Transcript The role of hepatic cytochrome P

Psychological Distress and Recurrent Pain:
Results from the 2002 NHIS
Loren Toussaint, Ph.D. & Alyssa Cheadle
Luther College, Decorah, Iowa
email: [email protected] or [email protected]
Method
Results & Conclusions
Data from the 2002 National Health Interview
Survey (NHIS) were analyzed.
• Hypothesis 1: Results indicate that psychological distress symptoms of any type are
associated with 3 to 5 times greater odds of experiencing pain. Even after controlling for
a host of socio-demographic factors these associations remain robust, though noticeably
reduced, and statistically significant at the p < .001 level. (see Figure 1).
Background
Purpose
The present study sought to examine the
associations between recurrent pain, serious
psychological distress, and poor mental and
physical health in a large, representative sample of
U.S. adults.
Hypotheses
The hypotheses in this study are as follows:
•Individuals who experience serious psychological
distress will be at increased odds of experiencing
recurrent pain.
•Individuals who experience poor mental and/or
physical health will be at increased odds of
experiencing recurrent pain.
Sample
 The survey was administered to 31,044 adults
with a response rate of 74.4%.
Measures
Psychological distress was assessed with the
Kessler 6 Scale, which asks respondents
about six domains of distress that may have
been experienced in the past 30 days.
Symptoms of distress include: sadness,
nervousness, restlessness, hopelessness,
effort, and worthlessness.
• Hypothesis 2: Results indicate that symptoms of poor mental and physical health are
associated with 5 to 6 times greater odds of experiencing pain. Again, after controlling
for socio-demographic factors these associations are reduced but statistically significant
at the p < .001 level. (see Figure 2).
• Conclusions: Psychological distress and poor mental and physical health symptoms are
associated with increased odds of experiencing recurrent pain. Contrary to McBeth et
al.’s (2002) findings, we do not observe that this relationship can be accounted for by
other potentially confounding variables. Nevertheless, we are unable to assert causality
given the cross-sectional nature of NHIS data.
Health symptoms were assessed with singleitem indicators assessing the 12-month
prevalence of anxiety/depression, insomnia,
and fatigue.
Analyses
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5
Odds Ratio
 Recurrent pain in the past 12 months was
assessed using a single-item that queried
respondents on recurrent pain due to any
cause.
Figure 1.
Psychological Distress and Increased Odds of
Chronic Pain
Data on serious psychological distress, each
symptom of distress, anxiety and depression,
insomnia, and fatigue were used in logistic
regression analyses to predict experience of
recurrent pain within the past 12 months.
Unadjusted and adjusted logistic models were
examined. Covariates in adjusted models
included gender, age, census region, race,
income level, educational attainment,
employment status, marital status, and selfreported health status.
 Population estimates were calculated using
NHIS weights, which are calibrated to census
totals for gender, age, and race/ethnicity of the
civilian, non-institutionalized 2002 U.S.
population. Because the NHIS is a multistage, clustered probability sample, all
analyses were conducted with AMSTAT which
uses Taylor-series approximation to correct for
biased standard errors.
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3
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1
0
Serious
Distress
Sad
Nervous
Restless
Hopeless
Effort
Worthless
Psychological Distress Symptom
Unadjusted
Adjusted
Figure 2.
12-Month Prevalence of Anxiety/Depression,
Insomnia, and Fatigue and Increased Odds of
Chronic Pain
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6
Odds Ratio
An extensive literature exists to support the notion
that stress and mental and physical health are
connected to the experience of pain. A key aspect
of normal psychological functioning is psychological
distress. Though not considered a diagnosable
psychopathological disorder, psychological distress
is a common affective experience for a notable
proportion of individuals in the general population.
Recent research has revealed an association
between psychological distress and the experience
of pain. For instance, McBeth et al. (2002) examined
pain and psychological distress utilizing a
prospective design and a population-based sample
of almost 2000 participants. McBeth found that
participants who experienced chronic, widespread
pain at baseline were at four times greater odds of
being distressed at follow-up. This association
persisted after controlling for baseline levels of
distress, but was slightly reduced (odds ratio = 3).
Interestingly, this study also revealed that the
association between pain and distress was fully
accounted for by concomitant features of pain (i.e.,
health anxiety, fatigue, poor self-care) experienced
at baseline.
Additional studies have shown relationships
between psychological distress and health
conditions associated with pain, including headache,
arthritis, and cardiovascular disease (Strine et al.,
2006; Shih et al., 2006; Ferketich & Binkley, 2005).
Although several of these of studies have utilized
the nationally representative, population-based
National Health Interview Survey as the data
source, few recent investigations into the connection
between psychological distress and the experience
of pain have looked at non-patient, general
population respondents.
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3
2
1
0
Anxiety / Depression
Insomnia
Health Symptom
Midwestern Psychological Association
79th Annual Meeting
May, 2007
Unadjusted
Adjusted
Fatigue