Journal of Behavioral Medicine

, Volume 38, Issue 3, pp 535–543 | Cite as

Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life

  • Samantha D. OutcaltEmail author
  • Kurt Kroenke
  • Erin E. Krebs
  • Neale R. Chumbler
  • Jingwei Wu
  • Zhangsheng Yu
  • Matthew J. Bair


Both posttraumatic stress disorder (PTSD) and depression are highly comorbid with chronic pain and have deleterious effects on pain and treatment outcomes, but the nature of the relationships among chronic pain, PTSD, and depression has not been fully elucidated. This study examined 250 Veterans Affairs primary care patients with moderate to severe chronic musculoskeletal pain who participated in a randomized controlled pain treatment trial. Baseline data were analyzed to examine the independent associations of PTSD and major depression with multiple domains of pain, psychological status, quality of life, and disability. PTSD was strongly associated with these variables and in multivariate models, PTSD and major depression each had strong independent associations with these domains. PTSD demonstrated similar relationships as major depression with psychological, quality of life, and disability outcomes and significant but somewhat smaller associations with pain. Because PTSD and major depression have independent negative associations with pain, psychological status, quality of life, and disability, it is important for clinicians to recognize and treat both mental disorders in patients with chronic pain.


Chronic pain PTSD Depression Veterans Quality of life Disability 



This work was supported by a Department of Veterans Affairs Health Services Research and Development (VA HSR&D) Merit Review award to Dr. Kroenke (IIR 07-119) and Career Development Award to Dr. Krebs (CDA 07-215). The sponsor had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Conflict of interest

Samantha D. Outcalt, Kurt Kroenke, Erin E. Krebs, Neale R. Chumbler, Jingwei Wu, Zhangsheng Yu, and Matthew J. Bair declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for which identifying information is included in this article.


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Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  • Samantha D. Outcalt
    • 1
    • 2
    • 3
    • 9
    Email author
  • Kurt Kroenke
    • 1
    • 3
    • 4
  • Erin E. Krebs
    • 5
    • 6
  • Neale R. Chumbler
    • 7
  • Jingwei Wu
    • 8
  • Zhangsheng Yu
    • 8
  • Matthew J. Bair
    • 1
    • 3
    • 4
  1. 1.Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416Center for Health Information and CommunicationIndianapolisUSA
  2. 2.Department of PsychiatryIndiana University School of MedicineIndianapolisUSA
  3. 3.Regenstrief Institute, Inc.IndianapolisUSA
  4. 4.Department of MedicineIndiana University School of MedicineIndianapolisUSA
  5. 5.Center for Chronic Disease Outcomes ResearchMinneapolis VA Health Care SystemMinneapolisUSA
  6. 6.Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisUSA
  7. 7.Department of Health Policy and Management, College of Public HealthUniversity of GeorgiaAthensUSA
  8. 8.Department of BiostatisticsIndiana University School of MedicineIndianapolisUSA
  9. 9.Roudebush VA Medical CenterIndianapolisUSA

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