Citation

Rayner L, Hotopf M, Petkova H, Matcham F, Simpson A, McCracken L. Pain 2016; 157(7): 1472-1479.

Affiliation

1King's College London, Institute of Psychiatry Psychology and Neuroscience, Department of Psychological Medicine, Denmark Hill, London, UK 2King's College London, Institute of Psychiatry Psychology and Neuroscience, Department of Health Services and Population Research, Denmark Hill, London, UK 3King's College London, Institute of Psychiatry Psychology and Neuroscience, Health Psychology Section, Department of Psychology & INPUT Pain Management Centre, Guy's and St Thomas' NHS Foundation Trust, London UK.

Copyright

(Copyright © 2016, Lippincott, Williams and Wilkins)

DOI

10.1097/j.pain.0000000000000542

PMID

26963849

Abstract

This cross-sectional study aimed to determine the prevalence and impact of depression on healthcare costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic, disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning and service use in the preceding three months. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Self-report healthcare utilisation was measured across four domains: GP contacts, contacts with secondary/tertiary care doctors, Accident and Emergency Department visits, and days hospitalised. The participation rate was 89%. 732 patients (60.8%, 95% CI 58.0-63.6) met criteria for probable depression and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work due to ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total healthcare costs per three-month period were £731 (95% CI £646-£817) for patients with depression, compared to £448 (95% CI £366-530) for patients without depression. A positive association between severe depression and total healthcare costs persisted after controlling for key demographic, functional and clinical covariates using multiple linear regression models. These findings reveal the extent, severity and impact of depression in chronic pain patients and make evident a need for action. Effective treatment of depression may improve patient health and functioning, and reduce the burden of chronic pain on healthcare services.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Language: en