Psychosocial stress and anxiety in musculoskeletal pain patients with and without depression

Objective: The objective of this study was to determine if psychosocial stress and anxiety were associated with depression severity in primary care patients with chronic musculoskeletal pain. Methods: A cross-sectional sample of 500 primary care patients with musculoskeletal pain (250 with depression and 250 without depression) was assessed for anxiety, psychosocial stress, depression severity and demographics. The depressed and nondepressed participants were compared using t test and chi(2) analyses. Multiple linear regression analyses were used to evaluate the respective associations of psychosocial stressors and anxiety with depression severity based on the 20-item Symptoms Check List across all 500 participants. Results: Compared with nondepressed patients, the depressed patients reported significantly more psychosocial stressors and more severe anxiety. Depressed patients reported a higher frequency of difficulties with every psychosocial stressor assessed. After controlling for covariates, both anxiety and psychosocial stressors were found to be associated with depression severity. Conclusions: Both anxiety and psychosocial stress should be considered in the assessment and treatment of patients with musculoskeletal pain and depression. Psychosocial stressors among patients with pain may have an impact on depression beyond that of anxiety. Tailored, integrated treatments that target the psychosocial needs of patients with pain and depression are needed. In addition to pharmacotherapy, psychotherapy and other behavioral treatments may be especially important for depression complicated by anxiety or psychosocial stress. (C) 2009 Elsevier Inc. All rights reserved.