Presented at the 2012 AAPM Annual Meeting « Back

To Identify Comorbid Depression in Adults Seriously Bothered by Activity Interfering Pain a Single Question Appears Sufficient

Jana M. Mossey, PhD, jm55@drexel.edu, Drexel University, Philadelphia, Pennsylvania

Introduction and Significance: Comorbid depression adversely impacts the clinical course of chronic pain. Its presence in clinical pain patients should routinely be evaluated. Administration of depression screening instruments is often prohibitively time consuming and reliance on the pain clinician’s judgment may result in under-diagnosis. Patient self-report based on one or two questions represents a feasible alternative if the question answers are valid indicators of co-morbid depression. Methods: De-identified data from the National Epidemiologic Survey of Alcohol and Related Conditions 1) were used to evaluate the validity of answers to the SF-12 question: "During the past 4 weeks...have you felt downhearted and depressed". The 5595 adults reporting being bothered by activity limiting pain (past 4 weeks) "Quite a bit" or "Extremely" were studied. Respondents (N=3757) reporting depressed feelings "a little" to "all of the time" were considered 'positive' for depression. Results: Using the DSM IV diagnoses for major depression determined for each individual through administration of the Alcohol Use Disorder and Associated Disabilities Interview Schedule (2) as the validating criteria, sensitivity and specificity of the single SF-12 question were calculated as 93.5% and 37.8% respectively. To reduce false positives, preliminary analyses indicate adding a lifetime depression history question will improve specificity. Conclusions: These findings indicate the presence of co-morbid major depression can be determined from a brief question asked to persons seriously bothered by activity interfering pain. Its inclusion in the pain patient’s clinical evaluation is recommended. References: 1) National Epidemiologic Survey of Alcohol and Related Conditions, Website: (http://www.nesarc.niaaa.nih.gov). 2)Grant BF, Stinson FS, Dawson DA, Chou SP, et al. Prevalence and Co-occurrence of substance use disorders and independent mood and anxiety disorders. Archives of General Psychatry 2004;61:807-816.

Funding: None