Bidirectional Relationship Between Body Pain and Depressive Symptoms: A Pooled Analysis of Two National Aging Cohort Studies

The inflammatory and genetic mechanisms underlying the cumulative effect of co-occurring pain conditions on depression

Chronic pain conditions frequently coexist and share common genetic vulnerabilities. Despite evidence showing associations between pain and depression, the additive effect of co-occurring pain conditions on depression risk and the underlying mechanisms remain unclear. Leveraging data from 431,038 UK Biobank participants with 14-year follow-up, we found a significantly increased risk of depression incidence in individuals reporting pain, irrespective of body site or duration (acute or chronic), compared with pain-free individuals. The depression risk increased with the number of co-occurring pain sites. Mendelian randomization supported potential causal inference. We constructed a composite pain score by combining individual effects of acute or chronic pain conditions across eight body sites in a weighted manner. We found that depression risks increased monotonically in parallel with composite pain scores. Moreover, some inflammatory markers, including C-reactive protein, partially mediated the association between composite pain scores and depression risk. Considering the high prevalence of comorbid depression and pain, pain screening may help identify high-risk individuals for depression.

Longitudinal associations between pain and cognitive decline in middle-aged and older Chinese adults: the mediating role of depressive symptoms

Objective

The primary aim of this scholarly investigation was to elucidate the correlation between Number of Pain Sites and cognitive decline within the older adult population. Additionally, the study sought to examine the potential mediating influence of depressive symptoms in moderating the association between pain and cognitive deterioration.

Methods

We analyzed 8,835 participants aged 45 and above, with data collected from 2011 to 2018. Participants were categorized into two groups-stable and rapidly declining cognitive function-using the KML3D clustering method. Binary logistic regression analysis was conducted to examine the association between pain status, depressive symptoms, and cognitive trajectories, and mediation analysis was used to assess the mediating role of depression.

Results

Multi-site pain was significantly associated with the risk of rapid cognitive decline (adjusted OR = 1.30, 95% CI: 1.14-1.48), and depressive symptoms were also a significant predictor of rapid cognitive decline (adjusted OR = 1.49, 95% CI: 1.32-1.68). Mediation analysis revealed that depression mediated the effect of pain on cognitive decline, accounting for 25.71% of the total effect.

Conclusion

Our study establishes a significant longitudinal link between Number of Pain Sites and cognitive decline, mediated in part by depressive symptoms. This finding underscores the need for interventions that address pain and depression to potentially decelerate cognitive decline in older adults.

The association between speech impairments and depression in Chinese adults aged 45 and older: insights from the CHARLS database

BACKGROUND

Speech impairments significantly affect communication and are associated with social and psychological difficulties, particularly among adults aged 45 years and older. This study examines the relationship between speech impairments and depression using data from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

A total of 67,014 participants aged 45 years and older were included in the analysis. The baseline characteristics of participants with and without speech impairments were compared using chi-square tests. Multivariable logistic and linear regression models were employed to assess the association between speech impairments and depression. Sensitivity and subgroup analyses were performed to explore variations across different demographic and lifestyle characteristics.

RESULTS

Participants with speech impairments exhibited a significantly greater likelihood of depression, with adjusted odds ratios (Model II: OR = 2.16, 95% CI: 1.56-2.97, p < 0.0001) and higher depression scores (Model II: β = 3.03, 95% CI: 2.24-3.81, p < 0.0001) after controlling for confounders. Sensitivity analysis confirmed the robustness of these findings. Subgroup analysis revealed consistent associations across all the examined subgroups, with a statistically significant interaction between speech impairments and place of residence (p for interaction = 0.02), indicating a stronger association in urban residents.

CONCLUSION

Speech impairments are strongly associated with a greater likelihood of depression in middle-aged and elderly Chinese adults. This finding underscores the importance of targeted mental health interventions and support for this population, particularly in urban settings.

CLINICAL TRIAL NUMBER

Not applicable.

