI-2 test (hypochondria - Hs, depression - D, hysteria - Hy), evaluated at initial hospitalization period with
remission degree assessed by the Hamilton Depression Rating Scale (HDRS), following eight weeks of treatment with SSRI.
Subjects and methods: A group of 50 subjects took part in the study. The MMPI-2 test and HDRS were used in the study. The
HDRS was performed at the therapy onset and reapplied after 8 weeks of its continuation. The MMPI-2 test was applied at the
beginning of treatment.
Results: Higher scores in Hs (p=0.007), D (p=0.021) and Hy scales (p=0.001) are associated with the higher degree of
depression, measured by the HDRS at the therapy onset. The highest performance in Hs scale (p=0.003) and Hy scale (p=0.001)
evaluated on admission, was associated with the highest depression level after pharmacological treatment.
Conclusion: The higher the degree of hypochondria and hysteria symptoms, measured by the MMPI-2 test at the onset of therapy
in patients with depressive disorders, the higher severity of depression is being found after 8 weeks of therapy with SSRI agents,
measured by the HDRS scale.

Key words: depressive disorder - MMPI - pharmacotherapy

* * * * *

INTRODUCTION most recent advances in neurobiological research pro-

vide increasing evidence that inflammatory and neuro-
Affective disorders constitute one third of the main progressive processes play a significant role in
causes for psychiatric inpatient care, regarding both depression. Preclinical and clinical studies on depression
male and female subjects. Every year, approximately highlight an increased production of inflammatory
100 million people all over the world demonstrate markers, such as interleukin (IL)-1, IL-6, tumor necrosis
symptoms of depression, which means that depressive factor-α and interferon- α and γ. In animal models, acute
disorders affect at least 15% of the adult female and and chronic administration of cytokines or cytokine
10% of the adult male population (Talarowska et al. inducers trigger depressive symptoms (Maes 1999). By
2009). An early diagnosis of the disease with precise contrast, Pols & Battersby (2008) observed an inverse
identification of the character of its particular symptoms relationship, namely that among patients with somatic
and the disease course in each individual patient are key symptoms (including 300 examined subjects), 50%
factors for the efficacy of administered medical fulfilled the diagnostic criteria of depression, while
treatment (Klonsky & Bertelson 2000, Biles 2005). various degrees of anxiety are identified in the
According to the data, presented by the World remaining 35%. It should be kept in mind that intensive
Health Organisation, as many as 95% of all psychiatric somatic symptoms (including pain) accompany not only
patients report various physical ailments, depression the so-called masked depression but they occur together
being one of prevailing disease entities in this group of with typical depressive disorders as well. In the former
patients. In turn, almost 2/3 of patients with depressive group, out of the above-mentioned ones - somatic
disorders experience physical pain (Garcia-Cebrian et symptoms come into prominence and are thus relatively
al. 2006, Krebs & Bair 2008) and in approximately 90- early identified both by the patient himself/herself and
99% of the patients, at least one physical symptom is by his/her physician. In these cases, the symptoms
present (fatigue in 85%, sleep disorders in 78%, appetite which are characteristic for depressive disorders, such
changes in 58%, generalized pain in 49% and sexual as depressed mood, disturbed circadian rhythms, the
dysfunction in 48%) (Mustapha 2005). Furthermore, it feeling of guilt or loss of body weight are less frequent
may be concluded that as many as 69% of patients with and less enhanced, while physical complaints overlap
later diagnosed depression attend a GP for more or less the clinical picture of the base disease, impeding the
intense physical complaints (Lerman et al. 2010). The diagnosis (Mihaila 2004).

