The Utility of the Beck Depression Inventory in the Evaluation of Chronic Pelvic Pain Patients

Abstract

A substantial proportion of patients with chronic pelvic pain (CPP) have no abnormalities on diagnostic laparoscopy; estimates range from 14% to 90%. There is evidence that CPP encompasses a strong psychiatric element, and some have proposed analyzing psychiatric status early in the course of the work-up. The investigators carried out an observational cohort study of 28 women with CPP, defined as pelvic pain for at least 6 months preoperatively, and a control group of 30 women who underwent tubal ligation. All patients completed the Beck Depression Inventory preoperatively before undergoing diagnostic laparoscopy. The women with CPP were clinically and ultrasonographically normal. The authors' hypothesis was that patients with significant depression have less organic pathology and therefore may benefit from multidisciplinary management. Patients with a diagnosis of CPP had significantly higher depression scores than did control patients. Their rate of depressive comorbidity was 57% based on preoperative screening, compared to 10% of control patients. The CPP and control groups had significant pathology 50% and 40% of the time, respectively. The risk of abnormal pathology in CPP patients was not associated with depressive symptom scores. In addition to higher depression screen scores, CPP patients more often reported current or past treatment for depression, irritable bowel syndrome, migraine headaches, a history of pelvic inflammatory disease, and both physical and sexual abuse. Regardless of their depression screen scores, patients with CPP may benefit from early laparoscopy. Delaying diagnostic laparoscopy could impede the prompt diagnosis and treatment of clinically depressed patients with CPP.