Psychiatric morbidity in pain conditions: results from the Singapore Mental Health Study.
BACKGROUND
Chronic pain is a common problem among the general population and has been found to be associated with psychiatric disorders in studies based on both clinical samples and epidemiological surveys.


OBJECTIVE
To establish the prevalence, correlates and comorbidities of chronic pain disorders among the adult population of Singapore.


METHODS
The data used in the present analysis were derived from the Singapore Mental Health Study, a cross-sectional epidemiological survey of a representative sample of the adult resident population of Singapore. Diagnoses of psychiatric disorders were established using the Composite International Diagnostic Interview version 3.0. A modified version of the Composite International Diagnostic Interview 3.0 checklist of chronic medical disorders was used, in which the chronic medical disorders were reclassified into eight types of physical disorders. Chronic pain disorders included arthritis or rheumatism, back problems including disk or spine problems, and migraine headaches.


RESULTS
The lifetime prevalence estimates for arthritis, back pain and migraine in the Singapore general population were 6.0% (n=282), 7.0% (n=436) and 5.6% (n=446), respectively. After adjusting for sociodemographic factors, comorbid pain disorders and the presence of other chronic physical conditions, migraine remained significantly associated with major depressive disorder (adjusted OR=2.4), generalized anxiety disorder (adjusted OR=3.0) and alcohol use disorders (adjusted OR=2.1), while back pain was significantly associated with major depressive disorder (adjusted OR=2.0).


CONCLUSIONS
The significant association between pain and psychiatric disorders emphasizes the need to screen individuals with chronic pain conditions for psychiatric disorders, particularly depression. There is a need to develop integrated pharmacological and psychological treatments for both conditions.
Research Division, Institute of Mental Health, Buangkok Green Medical Park, Singapore. mythily@imh.com.sg
Mythily
M
Subramaniam
Janhavi Ajit
JA
Vaingankar
Edimansyah
E
Abdin
Siow Ann
SA
Chong
D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D008603:Mental Health; D008875:Middle Aged; D012846:Singapore / Q000453:epidemiology; D055815:Young Adult