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Psychol Med. 2017 Dec;47(16):2906-2917. doi: 10.1017/S0033291717001477. Epub 2017 Jun 22.

Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries.

Author information

1
Physiotherapy Department,South London and Maudsley NHS Foundation Trust,Denmark Hill, London SE5 8AZ,UK.
2
KU Leuven,Department of Rehabilitation Sciences,Leuven,Belgium.
3
Geriatrics Division,Department of Medicine-DIMED,University of Padova,Padova,Italy.
4
Faculty of Education and Health,University of Greenwich,London,UK.
5
New York Psychiatric Institute,Columbia University,New York, NY,USA.
6
Faculty of Health,Social Care and Education,Anglia Ruskin University,Chelmsford,UK.
7
Institute of clinical Research and Education in Medicine (IREM),Padova,Italy.
8
Kyambogo University,Kampala,Uganda.
9
Department of Clinical Medicine and Translational Psychiatry Research Group,Faculty of Medicine,Federal University of Ceará,Fortaleza, CE,Brazil.
10
Research and Development Unit,Parc Sanitari Sant Joan de Déu,Universitat de Barcelona,Fundació Sant Joan de Déu,Dr. Antoni Pujadas, 42,Sant Boi de Llobregat,Barcelona 08830,Spain.

Abstract

BACKGROUND:

Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.

METHODS:

Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.

RESULTS:

The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83-2.55], 1.45 (95% CI 1.22-1.73), and 2.11 (95% CI 1.87-2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54-4.37).

CONCLUSION:

Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.

KEYWORDS:

Comorbidity; depression; depressive symptoms; pain

PMID:
28637534
DOI:
10.1017/S0033291717001477
[Indexed for MEDLINE]

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