The Association of Depression and Anxiety with Pain: A Study from NESDA

de Heer, Eric W.; Gerrits, Marloes M. J. G.; Beekman, Aartjan T. F.; Dekker, Jack; van Marwijk, Harm W. J.; de Waal, Margot W. M.; Spinhoven, Philip; Penninx, Brenda W. J. H.; van der Feltz-Cornelis, Christina M.

doi:10.1371/journal.pone.0106907

Cited by 363Musculoskeletal pain and rehabilitationPsychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The Association of Depression and Anxiety with Pain: A Study from NESDA

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de Heer, Eric W., Gerrits, Marloes M. J. G., Beekman, Aartjan T. F., Dekker, Jack, van Marwijk, Harm W. J., de Waal, Margot W. M., Spinhoven, Philip, Penninx, Brenda W. J. H. +1 more·2014·PLoS ONE

DOI 10.1371/journal.pone.0106907PMC PMC4198088

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Abstract

Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (OR = 6.67; P<.001), anxiety (OR = 4.84; P<.001), or co-morbid depressive and anxiety disorder (OR = 30.26; P<.001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (OR = 3.53; P<.001) as compared to controls. A current anxiety disorder (OR = 2.96; p<.001) and a co-morbid depressive and anxiety disorder (OR = 5.15; P<.001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research.

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There is considerable evidence on the comorbidity of chronic pain and mood disorders.
“there is also considerable evidence on the comorbidity of chronic pain and mood disorders [84].”
From Pain acceptance creates an emotional context that protects against the misuse of prescription opioids: A study in a sample of patients with chronic noncancer pain (2021) · cites this paper as [84]
Patients with high levels of anxiety and depression receiving opioid treatment for chronic pain are at increased risk of developing opioid misuse.
“Previous studies have consistently found that patients with high levels of anxiety and depression receiving opioid treatment for chronic pain are at increased risk of developing opioid misuse [80,81,82,83,84,85,86,87,88,89,90].”
From Pain acceptance creates an emotional context that protects against the misuse of prescription opioids: A study in a sample of patients with chronic noncancer pain (2021) · cites this paper as [84]
The Introduction and Results discuss the association of depression and anxiety with chronic pain and pain-related disability. Searches for opioid misuse and opioid treatment found no passage addressing whether patients with anxiety or depression who receive opioids are at increased risk of misuse. (LLM, conf=0.76)
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Self-citation
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Liu, Y., Cheng, J., Gao, H., Chen, Y., Chen, H., Xia, Q., Yan, J., Li, C., Ju, P., & Zhu, C. (2026) · DOAJ (DOAJ: Directory of Open Access Journals)

Authors: de Heer, E. W., Gerrits, M. M. J. G., Beekman, A. T. F., Dekker, J., van Marwijk, H. W. J., de Waal, M. W. M., Spinhoven, P., Penninx, B. W. J. H., & van der Feltz-Cornelis, C. M.
Affiliations: Amsterdam Public Health (NL)
Arkin (NL)
Leiden University (NL)
ORCID: Gerrits, Marloes M. J. G.
Beekman, Aartjan T. F.
Dekker, Jack
Spinhoven, Philip
Penninx, Brenda W. J. H.
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2014-10-15
Volume: 9
Issue: 10
Pages: e106907
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0106907
PMC: PMC4198088
OpenAlex: W2015721095
Cited by: 363
References: 70
Citations by year: 2026: 20 · 2025: 34 · 2024: 33 · 2023: 39 · 2022: 37 · 2021: 57 · 2020: 37 · 2019: 22 · 2018: 32 · 2017: 15 · 2016: 25 · 2015: 11 · 2014: 1
FWCI: 12.59
Type: journal article
Language: en
Update notices: correction (2014-12-01)
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
Research portal (Tilburg University) (publishedVersion, other-oa)
PubMed (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Leiden Repository (Leiden University) (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Pure Amsterdam UMC (submittedVersion)
Research Explorer (The University of Manchester) (submittedVersion)
VU Research Portal (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
Funders: Eli Lilly and Company
College of Family Physicians of Canada
Universiteit Leiden (10‐000‐1002)
ZonMw (10‐000‐1002)
Vrije Universiteit Amsterdam
GGZ inGeest
Rivierduinen
GGZ Friesland
GGZ Drenthe
Nederlands Instituut voor Onderzoek van de Gezondheidszorg (10-000-1002)
Leids Universitair Medisch Centrum
Universitair Medisch Centrum Groningen
H. Lundbeck A/S
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: depression, anxiety, chronic pain, pain-related disability, pain intensity, pain localization, remitted depression, symptom severity, gastrointestinal pain, musculoskeletal pain, NESDA
MeSH terms: Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Pain Measurement, Surveys and Questionnaires, Severity of Illness Index, Comorbidity, Chronic Pain

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The Association of Depression and Anxiety with Pain: A Study from NESDA

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