Pain-related distress and clinical depression in chronic pain: A comparison between two measures

Abstract

Background and purposeDepression is a frequent co-morbid diagnosis in chronic pain, and has been shown to predict poor outcome. Several reviews have described the difficulty in accurate and appropriate measurement of depression in pain patients, and have proposed a distinction between pain-related distress and clinical depression. Aims of the current study were to compare (a) the overlap and differential categorisation of pain patients as depressed, and (b) the relationship to disability between the Structured Interview for DSM-IV (SCID-Depression module) and the Hospital Anxiety and Depression Scale (HADS-D). MethodsSeventy-eight chronic back pain patients were administered the SCID-D, the HADS-D and the Pain Disability Index (PDI). ResultsSignificantly more patients were categorised with possible and probable depression by the HADS than the SCID-D. Results from Receiver Operating Characteristic (ROC) curve analysis suggested that the HADS-D provided better discriminatory ability to detect disability, demonstrating a better balance between sensitivity and specificity compared to the SCID-D, although a direct comparison between the two measurements showed no difference. ConclusionsThe HADS-D is a reasonably accurate indicator of pain-related distress in chronic pain patients, and captures the link between disability and mood. ImplicationsIt is likely that the SCID-D is better suited to identifying sub-groups with more pronounced psychiatric disturbance. PerspectiveSeveral reviews have proposed a distinction between pain-related distress and clinical depression. This study compared the overlap and differential categorisation of pain patients as depressed and the relationship to disability between the Structured Interview for DSM-IV (SCID-D; Depression module) and the Hospital Anxiety and Depression Scale (HADS-D).