Pain Worsens Physical and Financial Burdens for Adults with Depression Nearing Retirement, Six-Year Study Shows
May 02 2005 - 2:28PM
PR Newswire (US)
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 Jennifer Yoder, +1-317-433-3445,
pager: +1-888-274-0289 (OUS), both of Eli Lilly and Company
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