Association between pain intensity and depressive status in patients with hip fracture: An observational study

Identifying depression symptoms in patients with hip fractures and studying the relationship between depression and pain intensity and pain location in hip fracture patients is of great significance for disease recovery in hip fracture patients. This cohort study analyzed 5 wave data from the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, 2018, and 2020, focusing on 1222 patients with hip fractures. The study utilized the CESD-10 Depression Scale to assess depressive symptoms in hip fracture patients and conducted analyses to explore the relationship between depression symptoms, pain, and pain intensity, including binary logistic regression and examination of interaction terms between pain variables and pain intensity in key body parts. Depression symptoms are strongly associated with pain intensity in hip fracture patients, particularly in key body areas. Severe pain significantly increases the risk of depressive symptoms. Moreover, absence of pain in other key body parts is linked to depressive symptoms. Multivariate analysis reveals that higher education levels, marriage, urban residence, and self-rated good health serve as protective factors against depression, while diabetes and heart disease pose significant risks for depressive symptoms in hip fracture patients. Hip fracture pain can induce discomfort and trigger depressive symptoms, showing varied trajectories among patients. Pain intensity predicts the course of depressive symptoms, emphasizing the importance of tailored pain management strategies including medication, physical therapy, and nonpharmacological interventions. Personalized rehabilitation and mental health plans should be designed based on individual patient needs and differences.

Does Helping Others Always Benefit Health? Longitudinal Evidence on the Relationship between Helping Behavior and Depression: The Mediating Role of Life Satisfaction and the Moderating Effect of IADL

Background

This study aims to explore whether helping behavior is always beneficial for alleviating depression or if there is a "moderation is the key" effect.

Materials and Methods

This study focused on a sample of 7,436 participants from the China Health and Retirement Longitudinal Study (CHARLS). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to identify the presence of depression. Linear mixed model and Quasi-Bayesian estimation methods were used to explore the mediating role of life satisfaction in the relationship between helping behavior and depression, as well as the moderating effects of the instrumental activity of daily living (IADL). Additionally, we employed the Johnson-Neyman technique to visualize the moderating effect of IADL.

Results

Helping behavior shows a negative correlation with depression (B = -0.170, p = 0.020), where life satisfaction fully mediates this relationship (effect = -0.055, 95% confidence interval = -0.088 to -0.022). Moreover, the association between helping behavior and life satisfaction is moderated by IADL (B = -0.047, p < 0.001). Specifically, when IADL is below 0.56, helping behavior positively impacts life satisfaction. In contrast, when IADL exceeds 1.99, helping behavior has a detrimental effect on life satisfaction.

Conclusions

This study highlights the significant positive impact of helping behavior on depression alleviation, which is achieved by increasing life satisfaction. Notably, although helping behavior has positive effects on individuals, not everyone can benefit directly from it. Only those without functional limitations are more likely to experience the benefits of such behavior. Therefore, when policymakers and researchers develop strategies to encourage individuals in helping behavior to combat depression, they should consider two key approaches. First, life satisfaction should be used as an important indicator in the treatment of depression, allowing for timely adjustments to ensure the effectiveness and individualization of treatment plans. Second, the principle of "moderation is the key" should be prioritized, ensuring that helping behavior can maximize its benefits and help individuals emerge from the shadows of depression.

Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up: A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Background

Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies.

Aim

This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator.

Methods

This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008-2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims.

Results

Changes in acceptance (β:0.424-0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177-0.233; all P<0.001) and changes in fear-avoidance (β: -0.152- -0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator.

Discussion and Conclusion

Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.

Prevalence and characteristics of fibromyalgia according to three fibromyalgia diagnostic criteria: A secondary analysis study

Objective

The purpose of this study was to explore the prevalence of fibromyalgia (FM) according to different diagnostic criteria in a clinical sample and to explore the clinical characteristics in cases and non-cases by the diagnostic criteria used.

Methods

A sample of 182 participants, both positive (n = 120) and negative (n = 62) FM individuals according to a clinical, pragmatic classification was used. Their characteristics were explored according to three different FM diagnostic criteria, i.e., the American College of Rheumatology (ACR) 1990, ACR 2016, and APS Pain Taxonomy (AAPT), respectively. Thus, impact of FM (FIQ), symptoms of anxiety and depression (HADS), tender point (TP) counts, and mechanical pressure sensitivity (in kPa) were compared in cases versus non-cases depending on diagnostic criteria of FM used. Descriptive analyses used chi-square statistic for categorical variables and non-parametric Mann-Whitney U tests for continuous variables.

