Researchers who conducted a study on pain and depression in primary care suggest that in light of the high prevalence of depression they uncovered in their study population, family physicians should routinely screen for depression, as well as anxiety, in patients who present with headache, back pain, and other pain symptoms.¹ The authors also found patients’ pain symptoms varied by sex, race, and age group.
 
Study population derived from the community
Researchers Janine Janosky, PhD, Jeannette South-Paul, MD, and Chyongchiou J Liu, PhD, of the Department of Family Medicine at the University of Pittsburgh, drew their study population from 10 community-based primary care health centers in Allegheny County, Pennsylvania. They felt that this model of a clinically undifferentiated population was more likely to mirror family practice, where patients often present for various undifferentiated complaints. In addition, underrepresented minorities were well represented among the study cohort.
 
Subjects interested in participating in health education projects (conducted by the Center for Primary Care Community-Based Research) were recruited at health fairs, farmers markets, and community gatherings over several years. A research registry was then created.
 
The study’s goal was to examine the relationship between depression and associated self-reported conditions in participants enrolled in the registry.

A look at the cohort
The cohort included 2421 participants, ranging in age from 11 to 91 years (mean, 46.6 years); 72.2% of the participants were women. More than half were African American (54.9%), and 38.5% were white. Most participants (68.9%) reported that their general health was good or very good.
 
Study findings
Researchers found that the prevalence of depression in this diverse, urban, community population (24.4%) was considerably higher than the 17% of the population that will exhibit a major depressive disorder in their lifetime.² Researchers also found that comorbid depression was common in participants reporting pain symptoms.
 
Among their key findings:
 
Women were significantly more likely than men to report that they suffer from:

• depression (26.6% vs 20.2%; P<.01)
• anxiety (22.1% vs 14.8%; P<.01)
• headache (14.5% vs 7.1%; P<.01).

Women in this study were also more likely than men to indicate that they had a family history of depression or anxiety and were more likely to be taking medications for depression or anxiety.
 
Whites were more likely than nonwhites to report that they suffered from:

• depression (26.3% vs 23.8%; P<.01)
• anxiety (25.5% vs 16.6%; P<.01)
• headache (14.2% vs 11.2%; P=.015).

In addition, whites were more likely than nonwhites to indicate that they had a family history of depression or anxiety and were more likely to be taking medications for depression or anxiety.
 
Nonwhites had a higher prevalence of leg pain compared with whites (18.8% vs 14.9%; P=.042). But nonwhites had a lower prevalence of headache than whites (11.2% vs 14.2%; P=.015).
 
Compared with other age groups, the 35- to 50-year-old group had the highest rate of depression (30.5%; P<.01), anxiety (24.0%; P<.01), and headache (13.6%; P<.01). Their use of antidepressants and antianxiety medications was also higher than that of other age groups.
 
So what does this mean for FPs?
In the study, which appeared in the Journal of the American Board of Family Medicine, the researchers reported that “In addition to showing a relationship to physical pain and to depression, the results of this study show a positive relationship between family history of depression, anxiety, or both and a person currently having depression.”¹
 
Jeannette South-Paul, MD, one of the study’s authors, recommends that when evaluating a patient with physical pain symptoms, family physicians should:

• consider the individual’s ethnic and cultural background
• routinely screen for depression
• take a thorough patient and family history.

 
 
References
1. Janosky JE, South-Paul JE, Lin CH. Pain and depression in a cohort of underserved, community-dwelling primary care patients. J Am Board Fam Med. 2012;25:300-307.
2. Kessler RC, Berglund PA, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593-602.