Objective: Our objectives were to describe trajectories of depressive symptoms and pain at hospital discharge and 6 weeks later and to examine the relationship of persistent depressive symptoms to pain.
Methods: Before and 6 weeks after hospital discharge, 251 patients undergoing cardiac surgery (mean [SD] age = 67.3 [9.5] years; 73% male) completed the Beck Depression Inventory and the Brief Pain Inventory (BPI). Patients were categorized into two groups based on the presence or absence of persistent depressive symptoms (Beck Depression Inventory score >10 at both times). Between-group differences in pain interference (BPI-INT) and pain severity (BPI-SEV) were evaluated using repeated-measures analysis of variance. Linear regressions were performed to determine if changes in depressive symptoms were related to BPI-INT and BPI-SEV, controlling for demographic and clinical data.
Results: Persistent (16.3%) or worsening depressive symptoms (15.3%) from hospital discharge to 6 weeks were observed; many experienced at least some persistent pain (BPI-INT 67.8%, BPI-SEV 47.8%). From discharge to 6 weeks, patients with persistent depressive symptoms sustained higher levels of BPI-INT (p < .001) and BPI-SEV (p < .003). In multivariate analysis, only changes in depressive symptoms, not clinical and demographic variables, were related to BPI-INT (p < .001) and BPI-SEV (p = .001).
Conclusions: Persistent depressive symptoms are independently associated with continued pain up to 6 weeks after hospital discharge. Successful treatment of ongoing pain should include screening for depressive symptoms and initiation of appropriate treatment.
Trial Registraton: Clinicaltrials.gov Identifier: NCT00522717.
From the University of California, Los Angeles, School of Nursing (L.V.D., B.C.), Los Angeles, California; University of California, Long Beach, School of Nursing (A.M.), Long Beach, California; California State University, Fullerton, School of Nursing (R.C.B.), Fullerton, California; and Cousins Center for Psychoneuroimmunology (M.R.I.), UCLA Semel Institute for Neuroscience, and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA.
Address correspondence and reprint requests to Lynn V. Doering, RN, DNSc, University of California, Los Angeles, School of Nursing, 700 Tiverton Ave, Factor Building 4-466, Los Angeles, CA 90095. E-mail: firstname.lastname@example.org
Received for publication September 17, 2013; revision received March 26, 2014.