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 Monika Talarowska, Krzysztof Zboralski, Marcelina Chamielec & Piotr Gałecki: THE MMPI-2 NEUROTIC TRIAD SUBSCALES AND DEPRESSION
LEVELS AFTER PHARMACOLOGICAL TREATMENT IN PATIENTS WITH DEPRESSIVE DISORDERS - CLINICAL STUDY
Psychiatria Danubina, 2011; Vol. 23, No. 4, pp 347-354

The Minnesota Multiphasic Personality Inventory pessimism. Subjects in this group react to difficult
(MMPI-2) test by S. Hathaway and J. McKinley is a situations with strong somatic symptoms. They are
psychological tool, used in the diagnostics of various nervous, impatient and live under constant tension
disorders, and is also helpful in determining the mode of (Kucharski 2002, Talarowska et al. 2010).
planned psychotherapeutic interventions. When The aim of this study was to identify possible
applying the MMPI-2 test profilogram during associations between scores in the neurotic triad in the
assessment of depression symptoms, there are multiple MMPI-2 test (hypochondria, depression, hysteria),
scales and subscales for disposal, characterised by measured at the time of hospital admission and
various degrees of diagnostic accuracy, e.g., the clinical remission degree assessed by the Hamilton Depression
depression scale (D), the Harris-Lingoes subscales of Rating Scale (HDRS) following 8 weeks of
depression (D1, D2, D3, D4 and D5), the depression pharmacological treatment with selective serotonin
content scale (DEP), the components of content scales, reuptake inhibitors (SSRI), in a group of patients
concerning depression (DEP1, DEP2, DEP3, DEP4), diagnosed with depressive disorders.
selected critical questions by Koss-Butcher and
Lachara-Wrobel or Wiener-Harmon’s scale of
SUBJECTS AND METHODS
symptoms of obvious (O-D) and subtle (S-D)
depression. Regarding patients with depression, those
Subjects
scales are also diagnostic, revealing patient's
concentration on somatic and physical functioning of The reported study comprised 50 subjects (women
his/her body, including the hypochondria scale (Hs) and n=30; men n=20), aged 20-62. The studied groups did
the hysteria scale (Hy). The depression, hypochondria not differ significantly in terms of gender (p>0.05).
and hysteria scales constitute the ‘neurotic triad’ Education was measured by the number of years of
(Hathaway & McKinley 1943, Jones 2001, Biles 2005). completed school education (years at school). Consi-
High scores in all the three scales are associated with an dering the Polish education system, the education period
excessive concentration on somatic health status, ≤9 years was considered as primary education, 10-12
frequent complaints of physical ailments, lack of years - secondary and >12 years - higher education. See
energy, sleep problems, impaired attention, Table 1 for the demographic characteristics of the
concentration and low self-esteem, diffidence and studied group and for data on the disease course.

Table 1. Demographic characteristics of the studied group and the data on disease course
Variable N % M SD range
Gender F 30 60.00 - - -
M 20 40.00 - - -
Age - - - 44.12 yrs 12.39 yrs 20-62 yrs
Education Primary 19 38 - - -
Secondary 23 46 - - -
High 8 16 - - -
Education period - - - 11.66 yrs 2.73 yrs 9-17 yrs
Disease Duration of the disease - - 8.06 yrs 8.73 yrs 2-30 yrs
Number of hospitalization episodes
- - 2.56 1.85 1.00-8.00
for depressive disorders
Number of depression episodes - - 7.05 7.54 1.00-16.00

Patients were selected for the study according to the (computer tomography and magnetic resonance) were
inclusion diagnostic criteria of ICD-10 (F32, F33) performed in order to assess changes in the CNS. The
(1993). Patients with the diagnosis of severe depressive study group included subjects, hospitalized for the first
episode with psychotic symptoms (F32.3), other de- time for depressive episode and depression treatment-
presssive episodes (F32.8), recurrent depressive disor- naïve, as well as those, treated for many years before
der, current episode severe with psychotic symptoms and with multiple hospitalisation episodes in their
(F33.3), recurrent depressive disorder, currently in history, the latter admitted for various degrees of health
remission (F33.4) and other recurrent depressive deterioration. All the subjects from the DD group were
disorders (F33.8) were not enrolled in the study. The examined during the course of their hospitalization. In
presence of mental disorders, other than depressive assessing the presence of organic changes in the CNS
episode, and the diagnosis of somatic diseases and the imaging studies (computed tomography and
injuries of the central nervous system (CNS), were also magnetic resonance imaging) were used. In all the
regarded as exclusion criteria. Brain imaging techniques included subjects, case history was obtained prior to

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 Monika Talarowska, Krzysztof Zboralski, Marcelina Chamielec & Piotr Gałecki: THE MMPI-2 NEUROTIC TRIAD SUBSCALES AND DEPRESSION
LEVELS AFTER PHARMACOLOGICAL TREATMENT IN PATIENTS WITH DEPRESSIVE DISORDERS - CLINICAL STUDY
Psychiatria Danubina, 2011; Vol. 23, No. 4, pp 347-354

main study procedure, using the standardized Compo- scale is designed to detect defensiveness and measures
site International Diagnostic Interview (Patten 1997). the willingness to disclose personal information. A high
Additionally, the number of depression episodes, the score reflects an uncooperative attitude and reluctance
disease duration periods and the number of hospital- to disclose personal information (Kucharski 2002).
lization episodes were recorded in each patient. Severity of depression. The severity of depression
No evaluations of the intellectual functions of the was assessed using the 21-item Hamilton Depression
enrolled patients were carried out prior to the Rating Scale (HDRS) (Hamilton 1960, Moonseong et
psychological examination. However, on the basis of al. 2007). The HDRS consists of items evaluating
medical records and anamnesis, it was established that depressed mood, psychomotor agitation, inhibition, the
none of the participants had been diagnosed with mental sense of guilt, sleep and appetite disorders, anxiety
disability or any of the analyzed intellectual deficits. symptoms, suicidal thoughts and self-criticism. The
During hospitalization, all the patients received anti- questionnaire was designed by Hamilton in 1960 and
depressant pharmacotherapy (monotherapy), including has been and still is one of the most frequently used
SSRI (Selective Serotonin Reuptake Inhibitors) group: tools to evaluate the degree of depression symptoms,
25 patients received fluoxetine, the onset dose (20 especially their dynamics during the episode. Cronbach
mg/day, the maximum dose: 60 mg/day, the mean dose a coefficient of reliability, calculated for the scale, was -
(M): 35 mg/day, SD 9.5), 8 patients received sertraline on the average - 0.70 (Bagby et al. 2004), of sensitivity
(the onset dose: 50 mg/day, the maximum dose: 200 0.78 and of specificity 0.75 (Aben et al. 2002). The
mg/day, M 130 mg/day, SD 14.7), 12 patients were severity of depressive symptoms were assessed using a
administered citalopram (the onset dose: 20 mg/day, the four-point scale (for questions 1-13) and at two-point
maximum dose: 40 mg/day, M 31 mg/day, SD 4.3), 5 scale (for questions 14015). The scores, obtained from
patients received paroxetine (the onset dose: 20 mg/day, the 4 last questions, were not included into the total
the maximum dose: 60 mg/day, M 32 mg/day, SD 3.9). result. Depressive symptom intensity levels were classi-
The specified agents were administered in therapeutic fied by the grades, specified in the study by Demytte-
doses as defined by Taylor, Paton and Kerwin (2007). naere and De Fruyt (2003): <7 - no depressive symptoms,
Although 66 patients were initially enrolled in the 8-12 - mild depressive symptoms, 13-17 - moderate
study, the data represent the results of those patients depressive symptoms, 18-29 - severe depressive symp-
(n=50) who achieved remission after 8 weeks of toms, >30 - very severe depressive symptoms (the
pharmacotherapy treatment. 10 patients dropped out authors based their interpretation of results on the 17-item
from the study group due to deterioration in mental state version of the scale). The HDRS scale is also used for
or lack of improvement, 6 due to serious adverse effects evaluation of clinical improvements after applied phar-
(2 - dizziness and headache, 2 - nausea and other macological therapy. Mental status improvement and
gastrointestinal symptoms, 2 - growing agitation and the efficacy of applied therapy were evaluated in two
anxiety). aspects: the response to therapy and disease remission.
The response to therapy was defined as ≥50% reduction
Methods of depression symptoms vs. the base level, while the
HDRS score <8 was regarded as disease remission.
Neurotic triad of MMPI-2. The Polish version of
the Minnesota Multiphasic Personality Inventory by S.
Rater and interrater training
Hathaway and J. McKinley, adapted by T. Kucharski
(MMPI-2) (2002), was used in the study in paper- and- The HDRS was performed at the therapy onset (on
pencil form. The result of the study in its standard admission) and after 8 weeks of its continuation. The
version is a scoring profile, comprising three control MMPI-2 test was applied at the beginning of the
scales and results of the following ten (10) clinical pharmacological treatment. All the patients were
scales: Hypochondria (Hs), Depression (D), Hysteria examined on admission, i.e., at the symptomatic phase,
(Hy), Psychopathic Deviate (Pd), Masculinity/ before or shortly after previous antidepressant drug
Femininity (Mf), Paranoia (Pa), Psychasthenia (Pt), regime modification. The study by the above-mentioned
Schizophrenia (Sc), Mania (Ma), Social Introversion tests was in each case performed by the same person:
(Si) (Moser et al., 2007). Results, obtained in the three MMPI-2 test was performed and its results were
scales of the, so-called, neurotic triad: hypochondria evaluated by the same psychologist, while HDRS
(Hs), depression (D), hysteria (Hy) were analyzed. evaluation was performed by the same physician-
psychiatrist.
Reliability evaluation. Gough Dissimulation Index
was used as a validity indicator for MMPI testing. It is
calculated from the raw test results: the results of the F
Data analysis
scale - results in the K scale. The scale of F detects Statistical analysis of the collected material
deviant and unusual/atypical ways of responding. High employed descriptive methods, as well as a statistical
results in F scale may indicate the severity of perceived conclusion. In order to describe the studied group of
live difficulties and reveal simulation tendencies. The K patients, structural indexes were calculated in the

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 Monika Talarowska, Krzysztof Zboralski, Marcelina Chamielec & Piotr Gałecki: THE MMPI-2 NEUROTIC TRIAD SUBSCALES AND DEPRESSION
LEVELS AFTER PHARMACOLOGICAL TREATMENT IN PATIENTS WITH DEPRESSIVE DISORDERS - CLINICAL STUDY
Psychiatria Danubina, 2011; Vol. 23, No. 4, pp 347-354

qualitative analysis of characteristics. In order to depressive disorder (F33). Due to the small number of
estimate the average values for the quantitative patients in the first group, no separate analysis was
characteristics, arithmetic means (M) were calculated. performed. This group included all antidepressants-
Standard deviation (SD) was adopted as the measure of naïve patients.
scatter of results. The mean values of results in the studied group for
The Lilliefors (Kolmogorov-Smirnov) test for Hs, D and for Hy scale are presented in Table 2.
normality was used to evaluate distribution normality of Statistically significant differences were found in the
the studied variables. The t-test for paired groups was intensity of depression symptoms, measured by the
used to evaluate differences in the degree of depressive HDRS in the examined group on therapy onset (HDRS-
disorders, both on admission (HDRS-I) and after 8 I) vs. the examination results after 8 weeks of treatment
weeks of the therapy continuation (HDRS-II). The (HDRS-II) (p<0.001) (see Table 2). The mean Gough
relationships between MMPI-2 performance levels, indicator values showed cooperative attitude and
evaluated on admission, depression degree, assessed by willingness to disclose personal information of subjects
the HDRS before and after eight (8) weeks of from the study group, allowing valid and reliable
pharmacological treatment, were expressed as Pearson's interpretation of the test results (see Table 2).
correlation coefficients. Student’s-t test was used to
evaluate differences in the neurotic triad performance
levels in the patients with remission and in those
without remission on the day of discharge. Statistical
analyses were performed using the STATISTICA
Program v. 8, and the p value for statistical significance
was: p<0.05.

