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Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs
Open accessAbstract
This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services.
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“Chronic pain is highly prevalent worldwide and associated with major personal and societal burden.1–5”
From Clinical and cost-effectiveness of a guided internet-based Acceptance and Commitment Therapy to improve chronic pain-related disability in green professions (PACT-A): Study protocol of a pragmatic randomised controlled trial (2020) · cites this paper as [4]
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Metadata
- Authors
- Rayner, L., Hotopf, M., Petkova, H., Matcham, F., Simpson, A., & McCracken, L. M.
- Affiliations
- Psychological Medicine and
- King's College London (GB)
- Corresponding author
- Rayner, Lauren
- Venue
- Pain
- Published
- 2016-03-08
- Volume
- 157
- Issue
- 7
- Pages
- 1472-1479
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- PMC
- PMC4912238
- OpenAlex
- W2293157729
- Cited by
- 290
- References
- 38
- Citations by year
- 2026: 21 · 2025: 26 · 2024: 36 · 2023: 42 · 2022: 34 · 2021: 30 · 2020: 33 · 2019: 32 · 2018: 19 · 2017: 15 · 2016: 2
- FWCI
- 18.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Pain (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (NF-SI-0515-10102)
- King's College London
- King's Health Partners
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- depression, chronic pain, health care costs, depression prevalence, severe depression, absenteeism, pain interference, pain acceptance, general practitioner contact, hospitalization, Patient Health Questionnaire
- MeSH terms
- Absenteeism, Adult, Cross-Sectional Studies, Depressive Disorder, Female, Humans, Male, Middle Aged, Prevalence, Health Care Costs, Chronic Pain, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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