Our New Study About Easy Screening for Co-existence of Pain and Depression
Both pain and depression are very frequent presented symptoms in primary care according a study we have just published. The study population was 715 persons visiting primary care, and the study demonstrates an easy way to screen for these conditions.
The paper is published in the International Journal of Family Medicine. We asked all patients coming to primary care to fill in a DoloTest, a depression test (Major Depression Inventory) and answer some questions; we call the study DoloTest General Practice Study or just GPS.
34,4% of the patients came due to a pain problem, and 16.1% of all patients met criteria for depression, making both conditions very frequent in primary care. But fact is, as often discussed here at the Picture of Pain Blog, that chronic pain and depression often are co-existing, and that both patients and care providers must be aware of both conditions to be able to provide the optimal treatment. In our study 65,6% of men and 54.2% of women who met criteria for depression came due to a pain problem, highlighting the importance for this awareness. They were not complaining of one or more complaints form the diagnostic criteria for depression, but complaining of the physical symptom “pain”. This means that patients with depression often present a physical symptom rather than one ore more psychological symptoms, making it easier to miss the important co-existence.
Turning the focus around to patients presenting a pain problem 22.8% of the men and 29.2% of the women met criteria for depression.
From DoloTest in General Practice Study: Sensitivity and Specificity Screening for Depression, Kim Kristiansen, Pernille Lyngholm-Kjaerby, and Claus Moe International Journal of Family Medicine. Volume 2012 (2012), Article ID 472505, doi:10.1155/2012/472505
These numbers are alarmingly high, and we know from many studies, that it is very important to be aware of this co-existence to provide the best possible treatment, and to achieve best possible improvement in quality of life. What more is, that a recent published study has also showed co-existence of depression and pain to be a major risk factor for opioid misuse both by using opioids for depression, stress and sleep problems instead of for pain alone, and by using more opioids than prescribed. The picture illustrates one of the figures from our paper showing DoloTest-Profiles for men and women with and without depression (MDD on the picture). With no problems towards the center and worst possible towards the periphery the overall burden and impact on quality of life is clear.
In our study we found that the scoring on the domain “To what extent do you experience low spirits” could be correlated to the risk of meeting the criteria for depression. Setting a cutoff score at “65” on the 0-100 scale allowed us to find 78% of persons with depression and eliminate 95% of persons without depression.
This demonstrates that DoloTest can be used to screen for depression besides providing an overview of quality of life.
In coming blog posts I will present and discuss more results from our study.
Kim Kristiansen, M.D: (2012). Our New Study About Easy Screening for Co-existence of Pain and Depression Picture of Pain Blog
DoloTest
This test seems very helpful in determining the proper treatment people with depression need. It is a fact that people with depression are upset with themselves and problematic issues that are occurring in their lives. Physical pain does make the most sense in this study, the pain can cause the person to be depressed because they don’t know whats wrong and it’s preventing them from living a normal life. Physical pain can sometimes be caused by stress, and if person has a certain lifestyle where stress is common, they are bound to become upset about frequent physical pain. Finding proper medicine to help physical pain may decrease the number of people diagnosed with depression.
Thank you for your comment Ashley. I do agree, it is crucial to identify what must be treated, and provide the relevant treatment.
I will also add, that is crucial to evaluate response to the treatment, and that the patient and clinician together make this evaluation and make the relevant adjustments.
Thanks
Kim