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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3062 — The Relationship between PTSD, Depression, and Pain Severity in Male Primary Care Patients

MacGregor KL (Center for Integrated Healthcare, Syracuse University), Funderburk JS (Center for Integrated Healthcare, Syracuse University), Masters K (Center for Integrated Healthcare, Syracuse University ), Bruehl S (Vanderbilt University School of Medicine), France C (Ohio University), Maisto SA (Center for Integrated Healthcare, Syracuse University)

Patients are annually screened in VA primary care clinics for the presence of depressive and post-traumatic stress symptoms, as well as for pain severity using the NRS pain scale. Although psychological factors have been shown to be correlated with reported pain severity, no published study has examined whether depression and PTSD interact to predict NRS pain ratings. In this regard, these symptoms tend to co-occur, particularly among veterans. The purpose of this study was to examine pain severity in primary care patients who screen positive for depression, PTSD, or both.

Data were obtained from the Department of Veteran Affairs electronic medical database on 8,872 male patients with a primary care encounter between January 1 and June 30, 2005. The following variables were retrieved: age (Mean = 64.34, SD = 15.82), marital status (61% married), NRS pain rating, and depression and post-traumatic stress disorder (PTSD) screens. Analyses were conducted using the general linear model, controlling for age and marital status, both of which have been shown to be related to reported pain.

After controlling for the aforementioned demographic variables, results revealed significant main effects for depression (F = 149.88, p < .01) and PTSD (F = 89.53, p < .01) such that patients who scored positive on these measures reported higher pain scores than those with negative screens. Analyses also revealed a significant interaction between depression and PTSD screens such that people who were positive for PTSD had the same pain score regardless of whether they were positive for depression or not (p < .01).

Across the spectrum of reported pain, results imply that both depression and PTSD are independently related to pain severity. However, in the presence of PTSD, depression does not appear to contribute to reported pain.

These results highlight the importance of assessing for psychological factors, particularly PTSD, in primary care patients reporting pain.

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