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Effect of Depression Treatment on Chronic Pain Outcomes

From the RAND Corporation (C.F.T.), Pittsburgh, PA; Department of Health Care Policy (A.M.Z.), Harvard Medical School, Boston, MA; Department of Psychiatry (C.F.R.), University of Pittsburgh School of Medicine, Pittsburgh, PA; Yale School of Public Health (P.D.C.), Yale School of Medicine, New Haven, CT.

Address correspondence and reprint requests to Carrie Farmer Teh, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213. E-mail: cteh{at}rand.org

Objective: To examine the effect of depression treatment on medical and social outcomes for individuals with chronic pain and depression. People with chronic pain and depression have worse health outcomes than those with chronic pain alone. Little is known about the effectiveness of depression treatment for this population.

Methods: Propensity score-weighted analyses, using both waves (1997–1998 and 2000–2001) of the National Survey of Alcohol, Drug, and Mental Health Problems, were used to examine the effect of a) any depression treatment and b) minimally adequate depression treatment on persistence of depression symptoms, depression severity, pain severity, overall health, mental health status, physical health status, social functioning, employment status, and number of workdays missed. Analyses were limited to those who met Composite International Diagnostic Interview Short-Form criteria for major depressive disorder, reported having at least one chronic pain condition, and completed both interviews (n = 553).

Results: Receiving any depression treatment was associated with higher scores on the mental component summary of the Medical Outcomes Study Short Form-12, indicating better mental health (difference = 2.65 points, p = .002) and less interference of pain on work (odds ratio = 0.57, p = .02). Among those receiving treatment, minimal adequacy of treatment was not significantly associated with better outcomes.

Conclusions: Depression treatment improves mental health and reduces the effects of pain on work among those with chronic pain and depression. Understanding the effect of depression treatment on outcomes for this population is important for employers, healthcare providers treating this population, and policymakers working in this decade of pain control and research to improve care for chronic pain sufferers.

Key Words: pain • depression • quality assessment • outcomes

Abbreviations: CIDI-SF = Composite International Diagnostic Interview Short-Form; HCC = Healthcare for Communities; MDD = major depressive disorder.