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Pain Worsens Physical and Financial Burdens for Adults with
Depression Nearing Retirement, Six-Year Study Shows
Results Call for Better Pain Diagnosis and Treatment Strategies
INDIANAPOLIS, May 2 /PRNewswire-FirstCall/ -- 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 http://www.lilly.com/.
P-LLY
(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.
(Logo: http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO )
http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO
DATASOURCE: Eli Lilly and Company
CONTACT: David Shaffer, +1-317-651-3710, pager: +1-877-656-9084 (US), or
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Lilly and Company