Neurological

Depressive Symptoms and Pain in Older Veterans: What’s the Link?

Pain and depressive symptoms are common among American veterans 50 and older, and both pain and depressive symptoms appear to be interacting in this population, according to study results published in Pain Medicine.

Depression and chronic pain are more common among American veterans. Previous estimates suggest that chronic pain in veterans can range from 25 to 72%, while 66.7% -69.8% of veterans ages 50 or older have pain and 7.1% -11.6% report severe pain. However, there is limited long-term data on how pain and depression are related in this patient population.

The aim of the current study was to investigate the relationship between depressive symptoms and pain in a group of elderly American veterans.

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The study relied on data from the ongoing observational Health and Retirement Study (HRS), which included Americans age 50 and older. The data collection in the HRS takes place either in person or by telephone every 2 years. For the study, the researchers relied on data from veterans of the HRS waves from 2002 to 2016 (n = 4302).

Researchers rated depressive symptoms in the cohort based on the Center for Epidemiological Studies’ 8-point modified version of the Depression Scale. In addition, the veterans also rated 2 questions that focused on the presence and degree of pain.

A cross-lagged panel model (CLPM) was compared with 2 random intercepts CLPMs (RI-CLPM), all of which assessed the association between pain and depressive symptoms during the HRS waves 2002 to 2016. The first RI-CLPM examined the bivariate relationship between pain and depressive symptoms. In contrast, the second RI-CLPM was adjusted for several baseline demographic variables, including age, self-reported health status, years of education, family / partner status, race / ethnicity, and gender. According to the researchers, the RI-CLPM was previously designed to study mutual effects between variables over time.

In the 2002 wave, around 26% of respondents were in favor of experiencing pain, including mild pain (30.55%), moderate pain (55.12%), and severe pain (14.32%). The traditional CLPM showed poor fit across the indices, and the researchers reported equivalent cross-delayed effects of pain on depressive symptoms and depressive symptoms on pain.

The fitted RI-CLPM showed good overall fit across all fitting indices, and the fitted model indicated evidence suggesting that depressive symptoms and pain had a trait-like component. In addition, there appeared to be a relationship between these trait-like traits. Overall, the researchers concluded that their analysis shows evidence of “roughly equivalent” but “very little” interaction between symptoms of depression and pain in the population of these elderly veterans over the 14 year period.

One limitation of the study included the use of only 2 questions to measure pain. The researchers suggest that a more comprehensive approach to pain assessment could use a multi-dimensional scale that is rated on psychometric properties.

Despite these caveats, the researchers wrote that “the results suggest that clinicians should treat both depressive symptoms and pain, rather than assuming that treatment benefits in one area translate into great benefits in another.”

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Griffin SC, Young JR, Naylor JC, Allen KD, Beckham JC, Calhoun PS. Interaction between Depressive Symptoms and Pain in Veterans Over 50. Pain Med. Published online October 13, 2021. doi: 10.1093 / pm / pnab294

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