|
Ed. Note: The following
story is a press release from Eli Lilly and Company.
May 2, 2005 When
depression and pain occur together, people nearing retirement (aged 50 to
61) suffer much larger increases in medical costs and limitations in their
ability to work and perform daily activities than individuals with
depression alone, according to a six-year study published in a recent
issue of Psychiatric Services.
The joint
occurrence of depression and pain was as common as depression alone in
this group, but outcomes were significantly worse. At baseline, two out of
three individuals with depression and mild or moderate pain reported
limitations in their ability to work, increasing to nine out of 10 among
those with more severe pain. In contrast, only one out of four individuals
with depression alone reported similar limitations. Paralleling this,
respondents with depression and co-morbid pain were much less likely to be
employed (21 percent with severe pain, 38 percent with mild to moderate
pain) than respondents with depression alone (54 percent). Similar
differences existed for private insurance.
Individuals with
depression and pain spent $14,000 to $25,000 more in average total
healthcare costs than those with depression alone. They also had
increasing difficulties in performing physical activities, such as
bathing, eating, dressing, walking across a room and getting into or out
of bed. The difference to individuals with depression only widened over
time. "We have
seen increased awareness of the social consequences of depression, but
this study makes the case for more education about the impact pain has
when it occurs simultaneously with depression," said Roland Sturm, PhD,
RAND Corporation, a nonprofit research organization. "Individuals with
depression and pain were also more likely to remain chronically depressed
than those without pain."
Co-morbid pain
occurs frequently in patients with clinically significant depressive
symptoms, often complicating both the recognition and treatment of
depression(i). Individuals with these conditions are significantly less
likely to receive mental health specialty care, often seeking
complementary and alternative treatments with questionable
effectiveness(ii).
"Patients should
be assessed for both depression and pain. If both are present but only one
treated, outcomes may be compromised," said Rebecca Robinson, MS, health
outcomes researcher, Eli Lilly and Company. "Respondents with depression
and severe pain may be particularly vulnerable to limited access to
adequate treatment for their mental illness due to higher rates of
unemployment and less of private insurance."
Methods
Researchers
analyzed the health status of participants in the national Health and
Retirement Study (HRS) from 1994 to 2000. HRS was a longitudinal national
survey initiated in 1992 to track national trends in health and economic
wellbeing among retired and near-retired Americans. Mental health status
was measured consistently from 1994 using an eight-item version of the
depression scale developed by the Center for Epidemiologic Studies (CES-D).
Participants were surveyed every two years. In 1994, 8,807 individuals
responded, followed by 7,992 subjects in 2000, an overall retention rate
of 76.3 percent.
Respondents were
also asked whether they often experienced pain, without reference to a
physical cause. Responses were categorized into no pain, mild/moderate
pain and severe pain. Pain and depression results were interpreted using
six-levels of classification that distinguished all of the possible
pain-depression combinations. Researchers also controlled for the presence
of physician-diagnosed diabetes, hypertension, cancer, stroke, heart
disease, lung disease and arthritis.
Limitations
The study
has typical limitations of large observational studies. The assessment of
mental health is not based on a clinical diagnosis. Measurement error on
the CES-D scale could have created bias in these co-efficient estimates.
The measurements of pain are limited and may reflect other unmeasured
chronic conditions. Although attrition was small for this type of survey
and there was little mortality, the possibility of bias cannot be
excluded. Because of the limited age range, it is unclear whether the
results generalize to elderly or younger populations.
About Lilly
Lilly, a
leading innovation-driven corporation, is developing a growing portfolio
of first-in-class and best-in-class pharmaceutical products by applying
the latest research from its own worldwide laboratories and from
collaborations with eminent scientific organizations. Headquartered in
Indianapolis, Ind., Lilly provides answers -- through medicines and
information -- for some of the world's most urgent medical needs.
Additional information about Lilly is available at
www.lilly.com.
(i) Bair MJ,
Robinson RL, Katon W, Kroenke K. Depression and Pain Comorbidity: A
literature review. Arch Int Med 2003;163:2433-2445
(ii) Bao Y, Sturm R, Croghan TW. How does chronic pain impact health care
utilization by depressed individuals? A national study. Psychiatric
Services 54:693-697, 2003.
Return To Table Of Contents |