Does Depression Screening Work for Chronic Pain Patients?
/By Crystal Lindell
For many patients with a chronic illness, every time they go to the doctor they have to fill out the infamous depression questionnaire – even if the reason for their visit has absolutely nothing to do with their mental health.
Formally known as “Patient Health Questionnaire-8 (PHQ-8),” it starts with this question:
"Over the last 2 weeks, how often have you been bothered by any of the following problems?"
It then lists things like "Little interest or pleasure in doing things" or if you are feeling tired, have trouble sleeping, or have a poor appetite.
Patients are then asked to rank their responses on a scale that goes from "Not at all" to "Nearly every day."
Over the years, I have often scored poorly on this questionnaire, which means I ranked very high for clinical depression during those times in my life.
Looking back, I’m pretty sure what it really measured was whether I was so depressed that I just didn’t care about trying to hide anything. But regardless, I do think that when I scored high, I actually was very depressed.
However, there has long been a belief that the questions don’t work well for chronic pain patients, who often have sound physical reasons for their poor sleep, appetite, and other symptoms. This would inflate their depression scores.
For example, "Feeling tired or having little energy" as well as "Trouble falling or staying asleep, or sleeping too much" and "Trouble concentrating on things" are all symptoms that can be greatly impacted by physical pain, regardless of your mental health.
Now, a new study claims to prove the questions are an accurate way to measure clinical depression – even in patients with chronic pain. Published in the Journal of Affective Disorders, the research analyzed how reliable the questions are for people with and without chronic pain.
In a news release about the study published by the University of Arizona, lead author Jennifer De La Rosa, PhD, discussed the motivation for her research.
"Could pain symptoms artificially inflate depression screening scores among those with chronic pain? It's a reasonable question, but it had not yet been definitively answered," said De La Rosa, who also serves as Director of Strategy at the school’s Comprehensive Center for Pain and Addiction.
"Using nationally representative population data, we rigorously evaluated this question and found no evidence to support this long-standing concern."
De La Rosa and her team analyzed data from nearly 32,000 U.S. adults who participated in the 2019 National Health Interview Survey. They found that the questionnaire achieved an excellent level of consistency for people with chronic pain and those without. They concluded that the consistency equaled reliability.
"Clinicians need to know that a positive depression screening is just as reliable in their patients with chronic pain as patients without chronic pain, and they should not hesitate to offer mental health supports to any patient with unmet mental health needs," De La Rosa said. "These conversations require sensitivity to ensure patients feel supported by these conversations rather than stigmatized.”
She also lamented that many clinical trials for depression exclude chronic pain patients. De La Rosa hopes that will change.
"This study provides robust evidence that there would be no scientific problem with including folks living with chronic pain in depression research to help develop treatments capable of meeting the needs of this uniquely underserved population," she said.
The study reinforces De La Rosa's previous research, which found that while 1 in 5 people with chronic pain have depression, more than half of those with clinically significant depression also have chronic pain.
Another recent study estimated that about 40% of chronic pain patients have clinical symptoms of depression or anxiety. The depression rate is even higher for those who have fibromyalgia or chronic pelvic pain.
