title: Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain.
abstract: BACKGROUND
  Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders. We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability.
  
  
  METHODS
  In this prospective study, 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and the Center for Epidemiologic Studies-Depression (CES-D) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain. In addition, pain scores were evaluated using a visual analog scale (VAS) during activity, and range of motion (ROM) and abduction strength (strength) measurements were measured. Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms (CES-D) and other clinical parameters to patient-perceived disability (DASH).
  
  
  RESULTS
  DASH scores were found to be moderately correlated (0.3 < r < 0.6) with ROM, strength, pain VAS and CES-D; DASH scores were more strongly correlated with CES-D scores than with pain VAS scores or range of motion (r = 0.58; p < 0.001, 0.37; p < 0.001, 0.32; p = 0.04 respectively). Multiple stepwise regression analyses revealed that gender, ROM, pain VAS and CES-D scores independently predicted DASH score and accounted for 43 % of the variance. CES-D score was found to be the strongest predictor of DASH score and accounted for 23 % of the variance.
  
  
  CONCLUSIONS
  Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain. Although a large proportion of perceived disability remains unexplained, perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms.
  
  
  METHODS
  Level 2, prospective cohort study, prognostic study.
authors.affiliation: Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.
authors.forename: Young Hak
authors.initials: YH
authors.lastname: Roh
authors.forename: Beom Koo
authors.initials: BK
authors.lastname: Lee
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Noh
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Oh
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Gong
authors.forename: Goo Hyun
authors.initials: GH
authors.lastname: Baek
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology*; D003863:Depression; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020069:Shoulder Pain / Q000523:psychology*; D013315:Stress, Psychological