The impact of comorbid pain and depression in the United States: results from a nationally representative survey.
chronic pain
depression
health status
healthcare utilization
Journal
Scandinavian journal of pain
ISSN: 1877-8879
Titre abrégé: Scand J Pain
Pays: Germany
ID NLM: 101520867
Informations de publication
Date de publication:
24 04 2019
24 04 2019
Historique:
received:
16
10
2018
accepted:
13
01
2019
pubmed:
14
2
2019
medline:
28
3
2020
entrez:
14
2
2019
Statut:
ppublish
Résumé
Background and aims The co-morbidity between pain and depression is a target of interest for treatment. However most of the published literature on the topic has used clinical cohorts as the population of interest. The goal of this study was to use a nationally representative sample to explore how health outcomes varied across pain and depression status in a cohort sampled from the general US population. Methods This was a cross-sectional analysis of adults ≥18 years in the 2009-2010 National Health and Nutrition Examination Survey. The cohort was stratified into: no pain/depression, pain alone, depression alone, and pain with depression. The primary outcome was self-reported general health status, and secondary outcomes were healthcare visits, overnight hospital stays and functional limitation. Survey weighted logistic regression was used to adjust for potential confounders. Results The cohort consisted of 4,213 individuals, of which 186 (4.4%) reported concurrent pain and depression. 597 (14.2%) and 253 (6.0%) were classified with either pain or depression alone, respectively. The majority of individuals with co-morbid pain and depression reported poor health (65.1%, p<0.001) and were significantly more likely than those with neither condition to rate their health as poor after adjustment (OR: 7.77, 95% CI: 4.24-14.26, p<0.001). Those with pain only or depression only were also more likely to rate their health as poor, albeit to a lesser extent (OR: 2.21, 95% CI: 1.21-2.34, p<0.001; OR: 3.75, 95% CI: 2.54-5.54, p<0.001, respectively). A similar pattern was noted across all secondary outcomes. Most notably, those with co-morbid pain and depression were the most likely to endorse functional limitation (OR: 13.15, 95% CI: 8.00-21.61, p<0.001). Comparatively, a similar trend was noted amongst those with pain only or depression only, though with a reduced effect size (OR: 4.23, 95% CI: 3.12-4.77, p<0.001; OR: 5.13, 95% CI: 3.38-7.82, p<0.001). Conclusions Co-morbid pain and depression in the general population resulted in markedly worse outcomes versus isolated pain or depression. Further, the effect appears to be synergistic. Given the substantial burdens of pain and depression, future treatments should aim to address both conditions simultaneously. Implications As a result of the co-morbidity between pain and depression, patients presenting with either condition should increase the index of suspicion among clinicians and prompt screening for the reciprocal condition. Early intervention for co-morbid pain and depression has the potential to mitigate future incidence of chronic pain and major depression.
Identifiants
pubmed: 30759071
doi: 10.1515/sjpain-2018-0323
pii: sjpain-2018-0323
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
319-325Références
WHO. Depression: fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed: 24 July 2018.
Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The NIMH Epidemiologic Catchment Area program. Historical context, major objectives, and study population characteristics. Arch Gen Psychiatry 1984;41:934–41.
Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health 2013;34:119–38.
GBD 2013 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet 2015;386:2145–91.
Rayner L, Hotopf M, Petkova H, Matcham F, Simpson A, McCracken LM. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain 2016;157:1472–9.
Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med 2003;163:2433–45.
Katon W, Egan K, Miller D. Chronic pain: lifetime psychiatric diagnoses and family history. Am J Psychiatry 1985;142:1156–60.
Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med 1999;341:1329–35.
Klinkman MS. Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. Gen Hosp Psychiatry 1997;19:98–111.
Emptage NP, Sturm R, Robinson RL. Depression and comorbid pain as predictors of disability, employment, insurance status, and health care costs. Psychiatr Serv 2005;56:468–74.
VonKorff M, Simon GE. The relationship between pain and depression. Br J Psychiatry 1996;168(S30):101–8.
Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med 2008;70:890–7.
Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain 2011;12:964–73.
Ang DC, Bair MJ, Damush TM, Wu J, Tu W, Kroenke K. Predictors of pain outcomes in patients with chronic musculoskeletal pain co-morbid with depression: results from a randomized controlled trial. Pain Med 2010;11:482–91.
Hardt J, Jacobsen C, Goldberg J, Nickel R, Buchwald D. Prevalence of chronic pain in a representative sample in the United States. Pain Med 2008;9:803–12.
Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 2002;32:509–15.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–13.
Jylha M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 2009;69:307–16.
Robinson MJ, Edwards SE, Iyengar S, Bymaster F, Clark M, Katon W. Depression and pain. Front Biosci (Landmark Ed) 2009;14:5031–51.
Outcalt SD, Kroenke K, Krebs EE, Chumbler NR, Wu J, Yu Z, Bair MJ. Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life. J Behav Med 2015;38:535–43.
Pan YJ, Pan CH, Chan HY, Kuo KH. Depression and pain: an appraisal of cost effectiveness and cost utility of antidepressants. J Psychiatr Res 2015;63:123–31.
Lerman SF, Rudich Z, Brill S, Shalev H, Shahar G. Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients. Psychosom Med 2015;77:333–41.
Rijavec N, Grubic VN. Depression and pain: often together but still a clinical challenge: a review. Psychiat Danub 2012;24:346–52.
Currie SR, Wang J. Chronic back pain and major depression in the general Canadian population. Pain 2004;107: 54–60.
Kiecolt-Glaser JK, Derry HM, Fagundes CP. Inflammation: depression fans the flames and feasts on the heat. Am J Psychiatry 2015;172:1075–91.
Narouze S, Souzdalnitski D. Obesity and chronic pain: systematic review of prevalence and implications for pain practice. Region Anesth Pain Med 2015;40:91–111.
Wang H, Ahrens C, Rief W, Schiltenwolf M. Influence of comorbidity with depression on interdisciplinary therapy: outcomes in patients with chronic low back pain. Arthritis Res Ther 2010;12:R185.
Shi Y, Weingarten TN, Mantilla CB, Hooten WM, Warner DO. Smoking and pain: pathophysiology and clinical implications. Anesthesiology 2010;113:977–92.
Lin CH, Yen YC, Chen MC, Chen CC. Depression and pain impair daily functioning and quality of life in patients with major depressive disorder. J Affect Disorders 2014;166:173–8.
Linton SJ, Bergbom S. Understanding the link between depression and pain. Scand J Pain 2011;2:47–54.