Open AccessChronic Pain, Depression, and Quality of Life: Correlations and Predictive Value of the SF‐36
Author(s) -
Elliott Thomas E.,
Renier Colleen M.,
Palcher Jeanette A.
Publication year - 2003
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2003.03040.x
Subject(s) - medicine , depression (economics) , chronic pain , quality of life (healthcare) , mental health , medical diagnosis , physical therapy , population , cross sectional study , center for epidemiologic studies depression scale , psychiatry , depressive symptoms , anxiety , pathology , nursing , environmental health , economics , macroeconomics
Objective. Depression is a major barrier to effective pain relief. The SF‐36 Health Survey may be useful as an outcome measure for chronic pain patients with and without depression. The study purpose was to determine the correlation between the SF‐36 Mental Composite Scale t ‐score and depression type in chronic pain patients and the positive predictive value of the SF‐36 in classifying depression type in chronic pain patients. Design. Cross‐sectional survey of chronic pain patients at baseline assessment. Setting. Interdisciplinary pain management center in the North Central United States. Patients. Two hundred forty‐two consecutive, chronic noncancer pain patients. Interventions. Assessments of patient‐reported health‐related quality of life (SF‐36), pain, pain type and diagnoses, mental health diagnoses, and patient demographics. Outcome Measures. SF‐36 Health Survey, pain diagnoses, and depression diagnoses. Results. Study participants were 160 women (66%) and 82 men (34%), 95% Caucasian, whose mean age was 46 (±0.8 SD) years (range: 19–83). All types and diagnoses of chronic pain were represented. The prevalence of major depressive disorder was 52%. The type of depression was highly correlated with SF‐36 score ( r =−0.567; P < 0.001). All chronic pain patients had very low SF‐36 scores. Compared with U.S. population norms, chronic pain patients with and without depression had significantly lower SF‐36 scores as measured by z ‐scores. Chronic pain patients with major depressive disorder had a significantly lower Mental Composite Score t ‐score than those with minor or no depression—34.1 and 47.6, respectively ( P < 0.001). The positive predictive value of the SF‐36 for differentiating major depression from minor or no depression was 98% (sensitivity=84.4%, specificity=93.9%). Conclusions. The SF‐36 Mental Composite Score and all subscales were highly correlated with depression type in chronic pain patients. The positive predictive value of the SF‐36 in classifying depression type was high. The SF‐36 may be a useful clinical tool to measure health‐related quality of life in chronic pain patients. In addition, the SF‐36 was able to detect major depression and demonstrate a dose‐effect relationship between depression type (severity) and health‐related quality of life in chronic pain patients.