Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients.
OBJECTIVE
To assess the relationship between depression and anxiety comorbidity on pain intensity, pain-related disability, and health-related quality of life (HRQL).


METHODS
Analysis of baseline data from the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. All patients (n = 500) had chronic pain (>or=3-month duration) of the low back, hip, or knee. Patients with depression were oversampled for the clinical trial component of SCAMP and thus represented 50% of the study population. Patients were categorized according to pain comorbid with depression, anxiety, or both. We used analysis of variance and multivariate analysis of variance models to assess the relationships between independent and dependent variables.


RESULTS
Participants had a mean age of 59 years; they were 55% women, 56% White, and 40% Black. Fifty-four percent (n = 271) reported pain only, 20% (n = 98) had pain and depression, 3% (n = 15) had pain and anxiety, and 23% (n = 116) had pain, depression, and anxiety. Patients with pain and both depression and anxiety experienced the greatest pain severity (p < .0001) and pain-related disability (p < .0001). Psychiatric comorbidity was strongly associated with disability days in the past 3 months (p < .0001), with 18.1 days reported by patients with pain only, 32.2 days by those with pain and anxiety, 38.0 days by those with pain and depression, and 42.6 days in those with all three conditions. We found a similar pattern of poorer HRQL (p < .0001) in those with pain, depression, and anxiety.


CONCLUSIONS
The added morbidity of depression and anxiety with chronic pain is strongly associated with more severe pain, greater disability, and poorer HRQL.
Bair
Matthew J
MJ
VA Health Services Research and Development, Center of Excellence on Implementation of Evidenced-Based Practices, Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA. mbair@iupui.edu
Wu
Jingwei
J
Damush
Teresa M
TM
Sutherland
Jason M
JM
Kroenke
Kurt
K
D000041:Absenteeism; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D001521:Behavior Therapy; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012648:Self Care / Q000523:psychology; D020377:Self Efficacy; D012803:Sick Role; D012919:Social Behavior
D000928:Antidepressive Agents
J Clin Psychiatry. 2006 Aug;67(8):1187-93
16965195
Depress Anxiety. 2003;18(2):53-61
12964171
Behav Res Ther. 1995 Mar;33(3):335-43
7726811
Arch Fam Med. 1995 Oct;4(10):857-61
7551133
Psychosom Med. 2004 Jan-Feb;66(1):17-22
14747633
Pain. 2003 Nov;106(1-2):127-33
14581119
J Affect Disord. 1997 Apr;43(2):105-19
9165380
Arch Intern Med. 2003 Nov 10;163(20):2433-45
14609780
Gen Hosp Psychiatry. 2007 Nov-Dec;29(6):506-17
18022044
J Gen Intern Med. 2001 Sep;16(9):606-13
11556941
Spine (Phila Pa 1976). 2002 Nov 15;27(22):2564-73
12435995
J Neurol Neurosurg Psychiatry. 2003 Nov;74(11):1587-9
14617727
Arch Intern Med. 2006 May 22;166(10):1092-7
16717171
Vital Health Stat 13. 1999 Nov;(143):i-iv, 1-39
10633576
Depress Anxiety. 2007;24(3):185-95
16900465
Int J Psychiatry Med. 1986-1987;16(3):231-6
3804584
Psychother Psychosom. 2000 Jul-Aug;69(4):205-15
10867588
Am J Med. 1989 Mar;86(3):262-6
2919607
Pain. 1992 Aug;50(2):133-149
1408309
JAMA. 1999 Nov 10;282(18):1737-44
10568646
Arch Neurol. 2003 Nov;60(11):1524-34
14623723
Psychosomatics. 2009 Nov-Dec;50(6):613-21
19996233
Med Clin North Am. 1999 May;83(3):737-60, vii
10386123
Psychiatr Clin North Am. 1996 Sep;19(3):589-611
8856818
Psychosomatics. 2004 Jan-Feb;45(1):17-28
14709757
Med Care. 1993 Mar;31(3):247-63
8450681
Arch Gen Psychiatry. 1996 Oct;53(10):924-32
8857869
JAMA. 1995 Apr 5;273(13):1026-31
7897786
J Clin Psychiatry. 2003 Dec;64(12):1465-75
14728109
Am J Psychiatry. 1997 Dec;154(12):1734-40
9396954
Spine (Phila Pa 1976). 1983 Mar;8(2):141-4
6222486
Arch Intern Med. 2006 Oct 23;166(19):2087-93
17060538
JAMA. 2003 Jun 18;289(23):3135-44
12813119
Prog Brain Res. 2000;122:245-53
10737063
Arch Intern Med. 1993 Nov 8;153(21):2474-80
8215752
J Dev Behav Pediatr. 1996 Jun;17(3):154-61
8783061
JAMA. 2003 Nov 12;290(18):2435-42
14612480
Semin Clin Neuropsychiatry. 1999 Jul;4(3):203-20
10498788
Fam Pract. 2001 Jun;18(3):292-9
11356737
Acta Psychiatr Scand Suppl. 2003;(417):38-50
12950435
Pain. 1992 Aug;50(2):157-162
1408311
JAMA. 1995 Nov 15;274(19):1511-7
7474219
JAMA. 1994 Dec 14;272(22):1749-56
7966923
Ann Acad Med Singap. 1994 Mar;23(2):129-38
8080219
Lancet. 1997 May 17;349(9063):1436-42
9164317
Neuroscientist. 2003 Oct;9(5):354-69
14580120
Gen Hosp Psychiatry. 2006 Mar-Apr;28(2):125-32
16516062
J Pain. 2004 Mar;5(2):133-7
15042521
Arch Gen Psychiatry. 1988 Nov;45(11):977-86
3263101
Behav Res Ther. 1998 May;36(5):527-35
9648328
J Clin Epidemiol. 2004 Oct;57(10):1040-8
15528055
J Psychiatry Neurosci. 2001 Jan;26(1):30-6
11212591
Pain. 1988 Feb;32(2):173-183
3362555
Med Care. 2002 Sep;40(9):771-81
12218768
Ann Intern Med. 2007 Mar 6;146(5):317-25
17339617
J Clin Psychiatry. 1999 Jul;60(7):427-35
10453795
JAMA. 2002 Dec 11;288(22):2836-45
12472325
BMJ. 1999 Feb 13;318(7181):436-9
9974461
Am J Epidemiol. 2002 Dec 1;156(11):1028-34
12446259
Int J Psychiatry Med. 2006;36(1):13-34
16927576
Pain. 1985 Jul;22(3):289-294
3162136
Pain. 1986 Aug;26(2):181-197
3763232
JAMA. 2001 Dec 19;286(23):2947-55
11743835
Spine (Phila Pa 1976). 2000 May 1;25(9):1148-56
10788861