Results

From the clinical positive FM sample (n = 120), n = 99, 108, and 110 persons were diagnosed positive according to the ACR 1990, ACR 2016, and AAPT FM diagnostic criteria, respectively. All these three diagnostic tools discriminated FM positively from diagnostic FM non-cases when measuring TP-counts, mechanical pressures, and most FIQ-items, but they varied for anxiety and depression.

Conclusion

The prevalence of FM differed somewhat with the use of ACR 1990, ACR 2016, and the AAPT as diagnostic tools. The anxiety and depression symptoms differed significantly between cases and non-cases using some but not all the diagnostic criteria. Regarding other FM symptoms, e.g., TPs and most FIQ items, all diagnostic criteria contrasted case from non-case.

The multi-generational familial aggregation of interstitial cystitis, other chronic nociplastic pain disorders, depression, and panic disorder

BACKGROUND

Interstitial cystitis/painful bladder syndrome (IC) is a chronic pelvic pain condition which has high comorbidity with other nociplastic, or unexplained, pain disorders [e.g. fibromyalgia (FM), irritable bowel syndrome (IBS), and myalgic encephalomyelitis/chronic fatigue (ME/CFS)] and some psychiatric conditions [major depressive disorder (MDD) and panic disorder (PD)]. Here we investigated the shared familiality of IC and these other nociplastic and psychiatric conditions.

METHODS

Subjects were identified in the Utah Population Database, which links genealogy data back to the 1800s to medical record diagnosis billing code data back to 1995. We computed the relative risk of each of these disorders among first (FDR), second (SDR), and third-degree relatives (TDR) of six proband groups: IC, FM, IBS, ME/CFS, PD, and MDD. Given the known familial aggregation of each of these disorders, we conducted our analyses to test for heritable interrelationships using proband subgroups whose members did not have the diagnosis assessed in their relatives.

RESULTS

We observed strong evidence for heritable interrelationships among all six disorders. Most analyses indicated significantly increased risk for each of the six disorders in FDR, SDR, and TDR of all or most proband groups. Out of 30 possible bidirectional disorder interrelationships, 26 were significant among FDR, 23 were significant among SDR, and 7 were significant among TDR. Clustering was observed in both close and distant relatives.

CONCLUSIONS

Our results support a common, heritable component to IC and other nociplastic and psychiatric conditions.

Association between pain intensity and depressive symptoms in community-dwelling adults: longitudinal findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)

PURPOSE

To investigate the longitudinal associations between pain and depressive symptoms in adults.

METHODS

Prospective cohort study on data from 28,515 community-dwelling adults ≥ 50 years, free from depression at baseline (Wave 5), with follow-up in Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Significant depressive symptoms were defined by a EURO-D score ≥ 4. The longitudinal association between baseline pain intensity and significant depressive symptoms at follow-up was analysed using logistic regression models; odds ratios (ORs) and confidence intervals (CI) were calculated, adjusting for socio-demographic and clinical factors, physical inactivity, loneliness, mobility and functional impairments.

RESULTS

Mean age was 65.4 years (standard deviation 9.0, range 50-99); 14,360 (50.4%) participants were women. Mean follow-up was 23.4 (standard deviation 3.4) months. At baseline, 2803 (9.8%) participants reported mild pain, 5253 (18.4%) moderate pain and 1431 (5.0%) severe pain. At follow-up, 3868 (13.6%) participants-1451 (10.3%) men and 2417 (16.8%) women-reported significant depressive symptoms. After adjustment, mild, moderate and severe baseline pain, versus no pain, were associated with an increased likelihood of significant depressive symptoms at follow-up: ORs (95% CI) were 1.20 (1.06-1.35), 1.32 (1.20-1.46) and 1.39 (1.19-1.63), respectively. These associations were more pronounced in men compared to women, and consistent in participants aged 50-64 years, those without mobility or functional impairment, and those without loneliness at baseline.

