Explaining high rates of depression in chronic pain: A diathesis-stress framework

Depression has been observed to accompany chronic pain. Yet, controversy remains regarding the extent and nature of the relationship between these 2 disorders. The authors analyze the literature regarding depression rates in chronic pain and other chronic medical populations and argue that depression appears to be highest among chronic pain patients. Drawing from cognitive-behavioral models of depression, the authors explore the unique psychological experiences of living with chronic pain that may account for the high prevalence of depression. Then a diathesis-stress framework is proposed to conceptualize the development of depression in chronic pain. Clinical and heuristic implications are discussed.