title: Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders.
abstract: BACKGROUND
  Studies suggest that poor physical health might be associated with increased depression and anxiety recurrence. The objectives of this study were to determine whether specific chronic diseases and pain characteristics are associated with depression and anxiety recurrence and to examine whether such associations are mediated by subthreshold depressive or anxiety symptoms.
  
  
  METHODS
  1122 individuals with remitted depressive or anxiety disorder (Netherlands Study of Depression and Anxiety) were followed up for a period of four years. The impact of specific chronic diseases and pain characteristics on recurrence was assessed using Cox regression and mediation analyses.
  
  
  RESULTS
  Chronic diseases were not associated with recurrence. Neck (HR 1.45, p < .01), chest (HR 1.65, p < .01), abdominal (HR 1.52, p < .01) pain, an increase in the number of pain locations (HR 1.10, p < .01) and pain severity (HR 1.18, p = .01) were associated with an increased risk of depression recurrence but not anxiety. Subthreshold depressive symptoms mediated the associations between pain and depression recurrence.
  
  
  CONCLUSIONS
  Pain, not chronic disease, increases the likelihood of depression recurrence, largely through its association with aggravated subthreshold depressive symptoms. These findings support the idea of the existence of a mutually reinforcing mechanism between pain and depression and are indicative of the importance of shedding light on neurobiological links in order to optimize pain and depression management.
authors: Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands. mj.gerrits@vumc.nl.
authors: Marloes M J G
authors: MM
authors: Gerrits
authors: Patricia
authors: P
authors: van Oppen
authors: Stephanie S
authors: SS
authors: Leone
authors: Harm W J
authors: HW
authors: van Marwijk
authors: Henriëtte E
authors: HE
authors: van der Horst
authors: Brenda W
authors: BW
authors: Penninx
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D002908:Chronic Disease; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology* / Q000523:psychology; D012008:Recurrence; D055815:Young Adult