Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults

Louise Sharpe,Tanya Meade,Tanya Meade,Sarah Mcdonald,Sarah Mcdonald,Patrick J Raue,Patrick J Raue,Patrick J Raue,Patricia Arean,Helen Correia,Michael Nicholas,Michael Nicholas

doi:10.1186/s12888-017-1334-y

Abstract

BackgroundMulti-morbidity in older adults is commonly associated with depressed mood. Similarly, subjective reports of pain are also associated with both physical illness and increased depressive symptoms. However, whether pain independently contributes to the experience of depression in older people with multi-morbidity has not been studied.MethodsIn this study, participants were 1281 consecutive older adults presenting to one of 19 primary care services in Australia (recruitment rate = 75%). Participants were asked to indicate the presence of a number of common chronic illnesses, to rate their current pain severity and to complete the Geriatric Depression Scale.ResultsResults confirmed that the number of medical illnesses reported was strongly associated with depressive symptoms. Twenty-six percent of participants with multi-morbidity scored in the clinical range for depressive symptoms in comparison to 15% of participants with no illnesses or a single illness. In regression analyses, the presence of chronic pain (t = 5.969, p < 0.0005), diabetes (t = 4.309, p < 0.0005), respiratory (t = 3.720, p < 0.0005) or neurological illness (t = 2.701, p = 0.007) were all independent contributors to depressive symptoms. Even when controlling for each individual illness, and the overall number of illnesses (t = 2.207, p = 0.028), pain severity remained an independent predictor of depressed mood (F change = 28.866, p < 0.0005, t = 5.373, p < 0.0005).ConclusionsPhysicians should consider screening for mood problems amongst those with multi-morbidity, particularly those who experience pain.

Highlights

Multi-morbidity in older adults is commonly associated with depressed mood
The average level of depressive symptoms, according to the Geriatric Depression Scale (GDS) was 2.54 (SD = 2.71) and 22% of the sample fell above the clinical cut-off point for likely depression (GDS ≥ 5)
In large samples of this nature, the reliability of responses is largely unavoidable. These limitations notwithstanding, this study contributes to a body of literature that confirms that multimorbidity is associated with depressive symptoms and pain [2, 3]

Summary

Introduction

Multi-morbidity in older adults is commonly associated with depressed mood. Subjective reports of pain are associated with both physical illness and increased depressive symptoms. Multi-morbidity is defined as the presence of two or more chronic illnesses. Multi-morbidity is becoming an increasing problem with nearly a quarter of all primary care patients experiencing two or more medical conditions [1]. Estimates of multi-morbidity indicate that over 75% of adults older than 75 years presenting to primary care services have two or more chronic illnesses [3]. There is a considerable literature that confirms that the presence of multi-morbidity is associated with increased. Just as multi-morbidity confers risk of developing clinically significant symptoms of depression in older adults, so too does the experience of pain [14]. While most of the research on the relationship between pain and mood involves self-report of depressive symptoms, a strong relationship

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