Symptoms of depression predict the trajectory of pain among patients with early inflammatory arthritis: a path analysis approach to assessing change.
OBJECTIVE
To assess the longitudinal relationships, including directionality, among chronic pain, symptoms of depression, and disease activity in patients with early inflammatory arthritis (EIA).


METHODS
One hundred eighty patients with EIA completed an examination, including swollen joint count, and were administered the Center for Epidemiological Studies Depression Scale (CES-D) and the McGill Pain Questionnaire (MPQ) at 2 timepoints 6 months apart. Cross-lagged panel path analysis was used to simultaneously assess concurrent and longitudinal relationships among pain, symptoms of depression, and number of swollen joints.


RESULTS
Pain, symptoms of depression, and number of swollen joints decreased over time (p < 0.001) and were prospectively linked to pain, symptoms of depression, and number of swollen joints, respectively, at 6 months. Symptoms of depression and pain were correlated with each other at baseline (0.47) and at 6-month followup assessments (0.28). Baseline symptoms of depression significantly predicted pain symptoms at 6 months (standardized regression coefficient = 0.28, p = 0.001), whereas pain and disease activity did not predict the course of any other variable after controlling for baseline values.


CONCLUSIONS
Symptoms of depression predicted the trajectory of pain from baseline to 6 months. In addition, there were reciprocal/bidirectional associations between pain and symptoms of depression over time. More research is needed to better understand the relationship between pain and depressive symptoms and how to best manage patients with EIA who have high levels of both.
Schieir
Orit
O
SMBD-Jewish General Hospital, 4333 Cote Ste Catherine Road, Montreal, Quebec H3T 1E4.
Thombs
Brett D
BD
Hudson
Marie
M
Taillefer
Suzanne
S
Steele
Russell
R
Berkson
Laeora
L
Bertrand
Carole
C
Couture
Francois
F
Fitzcharles
Mary-Ann
MA
Gagné
Michel
M
Garfield
Bruce
B
Gutkowski
Andrzej
A
Kang
Harb
H
Kapusta
Morton
M
Ligier
Sophie
S
Mathieu
Jean-Pierre
JP
Ménard
Henri
H
Mercille
Suzanne
S
Starr
Michael
M
Stein
Michael
M
Zummer
Michel
M
Baron
Murray
M
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D015984:Causality; D002908:Chronic Disease / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology; D004185:Disability Evaluation; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010147:Pain Measurement / Q000379:methods*; D010148:Intractable Pain / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic