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Pain associated with specific anxiety and depressive disorders in a nationally representative population sample

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Abstract

Objective

To examine in a nationally representative sample (a) the differential association of specific anxiety and depressive disorders defined according to DSM-IV with pain disorder (PD) and pain symptoms, and (b) whether pain-associated anxiety and depressive disorders and their comorbidity have different implications in terms of impairment, disability, health care utilization, and substance use.

Method

A nationally representative community study was conducted in Germany. Symptoms, syndromes and diagnoses of mental disorders, and pain were assessed in N = 4,181 participants aged 18–65 years using the DSM-IV/M-CIDI.

Results

Logistic regressions revealed that pain is associated with both specific anxiety and depressive disorders, with increasing significant odds ratios (OR) for medically explained pain symptoms (EPS; OR range: 1.9–2.0), to unexplained pain symptoms (UPS; OR range: 2.4–7.3), to PD (OR range: 3.3–14.8). PD and UPS persistently showed associations after adjusting for comorbid other anxiety and depressive disorders and physical illnesses. All types of pain, particularly PD/UPS, are associated with decreased quality of life, greater impairment in role functioning, disability, health care utilization, and substance use. Depressive disorders, even more so anxiety disorders and their comorbidity account for a substantial proportion of variance in these functional correlates.

Conclusions

Pain is strongly associated with specific anxiety and depressive disorders. In light of the individual and societal burden due to pain, and the demonstrated role of comorbid anxiety or/and depression, our results call for further investigation of the underlying mechanisms for this association as well as targeted treatments for these comorbidities.

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Notes

  1. For ratios >1: {0 − [1 − (adjusted ratio − 1)/(unadjusted ratio − 1)] × 100},

    For ratios <1: {1 − [adjusted ratio − 1)/(unadjusted ratio − 1)] × 100}.

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Acknowledgments

The German Health Survey (GHS) was supported by grant 01EH970/8 (German Federal Ministry of Research, Education and Science; BMBF). The reported data on mental disorders were assessed in the Mental Health Supplement of the GHS, conducted by the Max-Planck-Institute of Psychiatry, Munich, Germany. Principal investigator was Dr. Hans-Ulrich Wittchen. Reported somatic health status variables come from the GHS-Core Survey, conducted by the Robert Koch-Institute, Berlin, Germany. Principal investigators of the GHS-Core Survey were Dr. Bärbel-Maria Kurth and Dr. Wolfgang Thefeld. Data from this study are available as a Public Use File from: Dr. Frank Jacobi, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Str. 46, 01187 Dresden, Germany; E-Mail: jacobi@psychologie.tu-dresden.de. For further information about the Core Survey and its Public Use File, contact the Robert Koch-Institute, Dr. Heribert Stolzenberg, Nordufer 20, 13353 Berlin, Germany; E-Mail: stolzenbergh@rki.de.

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  1. Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany

    Katja Beesdo, Frank Jacobi, Jürgen Hoyer, Michael Höfler & Hans-Ulrich Wittchen

  2. Department of Psychiatry, McGill University, 1033 Pine Ave West, Montreal, QC, H3A 1A1, Canada

    Nancy C. P. Low

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  1. Katja Beesdo
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  2. Frank Jacobi
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Correspondence to Katja Beesdo.

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Beesdo, K., Jacobi, F., Hoyer, J. et al. Pain associated with specific anxiety and depressive disorders in a nationally representative population sample. Soc Psychiat Epidemiol 45, 89–104 (2010). https://doi.org/10.1007/s00127-009-0045-1

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