Correlates of depression in chronic pain patients: a comprehensive examination.

This study examined the relations between depression and demographic, pain-related, and work-related variables in 254 chronic pain patients. Regression analyses were conducted, initially by category (i.e., demographic, pain-related, and work-related), and finally a comprehensive regression analysis was performed, containing the significant independent variables from each category. Among the demographic variables, education level and marital status were related to depression, and an interaction between age and gender was associated with depression, with younger women and older men reporting more depression. Among the pain-related variables, longer duration of pain was associated with increased depression. Among the work-related variables, unemployment was associated with depression, and there was an interaction between work status and litigation status, with working and litigating being associated with depression and not working and not litigating being associated with depression. In the comprehensive analysis, work status, education level, and marital status accounted for a significant amount of the variance in depression scores. These findings, together with future research directions, are discussed.

What does the Beck Depression Inventory measure in chronic pain?: a reappraisal.

The Beck Depression Inventory (BDI) is widely used to document the prevalence of depression in suffers of chronic pain and in research designs about this population. Williams and Richardson (1993) initially posed the question, "What does the BDI measure in chronic pain?". Results from their study found 3 independent constructs, which differed somewhat from those obtained in analyses with other non-pain subsamples. In our reappraisal of the question, we used confirmatory factor analytic procedures to assess the dimensionality of the BDI. Specifically, we questioned whether a hierarchical model in which a second-level depression construct underlies 3 constituent first-level constructs is reasonable for the data. Our results, based on a sample of 247 chronic pain patients, corroborated the adequacy of this model. The first-level constituent constructs were labeled Negative Attitudes/Suicide, Performance Difficulty, and Physiological Manifestations and were conceptually similar to first-level constructs obtained with other subsamples. Furthermore, external psychological measures and selected questionnaire items were used to assess convergent and discriminant validity of scales operationalizing the factor-analytically derived constructs. With these analyses, we clarify the constituents of depression as measured by the BDI. The findings from this study have implications for more refined epidemiologic and clinical research with chronic pain patients.