title: Subclinical psychosis and pain in an English national sample: The role of common mental disorders.
abstract: Information on the association between subclinical psychosis and pain is scarce, and the role of common mental disorders (CMDs) in this association is largely unknown. The aim of the current study was to therefore assess this association in the general population using nationally representative data from England.
  
  
  
  Data for 7403 adults aged≥16years were used from the 2007 Adult Psychiatric Morbidity Survey. Five forms of psychotic symptoms were assessed by the Psychosis Screening Questionnaire, while pain was assessed in terms of the level of its interference with work activity in the past four weeks. The Clinical Interview Schedule Revised (CIS-R) was used to assess anxiety disorders, depressive episode, and mixed anxiety-depressive disorder (MADD). Participants with probable or definite psychosis were excluded. The association between psychotic symptoms and pain was assessed by ordinal and binary logistic regression analysis.
  
  
  
  When adjusted for confounders other than CMDs, psychotic symptoms were significantly associated with pain [e.g., the OR (95%CI) for the severest form of pain (binary outcome) was 1.78 (1.11-2.85)]. However, this association was no longer significant when CMDs were controlled for in most analyses. Anxiety disorders and depressive episode explained 34.8%-47.1% of the association between psychotic symptoms and pain, while this percentage increased to 62.7%-78.0% when the sub-threshold condition of MADD was also taken into account.
  
  
  
  When coexisting psychotic symptoms and pain are detected, assessing for anxiety and depression (even at sub-threshold levels) may be important for determining treatment options.
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain. Electronic address: a.koyanagi@pssjd.org.
authors.forename: Ai
authors.initials: A
authors.lastname: Koyanagi
authors.affiliation: The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge 141 89, Sweden. Electronic address: andrew.stickley@sh.se.
authors.forename: Andrew
authors.initials: A
authors.lastname: Stickley
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain. Electronic address: jmharo@pssjd.org.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology
keywords: Common mental disorders; Epidemiology; Pain; Subclinical psychosis