Ethics
An informed, written consent for participation in the
study was obtained from each subject, according to the
protocol, approved by the Bioethical Committee of the
Medical University of Łódź (No RNN/603/08/KB). Figure 1. Severity of depression symptoms in the study
group (n=50) on admission and discharge
RESULTS
On admission, 2 subjects met the Hamilton
Depression Rating Scale score criteria for mild
depression episode, 9 for moderate one and 39 for
severe depression episode. On the day of discharge, 26
subjects did not meet the HDRS criteria for depressive
disorder, 20 met the HDRS criteria for mild depression
and 4 for moderate one (see Figure 1). Figure 2 demon-
strates the final evaluation of therapy efficacy in the
HDRS scale (see Figure 2).
In the study group, 10 patients were diagnosed with Figure 2. Evaluation of therapy efficacy in the study
depressive episode (F32), and 40 with recurrent group (n=50) by the HDRS scale

Table 2. Scores of particular MMPI-2 scales in the study group and the degree of depression symptoms, measured by
HDRS at the onset of pharmacological therapy and after 8 weeks of its continuation
Variable Min. Max. M SD t p
Hypochondria scale 43.00 93.00 74.89 14.67
Depression scale 50.00 99.00 79.85 11.17 - -
Hysteria scale 45.00 99.00 74.45 13.18
Gough Index -14.00 34.00 8.32 10.76
HDRS-I** 10.00 48.00 23.64 7.75
15.22 <0.001*
HDRS-II*** 1.00 15.00 6.82 4.09
Difference between HDRS-II and HDRS-I 1.00 44.00 16.82 7.82 - -
* p - statistically significant, p < 0.05; **HDRS-I - the degree of depression symptoms, measured by HDRS at the onset of
pharmacological treatment; ***HDRS-II - the degree of depression symptoms, measured by HDRS after 8 weeks of
pharmacological therapy continuation.

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 Monika Talarowska, Krzysztof Zboralski, Marcelina Chamielec & Piotr Gałecki: THE MMPI-2 NEUROTIC TRIAD SUBSCALES AND DEPRESSION
LEVELS AFTER PHARMACOLOGICAL TREATMENT IN PATIENTS WITH DEPRESSIVE DISORDERS - CLINICAL STUDY
Psychiatria Danubina, 2011; Vol. 23, No. 4, pp 347-354

No statistically significant differences were observed associated with the higher degree of depression,
in the neurotic triad performance levels between the measured by the HDRS at the therapy onset. The
patients with remission on the day of discharge (HDRS highest performance in Hs scale (p=0.003) and Hy scale
<7 score) and those without remission on the day of (p=0.001) evaluated on admission, was connected with
discharge: Hs (t(48)=0.639, ns), D (t(48)=0.523, ns), Hy the highest depression level after pharmacological
(t(48)=0.326, ns). However, the patients in the former treatment. Also the difference between HDRS-II and
group obtained lower score values in each scale of the HDRS-I results negatively correlates with both above-
neurotic triad vs. those in the latter group (see Table 3). mentioned scales. The lower Hs (p=0.048) and Hy
Statistical analysis (see Table 4) revealed significant (p=0.031) degrees before pharmacotherapy, the higher
relationships between HDRS scores before and after 8 the difference between HDRS-II and HDRS-I, what
weeks of pharmacotherapy and MMPI-2 scales before indicated better health improvement of the examined
the administered treatment. Higher scores in Hs patients.
(p=0.007), D (p=0.021) and Hy scales (p=0.001) are

Table 3. Differences in performance levels of the scales in the MMPI-2 test neurotic triad between the patients with
remission on the day of discharge (HDRS < 7 score) and those without remission (HDRS > 7 score)
HDRS <7 points HDRS >7 points
Variable t p
M SD M SD
Hypochondria scale 73.96 14.826 75.96 14.761 -0.471 0.639
Depression scale 78.88 11.978 80.96 10.337 -0.644 0.523
Hysteria scale 72.69 14.246 76.43 11.866 -0.992 0.326
*p - statistically significant, p<0.05; **HDRS - Hamilton Depression Rating Scale

Table 4. The Pearson's correlation coefficient for scales of the MMPI-2 neurotic triad and HDRS values
Difference between
HDRS-I** HDRS-II***
HDRS-II and HDRS-I
Variable
Pearson's Pearson's Pearson's
p p p
correl. coef. correl. coef. correl. coef.
Hypochondria (Hs)
High scores reflect undefined physical
problems, concern for own health,
concentration on invented somatic 0.464 0.007* 0.378 0.003* -0.281 0.048*
problems, lack of energy, dissatisfaction,
sleep problems, complaining, claiming
attitude.
Depression (D)
High scores reflect depressive mood, low
self-esteem and the feeling of being 0.326 0.021* 0.072 0.262 -0.112 0.439
inappropriate, worrying, dissatisfaction with
life status, withdrawal
Hysteria (Hy)
High scores mean little insight into life
problems and emotions, numerous somatic 0.471 0.001* 0.438 0.001* -0.305 0.031*
fears, sleep problems, negation, claiming
approach, self-concentration.
* p - statistically significant, < 0.05; **HDRS-I - the degree of depression symptoms, measured by HDRS at the onset of
pharmacological treatment; *** HDRS-II - the degree of depression symptoms, measured by HDRS after 8 weeks of
pharmacological therapy continuation

