title: The adverse effects of comorbid pain on depression outcomes in primary care patients: results from the ARTIST trial.
abstract: OBJECTIVE
  To explore the effect of pain symptoms and improvements in pain on depression outcomes.
  
  
  METHODS
  We analyzed data from A Randomized Trial Investigating SSRI Treatment (ARTIST), a randomized longitudinal effectiveness study comparing selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression in primary care (n = 573). Depression outcome at month 6, defined as remission, partial response, and nonresponse using the Symptom Checklist-20, was the primary outcome.
  
  
  RESULTS
  Compared to patients with no pain at baseline, those with severe pain were less likely to achieve remission (OR = 0.11, 95% CI 0.05-0.25) and partial response (OR = 0.24, 95% CI 0.10-0.59) vs nonresponse. Patients with moderate pain were less likely to achieve remission vs nonresponse (OR = 0.25, 95% CI 0.13-0.48). Patients with early improvement in pain were more likely to achieve remission (OR = 1.90, 95% CI 1.03-3.49). Accounting for missing data with last observation carried forward or multiple imputation yielded similar results.
  
  
  CONCLUSIONS
  Pain symptoms are present in the majority of depressed primary care patients beginning antidepressant therapy. Pain symptoms are associated with worse depression outcomes, while improvement in pain is associated with significantly better depression outcomes. Attention to comorbid pain may be important in enhancing depression care.
authors.affiliation: Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, USA. angeladvg@gmail.com
authors.forename: Angela M
authors.initials: AM
authors.lastname: DeVeaugh-Geiss
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: West
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Betsy
authors.initials: B
authors.lastname: Sleath
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
mesh_terms: D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D010147:Pain Measurement; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors