Chronic pain and major depressive disorder in the general population

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Abstract

This study aims (1) to assess the prevalence of Chronic Painful Physical Condition (CPPC) and major depressive disorder (MDD) in the general population; (2) to evaluate their interaction and co-morbidity with sleep and organic disorders; and (3) to investigate their daily functioning and socio-professional consequences. A random sample of 3243 subjects (⩾18 years), representative of California inhabitants, was interviewed by telephone. CPPC duration was at least 6 months. Frequency, severity, duration and consequences on daily functioning, consultations, sick leave and treatment were investigated. MDD were assessed using DSM-IV criteria. The point prevalence of CPPC was 49% (95% confidence interval: 47.0–51.0%). Back area pain was the most frequent; 1-month prevalence of MDD was at 6.3% (95% CI: 5.5–7.2%); 66.3% of MDD subjects reported at least one CPPC. In 57.1% of cases, pain appeared before MDD. Pain severity was increased by poor sleep, stress and tiredness in MDD subjects. Being confined to bed, taking sick leave and interference of pain with daily functioning were twice as frequent among MDD subjects with CPPC than in non-MDD subjects with CPPC; obese individuals with CP were 2.6 times as likely to have MDD. Pain is highly linked with depressive disorder. It deteriorates physical, occupational and socio-professional activities. Pain and sleep disturbances are a prime motive of consultation rather than depressed mood, underlining the risk of missing a depression diagnosis.

Introduction

Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders and as such represents a major public health problem in the United States and Western Europe. Community based surveys in the USA have reported a 30-day prevalence of 4.9% (Blazer et al., 1994) and a 12-month prevalence of 6.6% (Kessler et al., 2003). However, MDD rarely occurs alone. In a study of 18,980 subjects, representative of 320 millions of Europeans, we reported that 43.4% of individuals who met criteria for MDD also had a Chronic Painful Physical Condition in contrast to 16.1% of the remaining general population (Ohayon and Schatzberg, 2003). In that study, Chronic Painful Physical Condition (CPPC) was defined as pain present for the last 6 months and resulting in either consulting a physician or taking medication. MDD subjects with CPPC had more severe symptoms of insomnia, fatigue, impaired concentration and psychomotor retardation than did MDD subjects without pain (Ohayon, 2004). Therefore, it was not surprising that physical symptoms were often the main reason cited by subjects with depressive disorders for seeking medical help (Ohayon and Schatzberg, 2003). This has also been observed in primary care settings: up to 69% of patients identified with MDD consulted their physician primarily for physical symptoms (Simon et al., 1999). The association between pain sites and depressive symptomatology has rarely been described in epidemiological studies and often limited to specific types of pain (Magni et al., 1993, Magni et al., 1994, McWilliams et al., 2003). Our previous epidemiological study (Ohayon and Schatzberg, 2003) had a narrow definition of chronic pain that included only those who consulted for pain or who took a medication for pain. Therefore, the segment of individuals with chronic pain who did not consult for pain was absent. Pain often hides the depressive syndrome thus delaying its recognition and treatment.

The objectives of this study were (1) to assess whether chronic pain was associated with differences in depressive symptom patterns in a community sample representative of the California general population; (2) to investigate how the presence of chronic pain affected disability or impairment in depressive individuals; and (3) to examine how the presence of chronic pain influenced the likelihood of receiving treatment.

Section snippets

Sample

The study was performed in 2003 and 2004. The target population were adults (18 years and older) living in the state of California (USA). This represented 24 million inhabitants. A total of 3243 subjects out of 3787 eligible individuals participated in the survey (participation rate 85.6%).

Procedures

In the first stage, telephone numbers were pulled out proportionally to the population size of each county in California. Telephone numbers were randomly selected within each county using a computerized

Results

The sample included 3243 subjects between 18 and 94 years of age. Women represented 51.2% of the sample.

Discussion

This study examines the association between Chronic Painful Physical Condition (CPPC) and major depressive disorder (MDD) in a community sample of 3243 subjects, representative of the general population of the state of California (24 million inhabitants aged 18 years and older). An overwhelming majority of subjects who meet criteria for MDD also reported CPPC (73.3%).

  • (1)

    In our earlier study (Ohayon and Schatzberg, 2003), we used a shorter questionnaire on pain, and the analyses were limited to

Contributors

M.M.O. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. He is the principal investigator for this study. As such, he designed the protocol and supervised the data collection. He participated in the data analyses strategies, interpretation of data and writing of the manuscript.

Dr. Schatzberg participated in the data analyses strategies, interpretation of data and writing of the manuscript.

Role of funding sources

The sponsors had no role in the design and conduct of the study (collection, management, analysis) nor in the interpretation of the data. The sponsors have not seen the manuscript. M.M.O. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

Dr. Schatzberg has in the past been a paid consultant for Eli Lilly, Wyeth, Pfizer, and Forest Laboratories and has equity in Pfizer and Forest Laboratories.

Acknowledgements

This study was supported by the Arrillaga Foundation (M.M.O.) and an unrestricted educational grant from Eli Lilly (M.M.O.).

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