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Prevalence of Psychiatric Disorders in Patients With Chronic Work-Related Musculoskeletal Pain Disability

Dersh, Jeffrey PhD; Gatchel, Robert J. PhD; Polatin, Peter MD; Mayer, Tom MD

Journal of Occupational and Environmental Medicine: May 2002 - Volume 44 - Issue 5 - p 459-468

The cost and prevalence of chronic work-related musculoskeletal pain disability in industrialized countries are extremely high. Although unrecognized psychiatric disorders have been found to interfere with the successful rehabilitation of these disability patients, few data are currently available regarding the psychiatric characteristics of patients claiming work-related injuries that result in chronic disability. To investigate this issue, a consecutive group of patients with work-related chronic musculoskeletal pain disability (n = 1595), who started a prescribed course of tertiary rehabilitation, were evaluated. Psychiatric disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. Results revealed that overall prevalences of psychiatric disorders were significantly elevated in these patients compared with base rates in the general population. A majority (64%) of patients were diagnosed with at least one current disorder, compared with only 15% of the general population. However, prevalences of psychiatric disorders were elevated in patients only after the work-related disability. Such findings suggest that clinicians treating these patients must be aware of the high prevalence of psychiatric disorders and be prepared to use mental health professionals to assist in identifying and stabilizing these patients. Failure to follow a biopsychosocial approach to treatment will likely contribute to prolonged pain disability in a substantial number of these patients.

From the PRIDE Research Foundation (Dr Dersh); and the Departments of Psychiatry and Rehabilitation Sciences (Dr Gatchel), Psychiatry (Dr Polatin), and Orthopedic Surgery (Dr Mayer), University of Texas Southwestern Medical Center at Dallas.

Address correspondence to: Robert J. Gatchel, PhD, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9044;

This work was supported in part by grants 2R01-MH46452 and 2K02-MH01107 from the National Institutes of Health.

Copyright © by American College of Occupational and Environmental Medicine

©2002The American College of Occupational and Environmental Medicine