CONCLUSION

Higher baseline pain intensity was longitudinally associated with a greater risk of significant depressive symptoms at 2-year follow-up, in community-dwelling adults without baseline depression.

Risk Factor Analysis and a Predictive Model of Postoperative Depressive Symptoms in Elderly Patients Undergoing Video-Assisted Thoracoscopic Surgery

Among the elderly, depression is one of the most common mental disorders, which seriously affects their physical and mental health and quality of life, and their suicide rate is particularly high. Depression in the elderly is strongly associated with surgery. In this study, we aimed to explore the risk factors and establish a predictive model of depressive symptoms 1 month after video-assisted thoracoscopic surgery (VATS) in elderly patients. The study participants included 272 elderly patients (age > 65 years) undergoing VATS from April 2020 to May 2021 at 1 of 18 medical centers in China. The patients were divided into a depression group and a nondepression group according to the Chinese version of the nine-item Patient Health Questionnaire (PHQ-9). The patients' pre- and postoperative characteristics and questionnaires were collected and compared. Then, binary logistic regression was used to determine the risk factors that affect postoperative depressive symptoms, and the predictive model was constructed. The prediction efficiency of the model was evaluated by drawing the receiver operating characteristic curve (ROC), and the area under the curve (AUC) was calculated to evaluate the value of the predictive model. Among all of the included patients, 16.54% (45/272) suffered from depressive symptoms after VATS. The results of the univariate analysis showed that body mass index (BMI), chronic pain, leukocyte count, fibrinogen levels, prothrombin time, ASA physical status, infusion volume, anxiety, sleep quality, and postoperative pain were related to postoperative depressive symptoms (all p < 0.05). The results of multivariate logistic regression analysis showed that a high fibrinogen level (OR = 2.42), postoperative anxiety (OR = 12.05), poor sleep quality (OR = 0.61), and pain (OR = 2.85) were risk factors of postoperative depressive symptoms. A predictive model was constructed according to the regression coefficient of each variable, the ROC curve was drawn, and the AUC value was calculated to be 0.889. The prediction model may help medical personnel identify older patients at risk of developing depressive disorders associated with VATS and may be useful for clinical purposes.

A Cross-Sectional and Longitudinal Study of Pain among Middle-Aged and Older Adults in Thailand

Objective

The present study aimed to assess the prevalence and risk factors of pain among ageing adults in Thailand.

Methods

Cross-sectional and longitudinal data were analysed from two consecutive national waves of the Health, Aging, and Retirement in Thailand (HART) study in 2015 and 2017. The dependent variable pain was defined as moderate or severe pain in any of the 13 areas of the body over the past month. Independent variables included sociodemographic factors, health risk behaviour, physical and mental health conditions, and healthcare utilization.

Results

The baseline or cross-sectional sample consisted of 5,616 participants (≥45 years), and the follow-up or incident sample consisted of 2,305 participants. The proportion of pain in the cross-sectional/baseline sample was 36.0%, and in the incident/follow-up sample 39.9%. In the cross-sectional/baseline multivariable model, poor self-reported mental health, sleep problem, arthritis or rheumatism, brain disease and/or psychiatric problems, lung disease, use of hospital in-patient, conventional out-patient, and traditional medicine practitioners were positively associated with pain. In the incident/follow-up multivariable model, older age, Buddhist religion, class I obesity, poor self-reported mental health, hospital in-patient, private clinic out-patient, and use of a practitioner of traditional medicine were positively associated with pain. Male sex and higher education were negatively associated with both cross-sectional and incident pain.

Conclusions

More than one-third of older adults in Thailand had past month moderate or severe pain. Risk factors of pain from cross-sectional and/or incident analysis included older age, female sex, lower education, obesity, poor self-reported mental health, sleep problem, arthritis or rheumatism, brain disease and/or psychiatric problems, lung disease, and conventional and traditional healthcare utilization.