DISCUSSION and hysteria symptoms at the beginning of therapy

positively correlated with the degree of depression
The presented results come from the first attempt of symptoms after 8 weeks of therapy continuation. Also
evaluating possible correlations between MMPI-2 test the difference between HDRS-II and HDRS-I results
results and the efficacy of anti-depression therapy. The (indicating the degree of improvement) negatively
degree of depression, hypochondria and hysteria at the correlated with both above-mentioned scales (see Table
beginning of the therapy positively correlated with the 4). Despite the fact that no significant differences were
degree of depression symptoms, measured by the HDRS demonstrated in the MMPI-2 performance between the
before pharmacotherapy. The degree of hypochondria patients with and without remission, still the patients in

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 Monika Talarowska, Krzysztof Zboralski, Marcelina Chamielec & Piotr Gałecki: THE MMPI-2 NEUROTIC TRIAD SUBSCALES AND DEPRESSION
LEVELS AFTER PHARMACOLOGICAL TREATMENT IN PATIENTS WITH DEPRESSIVE DISORDERS - CLINICAL STUDY
Psychiatria Danubina, 2011; Vol. 23, No. 4, pp 347-354

the former group obtained lower results in each of the sensations as more intensive than patients with pain
three scales of the neurotic triad (see Table 3). alone and the higher is the intensity of pain sensation,
Therefore, a conclusion may be considered that the which those patients report, the higher are their
higher the degree of hypochondria and hysteria scale depression symptoms (Bair et al. 2008, Ehnvall et al.
symptoms at therapy onset, the higher degree of 2009, Fister 2009). Chronic pain, which accompanies
depression symptoms (measured by HDRS) after 8 depressive disorders, complicates the course of therapy
weeks of pharmacological therapy with SSRI agents. No and is associated with lower efficacy of anti-depressant
such correlations were observed with regards to the treatment (Greco et al. 2004, Hush 2009). Pain
depression scale. symptoms are associated with various depression
These results are identical with the view which degrees, while pain alleviation may significantly
dominates in literature reports, namely that out of all the improve depression control (DeVeaugh-Geiss et al.
MMPI-2 test scales, the depression scale is the most 2010). The presented results also demonstrated a
accurate one for nosological and differential diagnosis necessity to evaluate somatic symptoms among patients
of depressive disorders (Nelson et al. 1996, Greenblatt with depressive disorders. Such an evaluation may
& Davis 1999, Baqby et al. 2005). Some authors influence the efficacy of applied therapy.
indicate, however, a higher diagnostic value of content The results of numerous studies indicate lower
scale components with regards to depression - DEP efficacy of SSRI agents in treatment of pain symptoms
(Gross 2002). According to Klonsky & Bertelson (headaches, pains in the course of fibromyalgia,
(2000), higher scores in the depression scale are neuropathic pains in the course of diabetes, arthralgias,
obtained both by patients with depressive disorders and idiopathic pains of various localisations) vs. tricycylic
those with identified dysthymia. However, only in the anti-depressants (TCAs) or drugs from the group of
former group, are high scores additionally observed in serotonin-norepinephrine reuptake inhibitors (SNRI)
the hypochondria and hysteria scales, which indicates a (Saper et al. 2001, Briley 2004, Moja et al. 2005,
higher number of somatic symptoms in those patients Mallinckrodt et al. 2007). Rahimi et al. (2008) evaluated
vs. those with dysthymia. As demonstrated in the the efficacy of SSRIs for the management of irritable
studies by Slesinger (2001), Hs, D and Hy scores are bowel syndrome (IBS) by the meta-analysis technique.
also elevated in depressive patients, who complain of SSRIs do not significantly improve abdominal pain,
enhanced pain sensations, when compared to depressive abdominal bloating or IBS symptoms. In the studies by
patients without such symptoms. Moreover, patients DeVeaugh-Geiss AM et al. (2010) when compared to
