Subclinical psychosis and pain in an English national sample: The role of common mental disorders

Abstract

BackgroundInformation on the association between subclinical psychosis and pain is scarce, and the role of common mental disorders (CMDs) in this association is largely unknown. The aim of the current study was to therefore assess this association in the general population using nationally representative data from England. MethodsData for 7403 adults aged≥16years were used from the 2007 Adult Psychiatric Morbidity Survey. Five forms of psychotic symptoms were assessed by the Psychosis Screening Questionnaire, while pain was assessed in terms of the level of its interference with work activity in the past four weeks. The Clinical Interview Schedule Revised (CIS-R) was used to assess anxiety disorders, depressive episode, and mixed anxiety-depressive disorder (MADD). Participants with probable or definite psychosis were excluded. The association between psychotic symptoms and pain was assessed by ordinal and binary logistic regression analysis. ResultsWhen adjusted for confounders other than CMDs, psychotic symptoms were significantly associated with pain [e.g., the OR (95%CI) for the severest form of pain (binary outcome) was 1.78 (1.11–2.85)]. However, this association was no longer significant when CMDs were controlled for in most analyses. Anxiety disorders and depressive episode explained 34.8%–47.1% of the association between psychotic symptoms and pain, while this percentage increased to 62.7%–78.0% when the sub-threshold condition of MADD was also taken into account. ConclusionsWhen coexisting psychotic symptoms and pain are detected, assessing for anxiety and depression (even at sub-threshold levels) may be important for determining treatment options.