A national study of the effect of chronic pain on the use of health care by depressed persons

Objective: The objective of this study was to provide national estimates of the impact of common pain conditions such as back pain, chronic headache,,self-reported arthritis, and unspecified chronic pain on the use of health services and quality of care among persons with depression. Methods: This was a cross-sectional study of data from a U.S. national household survey conducted in 1997-1998. The participants were 1,486 community-dwelling adults who met criteria for major depression or dysthymia according to the Composite International Diagnostic Interview Short-Form. Results: Depressed persons with comorbid pain (N=938) were older, had lower incomes, and reported more severe psychiatric distress than depressed persons who did not have pain. When sociodemographic characteristics and severity of psychological distress were adjusted for, comorbid pain was associated with about 20 percent more visits to medical providers by patients who made at least one visit during a year. However, the patients with comorbid pain were about 20 percent less likely to see a mental health specialist than patients without pain. Pain was also shown to be associated with greater use of complementary or alternative medicine but not with differences in the use of antidepressants. Conclusion: Comorbid pain among persons with depression is associated with more intensive use of general medical services but lower rates of use of mental health services.