Abstract
Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions.
Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions.
Design This was a prospective, associational study.
Methods Demographic, clinical, depressive symptom (Symptom Checklist 90–Revised), and outcome data were collected by self-report from a convenience sample of 8,304 patients. Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables. An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status. Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes.
Results Prevalence of severe depression was higher in women, in industrial and pain clinics, and in patients who reported chronic pain or prior surgery. Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain. Depressive symptoms had a moderate to large effect on pain ratings (Cohen d=0.55–0.87) and a small to large effect on functional status (Cohen d=0.28–0.95). In multivariate analysis, depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations, except for discharge values for the cervical region.
Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain. Depressive symptoms had a consistent detrimental influence on outcomes, except on discharge scores for the cervical anatomical region. Expanding screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy settings.
Footnotes
Dr George, Dr Beneciuk, Ms Valencia, and Dr Hart provided concept/idea/research design. Dr George, Mr Coronado, Mr Werneke, and Dr Hart provided writing. Dr Hart provided data collection. Dr George, Mr Coronado, and Dr Beneciuk provided data analysis. Mr Coronado provided clerical support. Dr George, Mr Coronado, Ms Valencia, and Dr Hart provided consultation (including review of manuscript before submission).
The Focus on Therapeutic Outcomes, Inc (FOTO) Institutional Review Board for the Protection of Human Subjects approved the original collection of the data from clinical encounters. The Institutional Review Board for Protection of Human Subjects at the University of Florida approved the use of the data in de-identified form for these analyses.
Dr Beneciuk received support from the National Institutes of Health T-32 Neural Plasticity Research Training Fellowship (grant HD043730) while preparing the manuscript.
Dr Hart is an employee of and an investor in FOTO, the database management company that manages the data analyzed in the study.
- Received May 27, 2010.
- Accepted November 10, 2010.
