In
addition to psychological and somatic symptoms,
physical symptoms such as pain are among the
principal presenting compaints in depression.
The prevalence of chronic (> 6 months) pain
(joint/articular, limb, or back pain, headaches,
or gastrointestinal diseases) and their
association with major depressive disorder has
been assessed.
A random sample of nearly 19 000 subjects aged
15 to 100 years old, representative of the
general populations of the UK, Germany, Italy,
Portugal and Spain were questioned in a
telephone survey. Using the Sleep-EVAL system,
telephone interviews enquired about mental
disorders and medical conditions. Questions
about medical treatment, consultations, and/or
hospitalizations for medical conditions and a
list of 42 diseases led to answers which
provided data on painful physical
conditions.
Subjects reporting at least one chronic painful
physical condition represented 17.1%. At least
one depressive symptom such as sadness,
depression, hopelessness, loss of interest, or
lack of pleasure was present in 16.5% of
subjects, and 27.6% of those with at least one
chronic painful physical condition. Diagnosis of
major depressive disorder was made in 4.0% of
the general population. 43.4% of these also
had at least one chronic painful physical
condition, which was 4 times greater than in
subjects without major depressive disorder.
Following the determination of a logistic
regression model, chronic painful physical
condition was strongly associated with major
depressive disorder; 24-hour presence of pain
independently contributed to the diagnosis of
major depressive disorder.
These finding support the suggestion that pain
syndrome plays a non-negligible role in
depression. Therefore, when patients consult for
a chronic painful physical condition,
practioners should systemically evaluate for the
presence of depressive symptoms and major
depressive disorder which is very often and
unfortunately underdiagnosed and consequently
undertreated. Arch
Gen Psychiat 60: 39-47, 2003