with the diagnosis of masked depression obtain higher patients with no pain at baseline, those with severe pain
scores in Hs and Hy scales, while patients with diagno- were less likely to achieve remission and partial
sed depressive disorders present with higher scores in response. Patients with early pain improvement were
the depression scale (Mihaila 2004). According to more likely to achieve remission (data from the
Grossardt et al. (2009), pessimistic, anxious, and Randomized Trial Investigating SSRI Treatment
depressive personality traits (measured by MMPI) were (ARTIST). Also in the studies of Perahia et al. (2009),
associated with increased all-cause mortality in both among patients, treated for depressive disorders with
men and women. These associations remained signify- agents of the SSRI group (HDRS score >15), in whom
cant even when personality was measured early in life enhanced somatic symptoms were observed, the
(ages 20-39 years). Those findings suggest that persona- improvement of health was rather slight. Our results are
lity traits, related to neuroticism, are associated with an conformable with those in the above reports. The drugs
increased risk of all-cause mortality, even when they are chosen from the SSRI group turned out to be less
measured early in life. Personality is linked to a variety effective among the patients who reported multiple
of health problems. In the study by Cardoni (2009), the somatic complaints before the onset of pharmaco-
relationship between elevations on MMPI clinical scales therapy. It should be emphasized that not only
and back surgery outcome was assessed. Further, mode- objectively diagnosed somatic diseases but also a
rator effects (such as treatment components, differences subjective evaluation of their intensity by the patient
in outcome measures, gender and age of patient, and himelf/herself is of key importance for remission of
location of injury) were analyzed to determine the im- depressive disorders. It should also be kept in mind that
pact of potential pre-existing factors on surgical outco- the degree of somatic complaints is significantly
me. Hypochondria, Depression, and Hysteria did result reduced during the first month of pharmacological
in medium-sized correlations with treatment outcome. therapy and the mood improves gradually in the course
Our results may also be supported by the of a few subsequent months of continued therapy (To et
relationships, observed between depression and somatic al. 2005, Tylee & Gandhi 2005), while an enhanced
sensations, including pain, which are extensively intensity of unpleasant somatic sensations (including
reported in literature. The majority of patients with pain) significantly increases the risk for recurrence of
depressive disorders come to a GP mainly for enhanced affective disorders.
physical sensations (Lerman et al. 2010, Teh et al. Since HDRS, as well as other , commonly known
2010). Patients with depression evaluate their pain scales, used for evaluation of depressive symptoms,

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 Monika Talarowska, Krzysztof Zboralski, Marcelina Chamielec & Piotr Gałecki: THE MMPI-2 NEUROTIC TRIAD SUBSCALES AND DEPRESSION
LEVELS AFTER PHARMACOLOGICAL TREATMENT IN PATIENTS WITH DEPRESSIVE DISORDERS - CLINICAL STUDY
Psychiatria Danubina, 2011; Vol. 23, No. 4, pp 347-354

does not include a sufficient number of questions, which 7. Cardoni M: Utility of the MMPI as a predictor for back
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List of abbreviations used in the paper:

MMPI-2 - The Minnesota Multiphasic Personality Inventory (2)
HDRS - Hamilton Depression Rating Scale
SSRI - selective serotonin reuptake inhibitors
ICD – 10 – International Classification of Diseases - 10
D – depression scale
Hs - hypochondria scale
Hy - hysteria scale
CNS - central nervous system
M – mean
SD – standard deviation
HDRS–I - degree of depressive disorders on admission
HDRS-II – degree of depressive disorders after 8 weeks of the therapy continuation

Correspondence:
Monika Talarowska
Department of Adult Psychiatry, Medical University of Lodz
Aleksandrowska 159, 91-229, Lodz, Poland
E-mail: talarowskamonika@[Link]

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