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Outcomes of newly referred neurology outpatients with depression and pain

From Roudebush VAMC (Drs. Williams and Jones); Departments of Neurology (Drs. Williams and Jones) and Medicine (J. Shen and Dr. Kroenke), Indiana University School of Medicine; Regenstrief Institute for Health Care (Drs. Williams and Kroenke); and Eli Lilly and Company (R.L. Robinson), Indianapolis, IN.

Address correspondence and reprint requests to Dr. Linda S. Williams, Roudebush VAMC HSR&D 11H, 1481 West 10th Street, Indianapolis, IN 46202; e-mail: lwilliams{at}hsrd.va.iupui.edu

Background: Although depression and pain are common in neurology outpatients, patient factors influencing chronicity are poorly understood. The authors sought to determine the predictors of persistent depression and pain symptoms at 3 and 12 months after an initial outpatient neurology clinic visit.

Methods: Consecutive new patients (n = 483) at three clinics completed the Patient Health Questionnaire nine-item depression scale and the Brief Pain Inventory at baseline and at 3- and 12-month follow-up. Multivariate analysis was used to model 3- and 12-month depression and pain severity.

Results: The prevalence of depression and pain at baseline/3/12 months was depression 33%/28%/27% and pain 66%/61%/62%. Independent predictors of depression severity at follow-up were more severe depression and pain at baseline and less improvement in pain (model r² = 0.53 to 0.56). Independent predictors of pain intensity at follow-up were more severe pain and depression at baseline and less improvement in depression (model r² = 0.44 to 0.46). Health care utilization and impairments in health status were greatest in patients with coexisting depression and pain and least in those with neither depression nor pain.

Conclusions: Depression and pain symptoms in neurology outpatients often persist for at least 12 months and have long-term negative effects on patients’ health status. Pain is more likely to persist in patients with depression, and depression is more likely to persist in those with coexistent pain.

Received December 5, 2003. Accepted in final form April 20, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the August 24 issue to find the title link for this article.

Dr. Kronke has received honoraria from Eli Lilly and Co.

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