Pain intensity and psychological distress show different associations with interference and lack of life control: A clinical registry-based cohort study of >40,000 chronic pain patients from SQRP

Background

Both chronic pain and depressive and/or anxiety symptoms are associated with negative impacts on daily living, including interference and lack of life control. However, little is known about how pain and psychological distress affect these impacts.

Aim

The first aim was to assess how pain intensity, psychological distress, and social support interact with interference and lack of life control. A second aim was to investigate whether the strength of these relationships is moderated by the presence or absence of depression and/or anxiety.

Subjects and methods

Patient-Reported Outcome Measures (PROMs), which are available in the Swedish Quality Registry for Pain Rehabilitation (SQRP), were retrieved for patients with chronic pain (N = 40,184). A theoretical model with the constructs/latent variables pain intensity, psychological distress, interference, lack of life control, and social support was proposed and analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Indicators for these constructs were identified from the PROMs of the SQRP. Two models of the total cohort, which differed with respect to the causal relationship between pain intensity and psychological distress, were investigated. The moderating effects of anxiety and/or depression were also analyzed.

Results

Relatively low correlation and explanatory power (R ²= 0.16) were found for the pain intensity-psychological distress relationship. Pain intensity had a stronger effect on interference than on lack of life control. The reverse was found for psychological distress - i.e., psychological distress seemed to have a higher negative influence on function than on interference. The underlying assumption of the causal relationship between pain intensity and psychological distress determined how strong pain intensity and psychological distress influenced interference and lack of life control. Social support showed very similar absolute significant correlations with interference and lack of life control. Interference and lack of life control showed relatively weak associations. The psychological distress level was a moderating factor for several of the paths investigated.

Discussion and conclusion

A clinical treatment consequence of the low correlation between pain intensity and psychological distress may be that clinically treating one may not reduce the effect of the other. The relative importance of pain intensity and psychological distress on interference and lack of life control depends on the underlying assumption concerning the pain intensity-psychological distress relationship. Interference and lack of life control showed relatively weak associations, underscoring the need to clinically assess them separately. Social support influenced both impact constructs investigated. The cohort display heterogeneity and thus presence of definite signs of anxiety and/or depression or not was a moderating factor for several of the associations (paths) investigated. The results are important both for the assessments and the design of treatments for patients with chronic pain.

Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia

Background:

About 4 out of 10 fibromyalgia patients suffer from depression. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend using antidepressants to treat fibromyalgia.

Objective:

To determine predictors of improved outcomes following a multicomponent treatment program.

Design:

We designed this longitudinal treatment outcome study to evaluate the prevalence of depression symptoms in patients diagnosed with fibromyalgia at a tertiary care facility, and the impact of depression on functional outcomes after completing a multicomponent fibromyalgia treatment program.

Setting:

Tertiary care center.

Patients:

This study included 411 adult patients with fibromyalgia who completed a multicomponent treatment program for fibromyalgia. Expert physicians performed comprehensive evaluations following American College of Rheumatology (ACR) criteria to confirm fibromyalgia before referral to the program.

Intervention:

An intensive outpatient multicomponent treatment program consisting of 16 hours of cognitive behavioral strategies served as the intervention.

Measurements:

Functional status was assessed using the Fibromyalgia Impact Questionnaire Revised (FIQR). Depression was evaluated with the Center for Epidemiologic Study of Depression (CES-D) measure. Measures were administered prior to participation in the program and approximately 5 months following completion of the program.

Results:

The cohort had a high prevalence of depressive symptoms (73.2% had depression at admission). Higher depression scores at baseline predicted poorer outcomes following multi-component treatment. Effectively treated depression resulted in improved functioning at follow-up.

Limitations:

Findings limited to tertiary care center cohort of fibromyalgia patients. Patients did not undergo a structured clinical diagnostic interview to diagnose depression.

Conclusions:

The current data links depression to poorer outcomes in patients with fibromyalgia. Depression is an important modifiable factor in the management of fibromyalgia. Guidelines should reflect the importance of assessing and effectively treating depression at the time of diagnosis of fibromyalgia, to improve functional outcomes.

Registration:

Specific registry and specific study registration number—Institutional Review Board—(IRB# 19-000495).

Funding Source:

No funding.