Depression and Anxiety with Pain
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The Association of Depression and Anxiety with Pain: A Study from NESDA Eric W. de Heer 1,2 * , Marloes M. J. G. Gerrits 3 , Aartjan T. F. Beekman 3,4 , Jack Dekker 5,6 , Harm W. J. van Marwijk 7 , Margot W. M. de Waal 8 , Philip Spinhoven 9,10 , Brenda W. J. H. Penninx 3 , Christina M. van der Feltz-Cornelis 1,2,11 1 TopClinical Center for Body, Mind, and Health, GGz Breburg Tilburg, Tilburg, The Netherlands, 2 Tilburg School of Behavioral and Social Sciences, Tranzo Department, University of Tilburg, Tilburg, The Netherlands, 3 Department of Psychiatry, EMGO Institute for Health and Care research, VU University Medical Centre, Amsterdam, The Netherlands, 4 GGZ inGeest, Mental Health Institute, Amsterdam, The Netherlands, 5 Arkin, Mental Health Institute, Amsterdam, The Netherlands, 6 Department of Clinical Psychology, VU University, Amsterdam, The Netherlands, 7 Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands, 8 Department of Public Health and Primary Care, Leiden university Medical Centre, Leiden, The Netherlands, 9 Institute of Psychology, Leiden University, Leiden, The Netherlands, 10 Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands, 11 Trimbos Institute, Utrecht, the Netherlands Abstract Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (OR = 6.67; P , .001), anxiety (OR = 4.84; P , .001), or co-morbid depressive and anxiety disorder (OR = 30.26; P , .001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (OR = 3.53; P , .001) as compared to controls. A current anxiety disorder (OR = 2.96; p , .001) and a co- morbid depressive and anxiety disorder (OR = 5.15; P , .001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research. Citation: de Heer EW, Gerrits MMJG, Beekman ATF, Dekker J, van Marwijk HWJ, et al. (2014) The Association of Depression and Anxiety with Pain: A Study from NESDA. PLoS ONE 9(10): e106907. doi:10.1371/journal.pone.0106907 Editor: H. Sunny Sun, National Cheng Kung University Medical College, Taiwan Received April 10, 2014; Accepted August 5, 2014; Published October 15, 2014 Copyright: ß 2014 de Heer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. Researchers can submit a research plan, which describes the background en methods of a proposed research question, and a request for specific data of the NESDA database to answer the research question. Information about NESDA data can be requested by contacting the principal investigator of NESDA: Prof. Dr. Brenda Penninx: b.penninx@ vumc.nl. Funding: The infrastructure for the NESDA study is funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (Zon-MW, grant number 10-000-1002) and is supported by participating universities and mental health care organisations (VU University Medical Center, GGZ inGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, IQ Healthcare, Netherlands Institute for Health Services Research [NIVEL], and the Netherlands Institute of Mental Health and Addiction [Trimbos]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors of this manuscript have read the journal’s policy and have the following competing interests: ATFB reports grants from Eli Lilly, grants from Astra Zeneca, grants from Jansen, grants from Shire, personal fees (as a speaker) from Eli Lilly, and personal fees (as a speaker) from Lundbeck, outside the submitted work. JD and CMFC report grants from Eli Lilly, outside the submitted work. BWJHP reports grants from Dutch government, ministryo f Health (ZonMw), during the conduct of the study. This does not alter their adherence to PLOS ONE policies on sharing data and materials, except those mentioned in the data availability statement. * Email: e.deheer@ggzbreburg.nl Introduction Chronic pain is common in up to 70% of patients with depressive and anxiety disorders [1–9]. Chronic pain and depression most likely have a bidirectional association: depression is a predictor of persistent pain and pain is a predictor of the persistence of depression [1,3,10]. A possible explanation is that impaired functioning caused by pain can lead to social isolation, which in turn can lead to a negative effect on depressive symptoms, and vice versa [11,12]. Furthermore, different brain areas, such as the amygdala and hypothalamus, play a role in both depression and pain [13,14]. Also, when depression and chronic pain are co-morbid, recognition and treatment of depression are less effective, as patients mostly only present their physical complaints and receive treatment accordingly [1]. Most studies up to now have only considered the relationship of pain with depression, whereas its association with anxiety disorders PLOS ONE | www.plosone.org 1 October 2014 | Volume 9 | Issue 10 | e106907
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