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Pain and the onset of depressive and anxiety disorders

Gerrits, Marloes M.J.G.a,b,*; van Oppen, Patriciaa,b; van Marwijk, Harm W.J.b; Penninx, Brenda W.J.H.a,c,d; van der Horst, Henriëtte E.b

doi: 10.1016/j.pain.2013.09.005

Summary Patients with severe pain, particularly in multiple locations, are at increased risk of developing a first depressive or anxiety disorder, independent of subthreshold affective symptoms.

ABSTRACT Patients with pain may be at increased risk of developing a first episode of depressive or anxiety disorder. Insight into possible associations between specific pain characteristics and such a development could help clinicians to improve prevention and treatment strategies. The objectives of this study were to examine the impact of pain symptomatology on depression and anxiety onset and to determine whether these associations are independent of subthreshold depressive and anxiety symptoms. Data from the Netherlands Study of Depression and Anxiety, collected between 2004 and 2011, were used. A total of 614 participants with no previous history and no current depression or anxiety at baseline were followed up for 4 years. Onset of depressive or anxiety disorder was assessed at 2- and 4-year follow-up by Composite International Diagnostic Interview. Baseline pain characteristics were location, duration, and severity, as assessed by chronic pain grade. Onset of depressive or anxiety disorder occurred in 15.5% of participants. Using Cox survival analyses, onset of depression and anxiety was associated with 6 pain locations (neck, back, head, orofacial area, abdomen, and joints; hazard ratio [HR] = 1.96 to 4.02; P < .05), increasing number of pain locations (HR = 1.29; P < .001), and higher severity of pain (HR = 1.57; P < .001). By contrast, there was no association with duration of pain symptoms (HR = 1.47; P = .12). Independent of subthreshold affective symptoms, only joint pain and increasing number of pain locations were still significantly associated with depression and anxiety onset. Clinicians should be aware that regardless of affective symptoms, pain, particularly at multiple locations, is a risk indicator for developing depressive and anxiety disorders.

aDepartment of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands

bDepartment of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

cDepartment of Psychiatry, Leiden University Medical Center, The Netherlands

dDepartment of Psychiatry, University Medical Center Groningen, The Netherlands

* Corresponding author. Address: Department of General Practice, VU University Medical Center and EMGO+ Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Tel.: +31 20 4446116; fax: +31 20 4448361.


Article history:

Received 25 April 2013

Received in revised form 23 August 2013

Accepted 3 September 2013

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2014 International Association for the Study of Pain
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