title: The effect of pain on presence and severity of depressive disorders in older persons: The role of perceived control as mediator.
abstract: BACKGROUND
  The relation between pain and depression is reported repeatedly. It is suggested that pain by itself is not sufficient for the development of depression. We aim to study the role of perceived control as mediating factor in the relation between pain and depressive disorders at old age.
  
  
  METHODS
  Baseline data of the Netherlands Study of Depression in Older Persons (NESDO) were used, including 345 persons with DSM-IV depressive disorders (CIDI) and 125 control persons without depressive disorders, aged 60 years and over. Measures included severity of depression (Inventory of Depressive Symptomatology), presence and intensity of pain and pain-related disability (Chronic Graded Pain scale), and a general measure of perceived control over life (Pearlin Mastery Scale). In mediation analyses direct and indirect effects were estimated.
  
  
  RESULTS
  Older persons with depressive disorders reported pain more frequently with higher intensity than controls. After controlling for confounding, the direct effect of pain intensity and the indirect effect through perceived control on depression were OR=1.10 (CI 95% .98;1.25) and OR=1.24 (1.15;1.35). For pain-related disability these were OR=1.14 (1.02;1.29) and OR=1.21 (1.13;1.29). In depressed persons there was a strong direct effect of pain intensity and disability and a smaller indirect effect through perceived control on severity of depressive symptoms.
  
  
  CONCLUSIONS
  This cross-sectional study cannot give evidence on causal direction.
  
  
  CONCLUSIONS
  Perceived control plays an important role as mediator in the association between pain and presence of depression. In depressed persons however, the direct role of pain seems more important in the association with depression severity.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: m.w.m.de_waal@lumc.nl.
authors.forename: M W M
authors.initials: MW
authors.lastname: de Waal
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Hegeman
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Gussekloo
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands; NIVEL, Netherlands Institute of Health Services Research, The Netherlands.
authors.forename: P F M
authors.initials: PF
authors.lastname: Verhaak
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands; Department of Psychiatry, CAPRI-University of Antwerp, Belgium.
authors.forename: R C
authors.initials: RC
authors.lastname: van der Mast
authors.affiliation: Department of Psychiatry/GGZ in Geest and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: Comijs
mesh_terms: D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis* / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010147:Pain Measurement; D058748:Pain Perception; D012720:Severity of Illness Index
keywords: Aged; Depressive disorder; Mediator; Pain; Perceived control