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Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries

Published online by Cambridge University Press:  22 June 2017

B. Stubbs ,
D. Vancampfort ,
N. Veronese ,
T. Thompson ,
M. Fornaro ,
P. Schofield ,
M. Solmi ,
J. Mugisha ,
A. F. Carvalho  and
A. Koyanagi
B. Stubbs*
Affiliation:
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, UK
D. Vancampfort
Affiliation:
KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
N. Veronese
Affiliation:
Geriatrics Division, Department of Medicine-DIMED, University of Padova, Padova, Italy Institute of clinical Research and Education in Medicine (IREM), Padova, Italy
T. Thompson
Affiliation:
Faculty of Education and Health, University of Greenwich, London, UK
M. Fornaro
Affiliation:
New York Psychiatric Institute, Columbia University, New York, NY, USA
P. Schofield
Affiliation:
Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
M. Solmi
Affiliation:
Institute of clinical Research and Education in Medicine (IREM), Padova, Italy Department of Neurosciences, University of Padova, Padova, Italy
J. Mugisha
Affiliation:
Kyambogo University, Kampala, Uganda Butabika National Referral and Mental Health Hospital, Kampala, Uganda
A. F. Carvalho
Affiliation:
Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
A. Koyanagi
Affiliation:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
*
*Address for correspondence: B. Stubbs, Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK. (Email: brendon.stubbs@kcl.ac.uk)
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Abstract

Background

Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.

Methods

Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.

Results

The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83–2.55], 1.45 (95% CI 1.22–1.73), and 2.11 (95% CI 1.87–2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54–4.37).

Conclusion

Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.

Keywords

Comorbiditydepressiondepressive symptomspain
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 16 , December 2017 , pp. 2906 - 2917
Copyright
Copyright © Cambridge University Press 2017 

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