title: Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain.
abstract: BACKGROUND
  Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design This was a prospective, associational study.
  
  
  METHODS
  Demographic, clinical, depressive symptom (Symptom Checklist 90-Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes.
  
  
  RESULTS
  Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d=0.55-0.87) and a small to large effect on functional status (Cohen d=0.28-0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region.
  
  
  CONCLUSIONS
  Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy settings.
authors.affiliation: Department of Physical Therapy, and Center for Pain Research and Behavioral Health, University of Florida, PO Box 100154, Gainesville, FL 32615, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.forename: Rogelio A
authors.initials: RA
authors.lastname: Coronado
authors.forename: Jason M
authors.initials: JM
authors.lastname: Beneciuk
authors.forename: Carolina
authors.initials: C
authors.lastname: Valencia
authors.forename: Mark W
authors.initials: MW
authors.lastname: Werneke
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Hart
mesh_terms: D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000473:pathology* / Q000523:psychology* / Q000534:rehabilitation; D010146:Pain / Q000473:pathology* / Q000523:psychology* / Q000534:rehabilitation; D010342:Patient Acceptance of Health Care; D026741:Physical Therapy Modalities; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome